Exhibit L-7_TCRS Historical Rebuttal Report (2017-2021) v1.xlsx

XLSX spreadsheet 19 KB Posted Jun 7, 2022

Attached to: TRICARE CLAIMS REVIEW SERVICE (TCRS) -- CANCELLED
Solicitation number: HT940221R0002
Issued by: Defense Health Agency

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Exhibit L-4_Solicitation Cross-Reference Table (Sections L M and C) v1.pdf	PDF	Jun 7, 2022
Exhibit L-9_Draft Quality Assurance Surveillance Plan (QASP) v1.docx	DOCX document	Jun 7, 2022
HT940221R0002_conformed 0002.pdf	PDF	Jun 7, 2022
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HT940221R0002_Amendment 0002.pdf	PDF	Jun 7, 2022
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HT940221R0002_conformed 0001.pdf	PDF	May 26, 2022
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Section J Attachments.zip	ZIP file	May 16, 2022

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Sheet1

TRICARE Purchased Care Contract	Compliance Review Cycle	Total # Claims	# of Rebuttals	% of Rebuttals	# of 2nd Rebuttals	% of 2nd Rebuttals
TDEFIC (T-14)	JAN - MAR 17	1,992	36	1.81%	2	0.10%
	APR - JUN 17	1,986	36	1.81%	0	0.00%
	JUL - SEP 17	1,922	18	0.94%	0	0.00%
	OCT - DEC 17	2,003	109	5.44%	0	0.00%
	JAN - MAR 18	1,963	65	3.31%	0	0.00%
	APR - JUN 18	2,013	95	4.72%	2	0.10%
	JUL - SEP 18	2,424	167	6.89%	20	0.83%
	OCT - DEC 18	2,443	107	4.38%	2	0.08%
	JAN - MAR 19	2,215	77	3.48%	0	0.00%
	APR - JUN 19	2,244	55	2.45%	0	0.00%
	JUL - SEP 19	2,380	227	9.54%	0	0.00%
	OCT - DEC 19	2,413	69	2.86%	0	0.00%
	JAN - MAR 20	2,369	235	9.92%	10	0.42%
	APR - JUN 20	2,409	153	6.35%	7	0.29%
	JUL - SEP 20	2,413	121	5.01%	15	0.62%
	OCT - DEC 20	2,392	109	4.56%	7	0.29%
	JAN - MAR 21	2,404	72	3.00%	2	0.08%
TOP (T-4)	DEC 16 - FEB 17	1,213	17	1.40%	3	0.25%
	MAR - MAY 17	1,223	48	3.92%	4	0.33%
	JUN - AUG 17	1,201	25	2.08%	3	0.25%
	SEP - NOV 17	1,204	135	11.21%	11	0.91%
	DEC - FEB 18	1,839	112	6.09%	0	0.00%
	MAR - MAY 18	1,888	146	7.73%	2	0.11%
	JUN - AUG 18	1,895	81	4.27%	7	0.37%
	SEP - NOV 18	1,894	121	6.39%	13	0.69%
	DEC - FEB 19	1,850	363	19.62%	40	2.16%
	MAR - MAY 19	1,832	101	5.51%	6	0.33%
	JUN - AUG 19	1,832	91	4.97%	0	0.00%
	SEP - NOV 19	1,854	79	4.26%	0	0.00%
	DEC - FEB 20	1,870	117	6.26%	0	0.00%
	MAR - MAY 20	1,860	102	5.48%	5	0.27%
	JUN - AUG 20	1,887	73	3.87%	6	0.32%
	SEP - NOV 20	1,875	94	5.01%	5	0.27%
	DEC - FEB 21	1,854	102	5.50%	8	0.43%
TPharm (T-4)	NOV 16 - JAN 17	2,605	200	7.68%	0	0.00%
	FEB - APR 17	2,608	243	9.32%	0	0.00%
	MAY - JUL 17	2,605	223	8.56%	0	0.00%
	AUG - OCT 17	2,572	308	11.98%	0	0.00%
	NOV - JAN 18	3,270	69	2.11%	0	0.00%
	FEB - APR 18	2,655	53	2.00%	0	0.00%
	MAY - JUL 18	2,598	149	5.74%	0	0.00%
	AUG - OCT 18	2,790	298	10.68%	0	0.00%
	NOV 18 - JAN 19	2,802	334	11.92%	0	0.00%
	FEB - APR 19	2,786	114	4.09%	0	0.00%
	MAY - JUL 19	2,796	99	3.54%	0	0.00%
	AUG - OCT 19	2,782	63	2.26%	0	0.00%
	NOV 19 - JAN 20	2,796	114	4.08%	0	0.00%
	FEB - APR 20	2,788	133	4.77%	0	0.00%
	MAY - JUL 20	2,812	55	1.96%	0	0.00%
	AUG - OCT 20	2,800	40	1.43%	0	0.00%
	NOV 20 - JAN 21	2,792	74	2.65%	0	0.00%
ADDP (T-4)	AUG 16 - JAN 17	1,178	8	0.68%	0	0.00%
	FEB 17 - JUL 17	1,133	11	0.97%	0	0.00%
	AUG 17 - JAN 18	1,186	14	1.18%	0	0.00%
	FEB 18 - JUL 18	1,187	8	0.67%	0	0.00%
	AUG 18 - JAN 19	1,194	58	4.86%	0	0.00%
	FEB 19 - JUL 19	1,217	16	1.31%	0	0.00%
	AUG 19 - JAN 20	1,180	13	1.10%	0	0.00%
	FEB 20 - JUL 20	1,201	15	1.25%	0	0.00%
	AUG 20 - JAN 21	1,201	15	1.25%	0	0.00%
East Region - T-17	JAN - MAR 18	2,369	1250	52.76%	93	3.93%
	APR - JUN 18	2,429	434	17.87%	54	2.22%
	JUL - SEP 18	2,385	264	11.07%	18	0.75%
	OCT - DEC 18	2,394	247	10.32%	9	0.38%
	JAN - MAR 19	2,426	209	8.62%	2	0.08%
	APR - JUN 19	2,386	205	8.59%	6	0.25%
	JUL - SEP 19	2,415	172	7.12%	1	0.04%
	OCT - DEC 19	2,406	178	7.40%	10	0.42%
	JAN - MAR 20	2,389	151	6.32%	9	0.38%
	APR - JUN 20	2,383	149	6.25%	2	0.08%
	JUL - SEP 20	2,399	136	5.67%	4	0.17%
	OCT - DEC 20	2,413	132	5.47%	3	0.12%
	JAN - MAR 21	2,399	120	5.00%	9	0.38%
Annual Audits	JAN - DEC 18	7,500	513	6.84%	0	0.00%
	JAN - DEC 19	7,500	368	4.91%	7	0.09%
	JAN - DEC 20	7,500	344	4.59%	10	0.13%	Estimated
West Region - T-17	JAN - MAR 18	2,374	456	19.21%	16	0.67%
	APR - JUN 18	2,403	125	5.20%	17	0.71%
	JUL - SEP 18	2,413	182	7.54%	12	0.50%
	OCT - DEC 18	2,394	149	6.22%	10	0.42%
	JAN - MAR 19	2,403	209	8.70%	11	0.46%
	APR - JUN 19	2,381	174	7.31%	9	0.38%
	JUL - SEP 19	2,397	139	5.80%	5	0.21%
	OCT - DEC 19	2,395	149	6.22%	14	0.58%
	JAN - MAR 20	2,408	176	7.31%	7	0.29%
	APR - JUN 20	2,407	178	7.40%	18	0.75%
	JUL - SEP 20	2,389	170	7.12%	11	0.46%
	OCT - DEC 20	2,413	118	4.89%	8	0.33%
	JAN - MAR 21	2,394	93	3.88%	12	0.50%
Annual Audits	JAN - DEC 18	7,500	233	3.11%	12	0.16%
	JAN - DEC 19	7,500	266	3.55%	12	0.16%
	JAN - DEC 20	7,500	227	3.03%	12	0.16%	Estimated
Total Completed Audit Cycles		231,954	14,201	6.12%	603	0.26%

Attachment L, Exhibit L-7

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File details come from the government source that posted it. Updated Jun 7, 2022.