TQMC_Section_L_Exhibit_L-6_TQMC_Workload_Report.xlsx

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Section L Exhibit L-6

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2012 12 Mo period of Workload

Section L, Exhibit L-6, TQMC Workload Report
2012 12-month period of TRICARE WORKLOAD REPORT
January Cases CompletedFebruary Cases CompletedMarch Cases CompletedApril Cases CompletedMay Cases CompletedJune Cases CompletedJuly Cases CompletedAugust Cases CompletedSeptember Cases CompletedOctober Cases CompletedNovember Cases CompletedDecember Cases CompletedMedianMeanStandard Deviation
Retrospective ReviewsMental Health Record Reviews0.000.000.000.000.000.000.000.000.000.000.000.000.000.000.00
Section C, Para 6.5.1.Retro Reviews1,628.00830.00624.001,202.001,295.001,426.001,604.001,148.001,521.001,600.001,041.00374.001,248.501,191.08392.38
Standards of Care ReviewsMTF SOC with Malpractice4.0019.0013.006.0015.0010.006.006.0012.008.007.008.008.009.504.25
Section C, Para 6.5.4., 6.5.4.5., andMTF SOC - Active Duty3.004.000.007.0026.008.006.0010.0012.008.0026.0014.008.0010.337.90
6.5.5. respectivelyCOR Directed Case Reviews0.000.000.000.000.000.000.000.000.000.000.000.000.000.000.00
Transition Asst. Mgt. PGMTAMP Reviews0.000.000.000.001.000.000.000.000.000.000.000.000.000.080.28
Section C, 6.5.3.2.
TMA Reviews Section C, Para 6.5.3.1.Internal Reviews0.000.000.000.000.000.000.000.000.000.000.000.000.000.000.00
TMA ReviewsUrgent External Reviews2.000.000.001.002.004.002.000.000.002.001.001.001.001.251.16
TMA ReviewsRoutine External Reviews11.0015.0018.0030.0017.0022.0028.0015.0014.0011.0017.0013.0016.0017.585.89
Reconsiderations/AppealsRecon/Appeals (Medical Necessity)58.0061.0056.0045.0060.0052.0057.0052.0038.0059.0045.0053.0054.5053.006.79
Section C, Para 6.5.2.
Witness AppearancePre-Hearing Preparations (Hours)1.000.001.000.000.000.000.000.000.000.000.0033.000.002.929.08
Section C, Para 6.5.3.1.Hearing Appearance (Hours)1.000.000.000.000.000.000.000.000.000.000.008.000.000.752.20
Post-Hearing (Hours)1.000.000.000.000.000.000.000.000.000.000.003.000.000.330.85
Transcription of Expert Witness (Hours)0.000.001.000.000.000.000.000.000.000.000.0010.000.000.922.75
TRAVEL Section C, Para 10.0Travel for Meetings0.000.000.000.000.000.000.000.000.000.000.001.000.000.080.28
Reports
Monthly Concerns and Workload Report1.001.001.001.001.001.001.001.001.001.001.001.001.001.000.00
Monthly Facilities Listing Report1.001.001.001.001.001.001.001.001.001.001.001.001.001.000.00
Quarterly CMS National Coverage Determinations1.000.000.001.000.000.001.000.000.001.000.000.000.000.330.47
Quaterly Contractor Performance Report1.000.000.001.000.000.001.000.000.001.000.000.000.000.330.47
Quarterly IQMP Report1.000.000.001.000.000.001.000.000.001.000.000.000.000.330.47
Quarterly Evolving Practices (HTAs) Rept.1.000.000.001.000.000.001.000.000.001.000.000.000.000.330.47
Semi-Annual Report0.000.000.000.000.001.000.000.000.000.000.000.000.000.080.28
HEDIS Annual Report0.000.000.000.000.000.000.000.000.001.000.000.000.000.080.28
Annual IQMP0.000.000.001.000.000.000.000.000.000.000.000.000.090.29
Studies Section C Para 6.7.Short HTA0.000.000.000.001.000.000.000.000.000.001.000.000.000.170.37
Long HTA0.001.000.000.000.003.000.000.001.000.000.000.000.000.420.86
Studies Section C, Para .6.6.1.Evolving Practices Reports Delivered0.000.000.000.000.000.000.000.000.000.000.000.000.000.000.00
Focus Studies (completion value = total staff hours160.000.000.000.0042.0042.0042.00262.5068.000.001.500.0021.7551.5077.78
MH Facility CertificationsMH Fac. Certification Application Reviews3.000.0013.002.004.006.006.000.006.002.002.000.002.503.673.57
Section C.6.4.MH Fac. Cert. (On-site Surveys)2.003.003.000.000.001.002.002.002.002.001.002.002.001.670.94

Case and Study Workload Totals 1,880.00 935.00 731.00 1,299.00 1,466.00 1,577.00 1,759.00 1,497.50 1,676.00 1,699.00 1,144.50 522.00 1,481.75 1,348.83 413.20

Section L, Exhibit L-7 Historical Information - TRICARE Workload Report

2013 12 Mo period of Workload

Section L, Exhibit L-6, TQMC Workload Report
2013 12-month period of TRICARE WORKLOAD REPORT
January Cases CompletedFebruary Cases CompletedMarch Cases CompletedApril Cases CompletedMay Cases CompletedJune Cases CompletedJuly Cases CompletedAugust Cases CompletedSeptember Cases CompletedOctober Cases CompletedNovember Cases CompletedDecember Cases CompletedMedianMeanStandard Deviation
Retrospective ReviewsMental Health Record Reviews0.000.000.000.000.000.000.000.000.000.000.000.000.000.000.00
Section C, Para 6.5.1.Retro Reviews1,495.001,483.001,477.001,092.00433.00498.000.00398.001,340.00755.00166.00127.00626.50772.00552.25
Standards of Care ReviewsMTF SOC with Malpractice14.002.0018.0012.0018.0011.0013.005.0025.0015.0011.002.0012.5012.176.49
Section C, Para 6.5.4., 6.5.4.5., andMTF SOC - Active Duty13.006.002.0014.0018.0014.0018.0011.006.0022.004.000.0012.0010.676.71
6.5.5. respectivelyCOR Directed Case Reviews0.000.000.000.000.000.000.000.000.000.000.000.000.000.000.00
Transition Asst. Mgt. PGMTAMP Reviews0.000.000.000.000.000.000.000.000.000.000.000.000.000.000.00
Section C, 6.5.3.2.
TMA Reviews Section C, Para 6.5.3.1.Internal Reviews0.000.000.000.000.000.000.000.001.003.000.000.000.000.330.85
TMA ReviewsUrgent External Reviews0.002.001.003.002.000.003.001.000.000.000.001.001.001.081.11
TMA ReviewsRoutine External Reviews11.0012.0017.0014.0014.0012.004.009.005.007.0011.006.0011.0010.173.85
Reconsiderations/AppealsRecon/Appeals (Medical Necessity)58.0035.0040.0036.0043.0026.0032.0029.0037.0026.0029.0030.0033.5035.088.62
Section C, Para 6.5.2.
Witness AppearancePre-Hearing Preparations (Hours)0.000.000.000.000.001.000.000.000.000.000.000.000.000.080.28
Section C, Para 6.5.3.1.Hearing Appearance (Hours)0.000.000.000.000.000.000.000.000.000.000.000.000.000.000.00
Post-Hearing (Hours)0.000.000.000.000.000.000.000.000.000.000.000.000.000.000.00
Transcription of Expert Witness (Hours)0.000.000.000.000.000.000.000.000.000.000.000.000.000.000.00
TRAVEL Section C, Para 10.0Travel for Meetings0.000.000.000.000.000.000.000.000.000.001.000.000.000.080.28
Reports
Monthly Concerns and Workload Report1.001.001.001.001.001.001.001.001.001.001.001.001.001.000.00
Monthly Facilities Listing Report1.001.001.001.001.001.001.001.001.001.001.001.001.001.000.00
Quarterly CMS National Coverage Determinations1.000.000.001.000.000.001.000.000.001.000.000.000.000.330.47
Quaterly Contractor Performance Report1.000.000.001.000.000.001.000.000.001.000.000.000.000.330.47
Quarterly IQMP Report1.000.000.001.000.000.001.000.000.001.000.000.000.000.330.47
Quarterly Evolving Practices (HTAs) Rept.1.000.000.001.000.000.001.000.000.001.000.000.000.000.330.47
Semi-Annual Report0.000.000.000.000.000.000.000.000.000.000.000.000.000.000.00
HEDIS Annual Report0.000.000.000.000.000.000.000.000.001.000.000.000.000.080.28
Annual IQMP0.000.000.001.001.000.000.000.000.000.000.000.000.180.39
Studies Section C Para 6.7.Short HTA0.001.000.002.001.000.000.000.000.000.001.000.000.000.420.64
Long HTA0.000.000.000.000.000.000.000.000.000.000.000.000.000.000.00
Studies Section C, Para .6.6.1.Evolving Practices Reports Delivered0.000.000.000.001.000.000.000.000.000.000.000.000.000.080.28
Focus Studies (completion value = total staff hours0.000.000.0045.7520.0036.7547.5037.5043.0038.0038.000.0037.1325.5419.18
MH Facility CertificationsMH Fac. Certification Application Reviews2.003.002.004.003.0014.009.004.004.007.0026.002.004.006.676.75
Section C.6.4.MH Fac. Cert. (On-site Surveys)2.001.001.001.002.002.001.002.001.002.002.001.001.501.500.50

Case and Study Workload Totals 1,601.00 1,547.00 1,560.00 1,229.75 558.00 617.75 133.50 498.50 1,464.00 882.00 291.00 171.00 749.88 879.46 548.89

1st Qtr2nd Qtr3rd Qtr4th Qtr
Direct Care ORYX Measure Chart Abstractions17,289.0016,438.0016,091.0016,438.0016,598.44616.42
Section C, Para 6.4.3.

Section L, Exhibit L-6, Historical Information - TRICARE Workload Report

2014 12 Mo period of Workload

Section L, Exhibit L-6, TQMC Workload Report
2014 12-month period of TRICARE WORKLOAD REPORT
January Cases CompletedFebruary Cases CompletedMarch Cases CompletedApril Cases CompletedMay Cases CompletedJune Cases CompletedJuly Cases CompletedAugust Cases CompletedSeptember Cases CompletedOctober Cases CompletedNovember Cases CompletedDecember Cases CompletedMedianMeanStandard Deviation
Retrospective ReviewsMental Health Record Reviews0.000.000.000.000.000.000.000.000.000.000.000.000.000.000.00
Section C, Para 6.5.1.Retro Reviews0.0022.001,477.001,092.00433.00498.000.00398.001,340.00755.00166.00127.00415.50525.67505.12
Standards of Care ReviewsMTF SOC with Malpractice5.0011.0018.0012.0018.0011.0013.005.0025.0015.0011.002.0011.5012.176.14
Section C, Para 6.5.4., 6.5.4.5., andMTF SOC - Active Duty4.001.002.0014.0018.0014.0018.0011.006.0022.004.000.008.509.507.27
6.5.5. respectivelyCOR Directed Case Reviews0.000.000.000.000.000.000.000.000.000.000.000.000.000.000.00
Transition Asst. Mgt. PGMTAMP Reviews0.000.000.000.000.000.000.000.000.000.000.000.000.000.000.00
Section C, 6.5.3.2.
TMA Reviews Section C, Para 6.5.3.1.Internal Reviews0.000.000.000.000.000.000.000.001.003.000.000.000.000.330.85
TMA ReviewsUrgent External Reviews0.001.001.003.002.000.003.001.000.000.000.001.001.001.001.08
TMA ReviewsRoutine External Reviews3.005.0017.0014.0014.0012.004.009.005.007.0011.006.008.008.924.41
Reconsiderations/AppealsRecon/Appeals (Medical Necessity)23.0022.0040.0036.0043.0026.0032.0029.0037.0026.0029.0030.0029.5031.086.40
Section C, Para 6.5.2.
Witness AppearancePre-Hearing Preparations (Hours)0.000.000.000.000.001.000.000.000.000.000.000.000.000.080.28
Section C, Para 6.5.3.1.Hearing Appearance (Hours)0.000.000.000.000.000.000.000.000.000.000.000.000.000.000.00
Post-Hearing (Hours)0.000.000.000.000.000.000.000.000.000.000.000.000.000.000.00
Transcription of Expert Witness (Hours)0.000.000.000.000.000.000.000.000.000.000.000.000.000.000.00
TRAVEL Section C, Para 10.0Travel for Meetings0.000.000.000.000.000.000.000.000.000.001.000.000.000.080.28
Reports
Monthly Concerns and Workload Report1.001.001.001.001.001.001.001.001.001.001.001.001.001.000.00
Monthly Facilities Listing Report1.001.001.001.001.001.001.001.001.001.001.001.001.001.000.00
Quarterly CMS National Coverage Determinations1.000.000.001.000.000.001.000.000.001.000.000.000.000.330.47
Quaterly Contractor Performance Report1.000.000.001.000.000.001.000.000.001.000.000.000.000.330.47
Quarterly IQMP Report1.000.000.001.000.000.001.000.000.001.000.000.000.000.330.47
Quarterly Evolving Practices (HTAs) Rept.1.000.000.001.000.000.001.000.000.001.000.000.000.000.330.47
Semi-Annual Report0.000.000.000.000.000.000.000.000.000.000.000.000.000.000.00
HEDIS Annual Report0.000.000.000.000.000.000.000.000.001.000.000.000.000.080.28
Annual IQMP0.000.000.001.001.000.000.000.000.000.000.000.000.180.39
Studies Section C, Para 6.7.Short HTA0.000.000.002.001.000.000.000.000.000.001.000.000.000.330.62
Long HTA0.000.000.000.000.000.000.000.000.000.000.000.000.000.000.00
Studies Section C, Para 6.6.1.Evolving Practices Reports Delivered0.000.000.000.001.000.000.000.000.000.000.000.000.000.080.28
Focus Studies (completion value = total staff hours30.0070.500.0045.7520.0036.7547.5037.5043.0038.0038.000.0037.7533.9218.95
MH Facility CertificationsMH Fac. Certification Application Reviews6.002.002.004.003.0014.009.004.004.007.0026.002.004.006.926.66
Section C Para 6.4.MH Fac. Cert. (On-site Surveys)1.001.001.001.002.002.001.002.001.002.002.001.001.001.420.49

Case and Study Workload Totals 78.00 137.50 1,560.00 1,229.75 558.00 617.75 133.50 498.50 1,464.00 882.00 291.00 171.00 528.25 635.08 510.34

1st Qtr2nd Qtr3rd Qtr4th QtrMedianMeanStd Dev
Direct Care ORYX Measure Chart Abstractions29,850.0022,583.0022,561.0018,878.0022,572.0023,147.824,597.24
Section C.6.4.3.

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