Section_L_Exhibit_L-2_TMEP_Workload_History_FINAL_08_21_2019.pdf

SECTION L

EXHIBIT L-2 WORLOAD HISTORY

HT940219R0003 L-L2-1

Calendar year 2015

Month

Claim

Receipts Adjustments Net Receipts

EMC

Receipts

Paper

Receipts

January 4,609,639 70,364 4,526,744 4,258,350 268,394

February 4,346,904 63,838 4,346,904 3,956,037 390,867

March 4,563,174 72,873 4,452,802 4,125,242 327,560

April 4,293,642 84,648 4,183,658 3,845,078 338,580

May 5,363,775 87,398 5,262,010 4,976,113 285,897

June 4,552,914 67,005 4,444,686 4,134,873 309,813

July 4,709,588 66,627 4,610,853 4,416,216 194,637

August 4,460,566 58,307 4,357,597 4,089,212 268,385

September 4,675,008 58,233 4,564,264 4,270,546 293,718

October 4,995,344 122,267 4,882,256 4,589,005 293,251

November 4,111,337 54,987 4,011,096 3,824,174 186,922

December 5,122,956 58,983 5,009,007 4,780,068 228,939

Grand

Total 55,804,847 865,530 54,651,877 51,264,914 3,386,963

Calendar year 2016

Claim

Receipts Adjustments Net Receipts

EMC

Receipts

Paper

Receipts

January 4,449,676 61,267 4,340,308 4,112,062 228,246

February 4,449,088 139,680 4,336,324 4,097,546 238,778

March 5,210,757 81,586 5,087,136 4,873,303 213,833

April 4,972,737 126,684 4,853,464 4,697,606 155,858

May 4,889,796 173,709 4,774,696 4,615,938 158,758

June 4,873,077 95,687 4,753,985 4,566,665 187,320

July 4,759,097 73,698 4,643,369 4,379,809 263,560

August 4,837,907 75,140 4,716,786 4,485,990 230,796

September 4,621,116 75,013 4,507,438 4,331,266 176,172

October 4,646,118 67,594 4,530,797 4,335,526 195,271

November 4,892,954 73,258 4,777,622 4,503,474 274,148

December 4,993,414 62,565 4,879,009 4,672,664 206,345

Total 57,595,737 1,105,881 56,200,934 53,671,849 2,529,085

Calendar year 2017

Claim

Receipts Adjustments Net Receipts

EMC

Receipts

Paper

Receipts

January 4,452,952 65,293 4,452,952 4,091,492 361,460

February 4,512,263 73,957 4,400,479 4,216,955 183,524

March 5,366,512 109,873 5,366,512 5,026,320 340,192

April 4,752,977 96,969 4,752,977 4,462,726 290,251

HT940219R0003 L-L2-2

May 5,101,870 73,756 5,101,870 4,795,109 306,761

June 4,790,675 65,407 4,790,675 4,519,314 271,361

July 4,929,331 238,613 4,929,331 4,601,009 328,322

August 5,737,888 353,511 5,737,888 5,150,560 587,328

September 4,413,927 60,158 4,413,927 3,743,098 670,829

October 4,811,980 61,888 4,811,980 4,556,047 255,933

November 4,918,249 77,035 4,918,249 4,657,284 260,965

December 5,121,068 75,314 5,121,068 4,819,651 301,417

Total 58,909,692 1,351,774 58,797,908 54,639,565 4,158,343

Calendar year 2018

Claim

Receipts Adjustments Net Receipts

EMC

Receipts

Paper

Receipts

January

4,755,933

56,702

4,613,732

4,471,519

142,213

February

4,783,375

54,577

4,626,928

4,511,056

115,872

March

5,497,264

88,823

5,317,613

5,215,390

102,223

April

5,159,750

338,210

4,984,046

4,851,219

132,827

May

6,003,424

500,571

5,871,656

5,730,312

141,344

June

5,401,528

294,404

5,294,627

5,121,844

172,783

July

5,034,789

240,291

4,927,829

4,733,783

194,046

August

5,431,989

149,789

5,334,231

5,158,896

175,335

September

5,349,587

585,958

5,252,329

5,111,272

141,057

October

6,242,683

836,401

6,136,792

5,941,670

195,122

November

5,613,746

478,972

5,509,778

5,383,698

126,080

December

4,694,151

67,907

4,599,548

4,472,396

127,152

Total

63,968,219

3,692,605

62,469,109

60,703,055

1,766,054

Total Routine Correspondence Inquiries by Year and month

Month 2015 2016 2017 2018 Grand Total

January 32,074 29,076 31,075 34,144 126,369

February 30,096 33,982 29,043 28,817 121,938

March 36,521 34,065 33,508 32,091 136,185

HT940219R0003 L-L2-3

April 39,302 33,566 30,770 31,618 135,256

May 35,464 33,777 35,663 37,009 141,913

June 39,569 33,313 32,760 45,919 151,561

July 35,208 29,516 31,620 21,246 117,590

August 31,779 37,571 39,917 38,725 147,992

September 34,172 34,575 32,710 29,575 131,032

October 32,487 31,841 33,940 32,054 130,322

November 32,517 30,428 35,033 42,479 140,457

December 28,196 28,808 29,412 36,427 122,843

Total 407,385 390,518 395,451 410,104 1,603,458

Total Priority Correspondence Inquiries by Year and month

January 47 49 70 63 229

February 54 58 35 90 237

March 87 84 44 65 280

April 100 48 44 82 274

May 5 59 56 88 208

June 59 61 54 63 237

July 54 47 73 65 239

August 49 58 79 89 275

September 66 51 53 67 237

October 55 47 72 60 234

November 49 43 80 88 260

December 62 33 48 49 192

Total 687 638 708 869 2,902

Total Phone calls attempted by Year and month

January 236,034 235,362 310,909 355,783 1,138,088

February 238,970 277,727 222,470 261,453 1,000,620

March 274,947 268,151 253,046 255,202 1,051,346

April 265,923 231,287 210,674 242,459 950,343

May 244,232 223,146 227,318 269,822 964,518

June 278,498 235,094 222,863 272,221 1,008,676

July 261,090 211,890 212,981 267,132 953,093

August 253,931 249,750 243,955 267,967 1,015,603

September 248,540 225,418 203,849 223,794 901,601

October 250,934 230,502 234,152 273,763 989,351

November 223,670 226,237 217,309 248,442 915,658

HT940219R0003 L-L2-4

December 209,859 220,439 191,554 219,079 840,931

Total 2,986,628 2,835,003 2,751,080 3,157,117 11,729,828

Total Phone calls received by Year and month

January 231,627 232,806 251,755 336,553 1,052,741

February 236,338 222,959 212,470 259,135 930,902

March 251,649 250,523 242,048 253,202 997,422

April 240,687 223,027 203,543 240,965 908,222

May 216,583 217,802 224,785 265,231 924,401

June 235,355 228,652 220,796 267,336 952,139

July 233,679 209,999 202,910 262,333 908,921

August 232,567 247,460 231,062 263,796 974,885

September 227,575 222,808 202,350 221,547 874,280

October 241,306 226,772 230,427 271,133 969,638

November 208,122 221,456 214,454 246,349 890,381

December 206,861 206,861 190,384 214,103 818,209

Total 2,762,349 2,711,125 2,626,984 3,101,683 11,202,141

Total Authorizations received by Year and month

January 658 767 711 752 2,888

February 666 678 661 535 2,540

March 792 846 783 648 3,069

April 818 707 607 775 2,907

May 709 755 721 734 2,919

June 719 823 747 705 2,994

July 861 695 654 670 2,880

August 712 810 758 735 3,015

September 772 787 701 637 2,897

October 726 784 699 760 2,969

November 636 771 799 489 2,695

December 784 670 712 491 2,657

Total 8,853 9,093 8,553 7,931 34,430

Total SNF Authorizations received by Year and month

January 491 523 536 463 1,812

February 501 486 459 347 1,614

HT940219R0003 L-L2-5

March 595 573 522 358 1,941

April 594 522 410 404 1,853

May 502 524 472 440 1,752

June 537 605 472 417 1,881

July 565 502 434 408 1,740

August 470 559 481 404 1,806

September 546 557 468 374 1,822

October 505 573 455 404 1,585

November 419 546 414 371 1,499

December 556 490 375 394 1,425

Total 6,281 6,460 5,498 4,784 22,771

Total Grievances received by Year and month

January 2 4 0 2 8

February 1 6 2 1 10

March 1 3 3 1 8

April 3 0 0 1 4

May 1 1 0 0 2

June 1 1 0 2 4

July 0 1 0 1 2

August 3 2 0 2 7

September 5 1 0 0 6

October 1 5 0 0 6

November 4 3 0 0 7

December 3 0 1 0 4

Total 25 27 6 10 68

Total Medical Appeals received by Year and month

January 6 3 3 3 15

February 6 4 3 1 14

March 5 5 4 3 17

April 4 5 1 2 12

May 10 4 4 4 22

June 4 2 4 2 12

July 4 3 2 3 12

August 3 3 0 3 9

September 6 2 2 1 11

October 5 6 7 3 21

HT940219R0003 L-L2-6

November 7 7 1 5 20

December 8 3 1 1 13

Grand

Total 68 47 32 31 178

Total Factual Appeals received by Year and month

Month 2015 2016 2017 2018 Grand Total

January 166 125 87 71 449

February 114 163 101 83 461

March 148 142 104 121 515

April 164 159 131 93 547

May 154 171 92 111 528

June 147 133 92 112 484

July 137 108 76 98 419

August 146 114 105 134 499

September 164 71 155 109 499

October 121 105 47 138 411

November 172 122 89 117 500

December 101 104 87 86 378

Grand

Total 1,734 1,517 1,166 1,273 5,690

Calendar Year 2018

Month

Inpatient

Hospital Claim

Receipts

Inpatient

Professional

Claim Receipts

Outpatient professional Claim

Receipts

Unique

Beneficiaries

January 62,376 716,690 4,392,806 1,221,060

February 52,402 621,599 3,901,475

1,160,697

March 54,402 642,535 4,149,233

1,190,172

April 51,481 605,833 4,104,859

1,195,145

May 51,991 614,381 4,293,958

1,211,297

June 49,256 585,680 4,007,390

1,173,146

July 49,356 584,488 3,976,264

1,165,568

August 51,060 596,977 4,283,789

1,205,412

September 46,517 555,581 3,737,389

1,145,253

October 52,419 607,337 4,343,578

1,228,754

November 48,616 580,845 3,881,327

1,169,910

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December 48,863 591,120 3,541,921

Grand

Total 618,739 7,303,066 48,613,989

1,115,793

Beneficiary State Unique Beneficiaries

Alabama 69,338

Alaska 5,527

Arizona 69,053

Arkansas 32,124

California 154,001

Colorado 50,085

Connecticut 11,305

Delaware 9,244

District of Columbia 1,696

Florida 222,978

Georgia 93,973

Hawaii 13,371

Idaho 16,294

Illinois 31,909

Indiana 27,206

Iowa 14,216

Kansas 23,226

Kentucky 29,272

Louisiana 29,106

Maine 8,236

Maryland 32,428

Massachusetts 18,111

Michigan 30,553

Minnesota 21,420

Mississippi 32,241

Missouri 42,834

Montana 10,142

Nebraska 14,171

Nevada 28,390

New Hampshire 7,398

New Jersey 19,668

New Mexico 22,361

New York 33,776

New Zealand 2

14,182,207

HT940219R0003 L-L2-8

North Carolina 98,097

North Dakota 4,838

Ohio 45,930

Oklahoma 38,954

Oregon 26,598

Pennsylvania 54,869

Rhode Island 6,113

Saint Pierre and Miquelon 2

South Africa 1

South Carolina 70,935

South Dakota 8,541

Tennessee 61,429

Texas 193,836

Utah 19,397

Vermont 4,012

Virginia 124,490

Washington 69,179

West Virginia 11,783

Wisconsin 23,200

Wyoming 5,118

2,092,977