Exhibit L-2 - Historical Data.pdf
PDF 179 KB Posted
- Solicitation number
- HT940226R0001
- Issued by
-
Defense Health Agency
About this file
This is Section L Exhibit L-2, a historical data appendix supporting a federal contract opportunity, containing operational metrics spanning calendar years 2023 through 2025 (partial year through July).
The exhibit presents comprehensive performance data across multiple operational categories including claim processing, correspondence management, telephone operations, authorization issuance, and appeal handling. Claim receipts demonstrate consistent volume across the three-year period, with 2023 totaling approximately $57.8 million in net receipts, 2024 at $60.5 million, and 2025 (through July) at $62.0 million. The data breaks down claim types into paper submissions (DD Form 2642, CMS 1500, UB92) and electronic claims (institutional and non-institutional), with processed claims in 2023 totaling 57.7 million, 2024 at 60.2 million, and 2025 at 61.9 million. Supporting operational metrics show routine correspondence inquiries averaging 650,000+ annually, telephone call volumes between 2.4 and 2.5 million attempted calls yearly with approximately 1 million agent-answered calls, and authorizations (including Skilled Nursing Facility designations) ranging from 5,169 to 5,557 annually. Medical and factual appeals demonstrate increasing trends, with factual appeals growing from 1,615 in 2023 to 2,701 in 2025. Grievances remain minimal (four to five total across the three-year period), indicating strong operational performance. This historical baseline data establishes performance expectations and operational capacity requirements for the soliciting federal healthcare program.
View the file
Other files
Show all 22
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
SECTION L EXHIBIT L-2 HISTORICAL DATA
Calendar Year 2023
Month Claim
Receipts Adjustment
Receipts Net Receipts January 4,140,748 59,269 4,090,805
February 4,704,763 45,181 4,657,264 March 5,266,558 44,236 5,198,983 April 4,730,621 36,114 4,673,023 May 5,191,056 31,531 5,122,448 June 4,977,531 31,785 4,914,002 July 4,565,462 56,975 4,533,800
August 5,253,941 51,773 5,205,394 September 4,895,342 43,994 4,850,464
October 4,806,784 32,973 4,746,761 November 5,219,590 47,437 5,178,136 December 4,720,000 39,811 4,672,896
Grand Total 58,472,396 521,079 57,843,976
Calendar Year 2024
Claim
Receipts Adjustment
Receipts Net Receipts January 4,960,354 44,800 4,911,361
February 4,784,334 50,676 4,754,788 March 4,296,753 29,017 4,265,525 April 5,200,392 36,456 5,137,649 May 5,826,791 118,866 5,846,269 June 5,007,068 25,475 4,950,817 July 4,943,882 61,347 4,924,388
August 5,410,851 33,856 5,360,697 September 4,828,027 18,965 4,765,880
October 5,473,072 59,973 5,447,142 November 5,311,388 19,902 5,253,427 December 4,890,984 34,870 4,844,350
Grand Total 60,933,896 534,203 60,462,293
Calendar Year 2025
Claim
Receipts Adjustment
Receipts Net Receipts January 4,701,575 36,670 4,654,437
February 4,948,008 28,621 4,896,855 March 5,090,847 25,824 5,033,261 April 5,433,956 38,281 5,391,756 May 5,590,434 38,851 5,555,716 June 4,835,710 38,039 4,800,030 July 5,413,042 39,233 5,377,002
August 5,351,365 35,968 5,318,719 September 5,055,758 35,537 5,025,612
October 4,969,175 50,974 4,949,269 November 5,803,642 35,689 5,773,062 December 5,252,973 44,905 5,209,673
Grand Total 62,446,485 448,592 61,985,392
Total Routine Correspondence Inquiries Received by Year and Month Year 2023 2024 2025 Grand Total
January 47,241 54,597 63,816 165,654 February 45,207 52,084 60,529 157,820
March 51,634 50,908 61,345 163,887 April 45,182 57,594 64,769 167,545 May 49,173 53,686 62,878 165,737 June 46,605 48,386 64,580 159,571 July 45,455 57,978 68,956 172,389
August 52,370 54,828 67,209 174,407 September 46,380 59,139 65,053 170,572
October 52,901 67,582 64,995 185,478 November 46,866 58,955 58,060 163,881 December 43,644 60,260 60,701 164,605
Grand Total 572,658 675,997 762,891 2,011,546
Total Priority Correspondence Inquiries Received by Year and Month
January 117 114 124 355
February 107 86 137 330 March 122 128 210 460 April 90 91 202 383 May 79 78 188 345 June 101 73 169 343 July 105 118 196 419
August 101 115 192 408 September 96 138 160 394
October 119 115 154 388 November 90 82 157 329 December 63 117 212 392
Grand Total 1,190 1,255 2,101 4,546
Total Telephone Call Attempted by Year and Month
January 241,069 218,606 239,210 698,885
February 200,525 196,392 200,358 597,275 March 222,958 197,267 210,472 630,697 April 186,387 192,151 201,794 580,332 May 199,990 195,099 201,352 596,441 June 201,585 188,501 194,644 584,730 July 190,850 210,113 212,640 613,603
August 204,932 211,873 202,895 619,700 September 182,776 199,246 194,151 576,173
October 207,615 238,698 204,686 650,999 November 195,418 209,210 173,389 578,017 December 174,811 204,428 187,486 566,725
Grand Total 2,408,916 2,461,584 2,423,077 7,293,577
Total Telephone Calls Received by Year and Month
January 240,227 217,591 238,302 696,120
February 199,747 195,251 199,696 594,694 March 222,207 190,131 209,285 621,623 April 185,761 191,113 201,144 578,018 May 199,328 194,247 200,671 594,246 June 200,891 184,876 193,692 579,459 July 190,112 208,606 212,031 610,749
August 204,261 209,854 199,519 613,634 September 182,096 198,622 193,534 574,252
October 206,535 237,967 203,408 647,910 November 194,559 203,455 172,821 570,835 December 174,099 203,491 186,699 564,289
Grand Total 2,399,823 2,435,204 2,410,802 7,245,829
Total Telephone Calls Answered by a Agent by Year and Month
January 92,929 99,755 103,980 296,664
February 82,035 83,582 86,084 251,701 March 97,155 82,009 90,600 269,764 April 81,919 86,600 90,060 258,579 May 88,514 87,612 91,830 267,956 June 83,274 79,401 85,393 248,068 July 84,016 94,350 95,973 274,339
August 90,950 94,111 91,121 276,182 September 81,067 88,476 88,631 258,174
October 91,355 101,404 87,066 279,825 November 83,556 84,517 76,123 244,196 December 81,341 90,179 86,643 258,163
Grand Total 1,038,111 1,071,996 1,073,504 3,183,611
Total Authorizations Issued by Year and Month (Including Skilled Nursing Facility (SNF) Authorizations)
January 453 549 405 1,407 February 424 438 392 1,254
March 437 411 393 1,241 April 395 441 445 1,281 May 410 445 425 1,280 June 415 412 416 1,243 July 432 498 450 1,380
August 559 549 426 1,534 September 431 420 447 1,298
October 470 468 483 1,421 November 527 470 377 1,374 December 380 456 510 1,346
Grand Total 5,333 5,557 5,169 16,059
Total SNF Authorizations Issued by Year and Month
January 258 359 287 904
February 232 300 272 804 March 286 288 257 831 April 272 320 241 833 May 292 333 263 888 June 298 288 282 868 July 326 356 280 962
August 359 371 260 990 September 301 308 283 892
October 327 338 311 976 November 327 324 241 892 December 294 336 345 975
Grand Total 3,572 3,921 3,322 10,815
Total Grievances Received by Year and Month
January 0 0 0 0
February 0 0 0 0 March 0 0 0 0 April 0 0 0 0 May 0 0 0 0 June 0 0 0 0 July 0 0 0 0
August 0 0 0 0
September 1 0 0 1 October 2 0 0 1
November 1 0 1 2 December 1 0 0 1
Grand Total 4 0 1 5
Total Medical Appeals Received By Year and Month
January 0 3 3 6 February 2 6 4 12
March 3 3 7 13 April 1 4 3 8 May 4 1 6 11 June 3 6 5 14 July 6 6 3 15
August 6 4 5 15 September 7 2 4 13
October 5 6 2 13 November 2 3 2 7 December 3 1 3 7
Grand Total 42 45 47 134
Total Factual Appeals Received by Year and Month
January 152 197 178 527
February 84 199 203 486 March 124 180 213 517 April 118 162 220 500 May 151 164 199 514 June 150 169 196 515 July 142 201 259 602
August 111 140 203 454 September 145 192 267 604
October 153 149 283 585 November 142 154 242 538 December 143 209 238 590
Grand Total 1,615 2,116 2,701 6,432
Processed Claims (TRICARE Encounter Data-(TED)) by Claim Type Calendar Year 2023
Year
Paper - DD Form
Paper - CMS
1500 Paper - UB92 Total Paper
Electronic Institutional
Claim
Electronic Non-
Institutional Claim
Total Electronic Grand Total
2023 7,361 1,387,873 223,393 1,618,627 7,556,762 48,565,903 56,122,665 57,741,292 2024 6,577 1,569,981 226,013 1,802,571 8,040,962 50,384,224 58,425,186 60,227,757 2025 6,903 1,531,492 225,046 1,763,441 8,382,878 51,741,520 60,124,398 61,887,839
File details come from the government source that posted it. Updated .