Exhibit_L_-_Medical_Discount_Pricing_File_(3_TABS_TO_COMPLETE,_DO_NOT_SUBMIT)_FINAL.xlsx

XLSX spreadsheet 46 KB Posted

Attached to
25-P-115TF Self-Funded Group Health Plan Administrative Services
Solicitation number
25-P-115TF
Issued by
Volusia County, Florida

About this file

Exhibit L is a comprehensive medical discount pricing file for Volusia County Government's self-funded group health plan administrative services contract, covering medical claims re-pricing for facility, ancillary, and professional services from January 1, 2024, to December 31, 2024. The Request for Proposals (RFP) seeks a contractor to provide administrative services only (ASO) for the county's health plan, which includes benefits for employees, retirees, and COBRA participants. The contract term is initially five years with a potential subsequent five-year renewal, contingent on mutual agreement and county council approval, with an intended effective date of January 1, 2027.

The pricing file details medical service categories with 100% discount rates across multiple healthcare facilities, including inpatient, emergency room, outpatient, and urgent care services from providers like AdventHealth and Orlando Health. The total billed amount for these services is $57,780,293, with ancillary services (radiology, laboratory, durable medical equipment) totaling $6,782,836 and professional services amounting to $14,548,822. All service categories show a consistent 100% discount rate, and the document is marked as confidential with instructions not to submit the pricing information with the proposal. The county intends to award a single contract to the most suitable respondent, covering comprehensive health plan administrative services.

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Other files

File Type Posted
25-P-115TF_Self-Funded_Group_Health_Plan_Administrative_Services_(Addendum_#6_Revision).pdf PDF
25-P-115TF_Self-Funded_Group_Health_Plan_Administrative_Services.pdf PDF
Exhibit_D_-_Insurance_Requirements_(For_DRAFT_Contract)_FINAL_.pdf PDF
25-P-115TF_Self-Funded_Group_Health_Plan_Admin_Srvs_Agreement_FINAL_DRAFT.pdf PDF
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Exhibit_G_-_County_Computing_Security_Procedures_FINAL.pdf PDF
Exhibit_F_-_HIPPA_Business_Associate_Agreement_FINAL.pdf PDF
Exhibit_E_-_Human_Trafficking_Affidavit_FINAL.pdf PDF
Exhibit_C_-_Summary_Plan_Document_(2025)_FINAL.pdf PDF
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Exhibit_B_-_Fees_and_Performance_Guarantees_FINAL.docx DOCX document
Exhibit_A.4_-_Onsite_Job_Descriptions_FINAL.pdf PDF
Exhibit_A.3_-_Claims_Reporting_Fields_FINAL.pdf PDF
Attachment_A.2_-_Network_and_Formulary_Disruption_(4_TABS_TO_COMPLETE)_FINAL.xlsx XLSX spreadsheet
Attachment_A.1_-_Worksheet_Health_Plan_Administrative_Services_FINAL.docx DOCX document
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Show all 20

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Text version

Facility Health Plan Administrative Services

Facility Services
Incurred: 01/01/2024 - 12/31/2024
Paid: 01/01/2024 - 02/28/2025

MEDICAL CLAIMS RE-PRICING - CONFIDENTIAL - DO NOT SUBMIT THIS INFORMATION WITH YOUR PROPOSAL

FACILITY PRICING

InpatientInpatient
FacilityBilled AmountAdmitsAllowed AmountDiscount %
ADVENTHEALTH DAYTONA BCH$4,369,379119100%
ADVENTHEALTH ORLANDO$2,948,49146100%
ORLANDO HLTH INC$2,448,63040100%
HCA FL LK MONROE HSP$1,891,90610100%
ADVENTHEALTH FISH MEML$1,853,71540100%
All Others$7,114,607130100%
Total Facility Inpatient$20,626,729385$0100%
Emergency RoomER
FacilityER Billed AmountER VisitsAllowed AmountDiscount %
ADVENTHEALTH DAYTONA BCH$3,413,883487100%
ADVENTHEALTH DELAND$1,742,518222100%
ADVENTHEALTH FISH MEML$1,690,557229100%
HALIFAX MED CTR$1,271,872158100%
ADVENTHEALTH NEW SMYRNA$767,34499100%
All Others$2,720,435446100%
Total$11,606,6091,641$0100%
OutpatientOutpatient
FacilityOutpatient Billed AmountOutpatient VisitsAllowed AmountDiscount %
ADVENTHEALTH DAYTONA BCH$2,638,455604100%
ADVENTHEALTH DELAND$2,230,357757100%
ADVENTHEALTH NEW SMYRNA$1,590,987348100%
ADVENTHEALTH FISH MEML$983,250273100%
ADVENTHEALTH ORLANDO$784,396126100%
All Others$16,563,5835,187100%
Total$24,791,0277,295$0100%
Urgent CareUrgent Care
FacilityBilled AmountVisitsAllowed AmountDiscount %
All Urgent Care Facilities$755,9272,283100%
Total$755,9272,283$0100%
Total Billed Amount$57,780,293Please transfer your Company's aggregate allowed amount and tabulated average discount to Exhibit B, Section 8, Item 2.
Total Allowed Amount$0
Average Discount100.00%

&"Arial,Bold"25-P-115TF &"Arial,Bold"Exhibit L - Medical Discount Pricing File (Facility)

&"Arial,Regular"Page &P of &N

Ancillary Health Plan Administrative Services

Ancillary
Incurred: 01/01/2024 - 12/31/2024
Paid: 01/01/2024 - 02/28/2025

MEDICAL CLAIMS RE-PRICING - CONFIDENTIAL - DO NOT SUBMIT THIS INFORMATION WITH YOUR PROPOSAL

ANCILLARY PRICING

Ancillary Type Billed Amount Visits Allowed Amount Discount %

RadiologyRadiology
All Radiology$991,6763,326100%
LaboratoryLaboratory
All Laboratory$5,439,8228,138100%
Durable Medical EquipmentDurable Medical Equipment
All DME$351,339915100%
Total Billed Amount$6,782,836Please transfer your Company's aggregate allowed amount and tabulated average discount to Exhibit B, Section 8, Item 2.
Total Allowed Amount$0
Average Discount100.00%

&"Arial,Bold"25-P-115TF &"Arial,Bold"Exhibit L - Medical Discount Pricing File (Ancillary)

&"Arial,Regular"Page &P of &N

Professional Health Plan Administrative Services

Professional Services
Incurred: 01/01/2024 - 12/31/2024
Paid: 01/01/2024 - 02/28/2025

MEDICAL CLAIMS RE-PRICING - CONFIDENTIAL - DO NOT SUBMIT THIS INFORMATION WITH YOUR PROPOSAL

PROFESSIONAL PRICING

Primary Care & SpecialistPCP & Specialist
PhysiciansBilled AmountVisitsAllowed AmountDiscount %
Primary Care Office Visits$1,975,4856,597100%
Specialty Care Office Visits$9,500,37816,490100%

Subtotal Primary Care & Specialist $11,475,864 23,087 $0 100%

Ancillary ProfessionalAncillary Professional
Ancillary Professional TypeBilled AmountVisitsAllowed AmountDiscount %
Anesthesiology$408,025210100%
Emergency Medicine$2,316,7311,549100%
Pathology$348,203832100%

Subtotal Ancillary Professional $3,072,959 2,591 $0 100%

Total Billed Amount$14,548,822Please transfer your Company's aggregate allowed amount and tabulated average discount to Exhibit B, Section 8, Item 2.
Total Allowed Amount$0
Average Discount100.00%

&"Arial,Bold"25-P-115TF &"Arial,Bold"Exhibit L - Medical Discount Pricing File (Professional)

&"Arial,Bold"Page &P of &N

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