J.3 Appendix C - WCRC Monthly Progress Report Example.pdf

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Workers’ Compensation Review Contractor (WCRC)

75FCMC23Cxxxx

Monthly Progress Report For Period Month 1 – xx, 20xx

Submitted to:

Centers for Medicare & Medicaid Services

Office of Financial Management

Division of Medicare Benefit Coordination

TABLE OF CONTENTS

TABLE OF CONTENTS

EXECUTIVE SUMMARY

FINANCIAL REPORT

WCRC TASK ACTIVITIES

Tasks 1 and 2 – Receiving & Evaluating; Procedures for Processing WCMSAs

WCMSA Receipts

WCMSA Proposal Screening

WCMSA Proposal Production

Task 3 – System Testing & Local Area Network Support

Task 4 – Customer Service & Education

Task 5 – Records Retention Management

Task 6 – Internal Controls

Task 7 – HIPAA Systems Security & Contractor Privacy Provisions

B73V Highlight

WCRC – Month Monthly Progress Report

Submitted Month xx, 20xx

Task 8 – Administrative Requirements

Task 9 – Interfaces with CMS Systems & Contractors

Education & Outreach

Meetings & Report Deliverables

PROJECT MILESTONES

CHALLENGES AND IMPROVEMENTS

ACTION ITEMS FOR MONTH, 20XX 2014

Monthly Statistical Report (Month, 20xx)

Option Year XX Period Statistical Report (xx/xx/20xx – xx/xx/20xx)

Contract Period Statistical Report (xx/xx/20xx – xx/xx/20xx)

Monthly RO Requested Re-Review Statistical Report (Month, 20xx)

Option Year XX Period RO Requested Re-Review Statistical Report (xx/xx/20xx – xx/xx/20xx)

Contract Period RO Requested Re-Review Statistical Report (xx/xx/20xx – xx/xx/20xx)

Monthly Inbound Call Analysis (xx/xx/20xx – xx/xx/20xx)

Monthly Inbound Call Wait Time Analysis (xx/xx/20xx – xx/xx/20xx)

The following chart displays the Case Outcomes since February 20xx

The graph below displays the cumulative call analysis for Option Year XX

WCRC – Month, 20xx Monthly Progress Report

Submitted Month, 20xx14, 2014

EXECUTIVE SUMMARY

Contractor XXXXX is pleased to provide this Monthly Progress Report for activity during Month, 20xx for the Workers’ Compensation Review Contractor (WCRC) Contract. In Month, the

WCRC received a total of 5,981 Workers’ Compensation Medicare Set-Aside (WCMSA) receipts, including 1,686 new proposals. This is the highest amount during this option year. The

WCRC submitted 2,336 cases to the Regional Offices (ROs) this month. The average case processing time, including screen and review stages, during the XXXXX reporting period was

1.70 hours per case. The increase in average time is attributed to the low productivity of four new reviewers who are still in training. The Customer Support Center staff provided prompt and thorough assistance to over 1,400 stakeholder phone inquiries. Since July 1, 2012, the WCMSA process has identified approximately $2.5 billion dollars in set-aside recommendations that will protect the Medicare Trust Fund.

Efficiencies and challenges brought on by the combination of Tasks 1 and 2 on July 1, 2013, continued into XXXXX. This change requires a majority of the new receipts to be reviewed and completed within a five-day period. In XXXXX, 76.67% of review deadlines were achieved and

83.99% of all new receipts were screened within the five-day deadline.

FINANCIAL REPORT

As of the beginning of XXXXX, the new Option Year, the WCRC was operating at 10.25% of the estimated budget with 8.33% of the budget year completed

Financial Report

Month, 20xx 2014

Costs incurred Month, 20xx 1, 2014 – Month, 20xx 31, 2014 $764,148

Cumulative costs incurred to date $764,148

Funds remaining in the Task Order $6,500,811

Expenditures that exceed 10% below total contract estimation $0

WCRC TASK ACTIVITIES

Tasks 1 and 2 – Receiving & Evaluating; Procedures for Processing WCMSAs

WCMSA Receipts

New Proposals: New proposals submitted to the Workers’ Compensation Case Control System

(WCCCS) are transferred to the System Name Here (if used) through a nightly file transfer process from the Benefits Coordination & Recovery Center (BCRC). In Month, 20xx, 1,686 new proposals were received, which was a significant increase over any other month since October

2013 (see chart on page 17).

Development Rates and Responses (DREC): The chart on page 17 shows the monthly development rate has decreased significantly over the last three months since the high of

95.71% in November. The WCRC continues to work closely with CMS to make every effort to lower the overall development rate. In Month, 20xx, the WCRC received 309 timely responses to previous development requests. Previously closed cases submitted to the ROs (which reopen to the WCRC in the WCCCS) are now also received through the nightly file transfer process from the BCRC. In Month, 20xx, the WCRC identified 3,956 reopened proposals, which was a significant increase over any other month since Month, 20xx . The majority of this increase was a result of cases reopening that CMS has identified for streamlining.

Re-Review Proposals: The WCRC received 40 re-review requests from ROs for re-evaluation, which was a slight increase from last month of 34. The number of re-review requests has consistently declined since Month, 20xx , from a high of 125 to the lowest of 30 in February

2014.

The graph below displays WCMSA receipts for the month of Month, 20xx, as compared to budgeted amounts where applicable. Notably, the WCRC received 1,686 new proposals in

Month, 20xx, as compared to the budgeted number of 2,500 new proposals. Additionally, 40 re-review proposals were received, as compared to the budgeted number of 200 re-reviews.

The following table displays WCMSA development rate for Option Year Two.

Total Case Review Activity - Monthly

Month New Receipts Total Developed Percentage Developed

Month, 20xx 1,686 678 40.21%*

YTD Total 1,686 678 40.21%

Avg/Month 1,686 678 40.21%

*Total number developed divided by total new receipts

The following table displays WCMSA receipts by month for Option Year Two.

WCMSA Proposal Receipts

YTD for Option Year Two

Month New Proposals Development

Responses

Reopened

Proposals

Re-Review

Proposals

Total

Receipts

Month, 20xx 1,686 309 3,946* 40 5,981

YTD Total 1,686 309 3,946* 40 5,981

Avg/Month 1,686 309 3,946* 40 5,981

*The majority of the reopened reviews are related to the CMS streamlining project currently underway.

WCMSA Proposal Screening

The WCRC received 1,686 new proposals, 1,416 (83.99%) of which were screened within the five-day screening deadline. The root cause of the failure to meet the five-day screening deadline for the new receipts has been an unintended consequence of combining Task 1 and

Task 2. In order to meet the five-day screening standard, a majority of the new receipts would need to be reviewed and completed within a five-day period. With the approval of the proposed modification of moving screening due dates from 5 to 10 it is anticipated that the WCRC will return to timely screening of cases. Additionally, the WCRC continues to analyze staffing and productivity statistics to mitigate this nonconformance and return to processing all of cases within the required SOW timelines.

The following table displays WCMSA proposal screening data by month for Option Year Two.

Month New Proposals New Proposals Screened

Within 5 Days

Percentage

Screened Timely

Month, 20xx 1,686 1,416 83.99%

YTD Total 1,686 1,416 83.99%

WCMSA Proposal Production

In Month, 20xx, a total of 2,336 WCMSA recommendations were submitted to ROs, including re-review recommendations. Additional effort was required to develop a total of 678 proposals. The detailed Month, 20xx 2014 Monthly and Cumulative Statistical Reports are located at the end of this report.

The following chart displays WCMSA proposal outcomes by month for Option Year Two.

WCMSA Proposal Outcomes

Month Proposals

Submitted to ROs

Proposals

Developed Total Outcomes

Month, 20xx 2,336 678 3,014

YTD Total 2,336 678 3,014

Avg/Month 2,336 678 3,014

Task 3 – System Testing & Local Area Network Support

All system testing and maintenance was completed as required by CMS and as outlined in the

System Security Plan to support the program. Required documentation is maintained and available from the System Security Officer upon request. The WCRC continues to assist in the testing of WCCCS enhancements as requested by the MSP IC and directed by CMS.

The WCCCS testing for the Month, 20xx Redbook Contractor pricing was completed and the updated Contractor pricing was installed into production.

Task 4 – Customer Service & Education

Technical Representatives (TRs) were available to provide professional and thorough assistance to stakeholders as outlined in the Statement of Work (SOW). The Technical

Representatives (TRs) handled a variety of inquiries which were focused on case-specific topics. Common inquiries remained the same from last month which included submitter questions regarding development requests and claimant questions regarding letter copies received.

The TRs were able to provide first-call resolution on approximately 98% of calls received, with the remainder elevated to the next appropriate level. Questions were elevated to Review Leads for research as needed through an email ticketing system which assists in timely turnaround of follow-up responses and close monitoring of requests.

The Customer Support Center received a total of 1,736 calls in Month, 20xx, as outlined in the statistical reports on page 15. This call volume represents an average of 79 calls per day, a slight increase from last month of 72. The average number of calls per day has increased over the last 11 months from a low of 48 to the highest of 95 in Month, 20xx.

The Month, 20xx abandoned call rate of 2.1% was well below the internal 5% service level threshold (SLT). This has been the lowest rate since July 2013. The average wait time for abandoned calls also dropped significantly from a little over 4 minutes in February 2014 to 19 seconds in Month, 20xx. The average wait time of 22 seconds met the internal 30 second SLT.

Meeting the internal SLT of a 30 second average wait time continues to be a challenge for the

Customer Support Center during high peak times throughout the day; however, Month, 20xx has had the lowest average wait time since July 2013.

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Total Calls Received by Month

Task 5 – Records Retention Management

All WCRC records are retained indefinitely and according to the retention plan as required by the program’s SOW.

Task 6 – Internal Controls

The goal of the WCRC’s quality assurance (QA) process is to identify strengths and weaknesses of the team as individuals and a group so that preventative or corrective actions can be taken in a timely manner. Ongoing QA activities include one-on-one QA supervision of

Reviewers with demonstrated deficiencies, QA review of a minimum of 5% of new WCMSAs received, and QA Panel review of special interest cases. Across the program, an emphasis is placed on continuous quality improvement (CQI) to ensure that program requirements are met.

The WCRC uses a QA Tool to assess the 5% random sample of the WCRC’s recommendation for new WCMSA proposals. By assessing the presence and/or accuracy of key components of the WCMSA review process, the QA Tool is used to evaluate the quality of WCMSA recommendations and generate a quality score. Any deficiencies identified during the QA review are immediately addressed to ensure that the 98% quality standard is achieved. For the month of Month, 20xx, the average QA score was 99.34%.

The QA Panel convened 13 times in Month, 20xx to review 40 RO requested re-reviews and other special interest cases. At QA Panel meetings, WCRC Subject Matter Experts (SMEs) and experienced team members provide decision-making for complex or high profile cases and program oversight—driving policy revision and development. A detailed log is maintained to analyze QA Panel outcomes and serves to document the significance of this feature of the

WCRC program. The Panel consists of the following WCRC Team Members:

• Marie Templeman, Program Director

• Angela Wolfe, Operations Manager

• George Costantino, Medical Director

• Elliott Cook, Pharmacist

• Jana Finder, Attorney

• George Vorys, Legal SME

• Kaija Blalock, QA Manager/Trainer

• Members of the QA Review Team

During Month, 20xx, the majority of re-review requests (25) continued to be pharmaceutical issues in one or more of the following categories:

1. Requests to remove medication(s)

2. Requests to add a drug (one request)

3. Requests to reduce quantity or change the frequency of a drug

4. Requests to reduce the Contractor pricing of a drug

Re-reviews also included 14 requests to remove, add or reduce the frequency of allocated treatment. Overall, the QA Panel found no Reviewer error in 62.50% of cases re -reviewed in

Month, 20xx.

Task 7 – HIPAA Systems Security & Contractor Privacy Provisions

There has been no activity under Task 7 during the Month, 20xx reporting period.

Task 8 – Administrative Requirements

In Month, 20xx, no PO Box mail or faxes were received. All inquiries received from CMS ROs were researched and responded to within the timelines dictated by the SOW.

Task 9 – Interfaces with CMS Systems & Contractors

There were 76 Problem Reports submitted to the COB&R Help Desk in Month, 20xx and all but

2 have been resolved. The majority of the Problem Reports were due to WCCCS image viewing issues, production errors and the commingle button not functioning. Status updates on pending

Problem Reports are indicated in the table below.

Entry Number Description Status

Entry #7305 Blank pages in the Display Documents window but the can view as a pdf Pending BCRC

Entry #6815 Bookmarks need to be removed. Pending BCRC

Submitted Month, 20xx

Education & Outreach

Previously, the WCRC held a Team-wide training session on 03/27/2014 to review the development process and ensure that only appropriate development occurs. An additional education session was held for 04/03/2014 targeting problem areas identified by the reviewers.

Development rate fell from 46% in March to 40% in Month, 20xx. Additionally, the closure rate fell from 77.69% in March to 39.05%, indicating that more cases are being reviewed following development/receipt of additional cases.

Three new reviewers in training progressed to independent status during Month, 20xx. Several other reviewers have been hired and began the training process in Month, 20xx, one beginning in May. The addition of independent reviewers will assist the WCRC in completing reviews on time.

Meetings & Report Deliverables

CMS and the WCRC held weekly and monthly team meetings as scheduled. The WCRC and

CMS discussed review-related topics at the weekly team meeting, as open communication with

CMS and contract management continues to be a Contractor primary goal of the WCRC.

Notable topics of discussion included the increase in Development Requests, Re-Review

Proposal, WCRC Backlog, Researching of NuQuest Cases, Extension of Screening from 5 to10

Days, Changes to the WCMSA Reference Guide, Backlog of Cases at the WCRC, Cases CMS is considering for a Streamlined Process and Customer Support Center statistics. Detailed information on the topics discussed is documented in the meeting minutes.

PROJECT MILESTONES

The WCRC accomplishments this month include:

• Provided customer support for over 1,400 stakeholder inquiries.

• Completed and submitted to the Regional Offices 2,336 WCMSAs.

• Achieved the quality standard of 99.34% for the average QA score.

• 100% of SOW required non-review deliverables were submitted timely.

• The abandoned call rate of 2.1% exceeded the internal 5% SLT.

• The average wait time of 17 seconds exceeded the internal 30 second SLT.

• Worked with CMS to update the reference guide.

CHALLENGES AND IMPROVEMENTS

During Month, 20xx, reviewers achieved an average of 99.34% accuracy, above the goal of

98% accuracy. Accuracy results ranged from a low of 98.99% during the week of 04/14/14 through 04/18/14 to a high of 99.67% during the weeks of 04/21/14 through 04/25/14. Review errors consisted of the following:

1. Absence of notes in two cases

2. One error in pharmacy Contractor price

3. Incorrect Pharmacy radio button in WCCCS, one case

4. One treatment omission in WCCCS

5. discrepancy regarding frequency of treatment

6. One incorrect Proposed Settlement Date

7. Life Expectancy discrepancy between OROS/WCCCS

8. Decision Rationale not pasted into the WCCCS Note Log

9. Two Seed calculation errors

WCRC Team-wide re- education regarding seed calculation is planned for May.

The WCRC team failed to meet quality assurance goals in two measures during Month, 20xx:

case screening timeliness and case review timeliness. Timely case screening was achieved in

83.99% of cases received, falling short of the goal of 100% timeliness. Timely case review completion rose to 76.67%. Due to the WCRC’s Contractor prior increased development rate, re-opened cases continued to lead to much higher daily numbers of reviews due.

During a WCRC Team-wide meeting on production in Month, 20xx, staff identified a difficulty in reviewing a re-opened case developed by another reviewer. As a result, administrative staff arranged for developed or re-opened cases to be returned to the reviewer who developed the case as often as possible.

During Month, 20xx, the WCRC continued a special interest QA review of developed cases. The

QA Reviewer found that 89.28% of developed cases reviewed were developed appropriately.

ACTION ITEMS FOR MONTH, 20XX 2014

• Continue to work toward compliance with the screening deadline for all new WCMSA proposals.

• Continue to provide efficient IT solutions by working toward improving system functionality, including enhanced reviewer screens, built-in standardized language, and automation of access to policy and calculation of treatment Contractor pricing.

• Continue to review/revise all standard operating procedures aimed toward achieving defensible recommendations.

• Continue to enhance customer service for both internal and external stakeholders.

• CONTRACTOR XXXXX will continue to work with CMS on the streamlining process.

Appropriate Signatory

Title

Monthly Statistical Report (Month, 20xx)

Total Settlement

Amount

Total Proposed

WCMSA

Total WCRC

Recommended

WCMSA

Submitter Medical

Proposed

WCRC Medical

Recommended

Submitter RX

Proposed*

WCRC Rx

Recommended*

Boston 415 163 252 $51,229,130.13 $16,326,117.39 $21,058,329.75 $8,434,657.63 $10,096,610.75 $7,891,459.76 $10,961,719.00 Beginning

(includes adjustments) 7,114

Philadelphia 393 183 210 $43,152,316.49 $20,754,739.94 $24,417,946.67 $9,797,891.40 $10,949,104.53 $10,956,848.54 $13,468,842.14

Chicago 373 217 156 $31,903,506.38 $12,487,851.97 $16,298,071.48 $5,415,227.22 $6,949,550.44 $7,072,624.75 $9,348,521.04

Dallas 252 101 151 $30,243,983.52 $16,888,888.89 $19,193,576.63 $7,390,433.35 $7,704,332.89 $9,498,455.54 $11,489,243.74

San Francisco 765 407 358 $73,240,084.84 $34,425,235.69 $43,553,354.88 $16,384,679.71 $20,561,688.79 $18,040,555.98 $22,991,666.09

Seattle 98 55 43 $8,253,179.57 $2,896,006.87 $3,873,210.79 $1,617,746.86 $2,121,846.79 $1,278,260.01 $1,751,364.00 Minus transfers out by ViPS of unworked cases

Total 2,296 1,126 1,170 $238,022,200.93 $103,778,840.75 $128,394,490.20 $49,040,636.17 $58,383,134.19 $54,738,204.58 $70,011,356.01 Minus cases submitted to

Regions/closed 2,336

$203,437.78 $88,699.86 $109,738.88 $41,915.07 $49,900.11 $46,784.79 $59,838.77 Ending*** 6,464

*For cases received or reopened prior to June 1, 2009, Rx proposed is Rx recommended unless denied liability is alleged and proven.

**Cumulative inventory data includes re-review cases.

***Ending balance includes 631 developed cases and 6,464 cases in an assigned status.

1,686 Plus Receipts from COBC

(April)

Plus new case entries received outside of COBC file transfer

Avg per case:

Monthly Statistical Report (April 2014)

Monetary Data Only for Eligible Cases Submitted to Regions

Region

Total

Cases

Submitted to Regions

Ineligible

Cases

Submitted to Regions

Eligible

Cases

Submitted to Regions

Monthly Inventory Data** as of 4/30/14

Option Year XX Period Statistical Report (xx/xx/20xx – xx/xx/20xx)

Contract Period Statistical Report (xx/xx/20xx – xx/xx/20xx)

Total Proposed

WCMSA

Total WCRC

Recommended

WCMSA

Submitter Medical

Proposed

WCRC Medical

Recommended

Submitter RX

Proposed*

WCRC Rx

Recommended*

Boston 415 163 252 $51,229,130.13 $16,326,117.39 $21,058,329.75 $8,434,657.63 $10,096,610.75 $7,891,459.76 $10,961,719.00 Beginning

(includes adjustments) 7,114

Philadelphia 393 183 210 $43,152,316.49 $20,754,739.94 $24,417,946.67 $9,797,891.40 $10,949,104.53 $10,956,848.54 $13,468,842.14

Chicago 373 217 156 $31,903,506.38 $12,487,851.97 $16,298,071.48 $5,415,227.22 $6,949,550.44 $7,072,624.75 $9,348,521.04

Dallas 252 101 151 $30,243,983.52 $16,888,888.89 $19,193,576.63 $7,390,433.35 $7,704,332.89 $9,498,455.54 $11,489,243.74

San Francisco 765 407 358 $73,240,084.84 $34,425,235.69 $43,553,354.88 $16,384,679.71 $20,561,688.79 $18,040,555.98 $22,991,666.09

Seattle 98 55 43 $8,253,179.57 $2,896,006.87 $3,873,210.79 $1,617,746.86 $2,121,846.79 $1,278,260.01 $1,751,364.00 Minus transfers out by ViPS of unworked cases

Total 2,296 1,126 1,170 $238,022,200.93 $103,778,840.75 $128,394,490.20 $49,040,636.17 $58,383,134.19 $54,738,204.58 $70,011,356.01 Minus cases submitted to

Regions/closed 2,336

$203,437.78 $88,699.86 $109,738.88 $41,915.07 $49,900.11 $46,784.79 $59,838.77 Ending*** 6,464

1,686

Ineligible

Cases

Submitted to Regions

Eligible

Cases

Submitted to Regions

Plus new case entries received outside of COBC file transfer

Avg per case:

Monetary Data Only for Eligible Cases Submitted to Regions

Option Year Inventory Data** as of 4/30/14

Option Year Two Period Statistical Report (4/1/2014 - 3/31/2015)

Region

Total

Cases

Submitted to Regions

Plus Receipts from COBC

(Option Year)

Total Settlement

Amount

Total Proposed

WCMSA

Total WCRC

Recommended

WCMSA

Submitter Medical

Proposed

WCRC Medical

Recommended

Submitter RX

Proposed*

WCRC Rx

Recommended*

Boston 7,536 2,911 4,625 $821,788,890.45 $296,948,483.48 $358,903,630.89 $142,692,095.94 $167,060,558.54 $154,256,387.54 $191,843,082.35 Beginning

(includes adjustments)

Philadelphia 6,764 2,882 3,882 $941,067,539.96 $452,638,463.39 $495,236,801.12 $183,819,065.09 $199,809,318.97 $268,803,398.30 $295,424,482.15

Chicago 7,921 3,913 4,008 $815,442,595.08 $328,054,963.77 $386,976,181.95 $155,701,132.95 $182,901,131.85 $172,353,801.25 $203,942,350.10

Dallas 5,093 1,935 3,158 $687,101,269.51 $327,522,335.07 $368,414,482.06 $128,359,838.37 $144,422,011.54 $199,162,496.70 $223,992,470.52

San Francisco 15,107 7,162 7,945 $1,774,898,506.71 $807,264,693.75 $931,658,359.47 $356,607,844.13 $400,527,740.52 $450,610,965.07 $531,129,573.95

Seattle 1,855 908 947 $209,359,687.86 $73,777,086.34 $88,970,427.78 $38,222,924.45 $43,686,167.17 $35,554,161.89 $45,284,260.61 Minus transfers out by ViPS of unworked cases

Total 44,276 18,585 23,395 $5,249,658,489.57 $2,286,206,025.80 $2,630,159,883.27 $1,005,402,900.93 $1,138,406,928.59 $1,280,741,210.75 $1,491,616,219.68 Minus cases submitted to

Regions/closed 45,817

$224,392.33 $97,721.99 $112,424.02 $42,975.12 $48,660.27 $54,744.23 $63,757.91 Ending*** 6,464

*For cases received or reopened prior to June 1, 2009, Rx proposed is Rx recommended unless denied liability is alleged and proven.

**Cumulative inventory data includes re-review cases.

Cumulative Inventory Data** as of 4/30/14

Plus Receipts from COBC

(Cumulative) 42,192

Avg per case:

Contract Period Statistical Report (7/1/2012 - 4/30/2014)

Region

Total

Cases

Submitted to Regions

Ineligible

Cases

Submitted to Regions

Eligible

Cases

Submitted to Regions

Monetary Data Only for Eligible Cases Submitted to Regions

Plus new case entries received outside of COBC file transfer 1,892

***Ending balance includes 631 developed cases and 6,464 cases in an assigned status.

Monthly RO Requested Re-Review Statistical Report (Month, 20xx)

Total Proposed

WCMSA

Total WCRC

Recommended

WCMSA

Submitter Medical

Proposed

WCRC Medical

Recommended

Submitter RX

Proposed*

WCRC Rx

Recommended*

Boston 4 0 4 $793,713.01 $437,027.00 $878,660.00 $266,726.00 $330,255.00 $170,301.00 $548,405.00

Philadelphia 10 2 8 $1,316,700.34 $553,835.13 $1,366,778.50 $251,901.98 $337,190.50 $301,933.15 $1,029,588.00

Chicago 13 1 12 $2,954,823.83 $1,314,369.96 $2,680,556.76 $386,626.96 $931,347.56 $927,743.00 $1,749,209.20

Dallas 5 2 3 $1,105,298.57 $1,003,302.57 $1,619,718.00 $297,430.87 $435,202.00 $705,871.70 $1,184,516.00

San Francisco 6 0 6 $1,765,945.00 $689,233.16 $1,927,525.00 $467,155.39 $612,224.00 $222,077.77 $1,315,301.00

Seattle 2 0 2 $90,806.00 $59,283.00 $212,067.00 $51,425.00 $66,310.00 $7,858.00 $145,757.00

Total 40 5 35 $8,027,286.75 $4,057,050.82 $8,685,305.26 $1,721,266.20 $2,712,529.06 $2,335,784.62 $5,972,776.20

$229,351.05 $115,915.74 $248,151.58 $49,179.03 $77,500.83 $66,736.70 $170,650.75

Monthly RO Requested Re-Review Statistical Report (April 2014)

Region

Total

Cases

Submitted to Regions

Ineligible

Cases

Submitted to Regions

Eligible

Cases

Submitted to Regions

Monetary Data Only for RO Requested Re-Review Cases Submitted to Regions Cumulative RO Requested

Re-Review Inventory Data as of 4/30/14

Beginning 1,504

Minus submitted to

Regions 1,495

Ending 9

Avg per case:

Option Year XX Period RO Requested Re-Review Statistical Report (xx/xx/20xx – xx/xx/20xx)

Contract Period RO Requested Re-Review Statistical Report (xx/xx/20xx – xx/xx/20xx)

Total Proposed

WCMSA

Total WCRC

Recommended

WCMSA

Submitter Medical

Proposed

WCRC Medical

Recommended

Submitter RX

Proposed*

WCRC Rx

Recommended*

Boston 4 0 4 $793,713.01 $437,027.00 $878,660.00 $266,726.00 $330,255.00 $170,301.00 $548,405.00

Philadelphia 10 2 8 $1,316,700.34 $553,835.13 $1,366,778.50 $251,901.98 $337,190.50 $301,933.15 $1,029,588.00

Chicago 13 1 12 $2,954,823.83 $1,314,369.96 $2,680,556.76 $386,626.96 $931,347.56 $927,743.00 $1,749,209.20

Dallas 5 2 3 $1,105,298.57 $1,003,302.57 $1,619,718.00 $297,430.87 $435,202.00 $705,871.70 $1,184,516.00

San Francisco 6 0 6 $1,765,945.00 $689,233.16 $1,927,525.00 $467,155.39 $612,224.00 $222,077.77 $1,315,301.00

Seattle 2 0 2 $90,806.00 $59,283.00 $212,067.00 $51,425.00 $66,310.00 $7,858.00 $145,757.00

Total 40 5 35 $8,027,286.75 $4,057,050.82 $8,685,305.26 $1,721,266.20 $2,712,529.06 $2,335,784.62 $5,972,776.20

$229,351.05 $115,915.74 $248,151.58 $49,179.03 $77,500.83 $66,736.70 $170,650.75

Minus submitted to

Regions 1,495

Ending 9

Beginning 1,504

Avg per case:

Option Year Two Period RO Requested Re-Review Statistical Report (4/1/2014 - 3/31/2015)

Region

Total

Cases

Submitted to Regions

Ineligible

Cases

Submitted to Regions

Eligible

Cases

Submitted to Regions

Monetary Data Only for RO Requested Re-Review Cases Submitted to Regions Cumulative RO Requested

Re-Review Inventory Data as of 4/30/14

Total Settlement

Amount

Total Proposed

WCMSA

Total WCRC

Recommended

WCMSA

Submitter Medical

Proposed

WCRC Medical

Recommended

Submitter RX

Proposed*

WCRC Rx

Recommended*

Boston 241 5 236 $56,932,927.46 $21,144,772.65 $41,947,857.01 $9,557,329.12 $13,205,569.58 $11,971,145.53 $28,742,287.43

Philadelphia 223 14 209 $56,112,150.02 $27,652,825.77 $44,393,550.77 $12,537,664.33 $15,566,640.01 $15,692,373.44 $28,826,910.76

Chicago 321 5 316 $84,301,633.75 $33,946,951.84 $59,264,350.78 $16,063,679.22 $21,464,866.07 $19,726,324.62 $37,799,484.71

Dallas 190 6 184 $49,946,189.37 $21,060,363.16 $37,167,550.47 $7,211,267.84 $9,100,495.07 $14,000,475.32 $28,067,055.40

San Francisco 461 1 460 $140,875,212.96 $69,157,677.33 $116,464,771.05 $25,771,764.23 $36,867,603.14 $43,422,584.10 $79,597,167.91

Seattle 68 1 67 $17,397,320.66 $5,785,396.17 $12,483,217.63 $2,752,477.05 $6,326,314.48 $3,167,097.12 $6,156,903.15

Total 1504 3 27 $405,565,434.22 $178,747,986.92 $311,721,297.71 $73,894,181.79 $102,531,488.35 $107,980,000.13 $209,189,809.36

$15,020,942.01 $6,620,295.81 $11,545,233.25 $2,736,821.55 $3,797,462.53 $3,999,259.26 $7,747,770.72Avg per case:

Contract Period RO Requested Re-Review Statistical Report (7/1/2012 - 4/30/2014)

Region

Total

Cases

Submitted to Regions

Ineligible

Cases

Submitted to Regions

Eligible

Cases

Submitted to Regions

Monetary Data Only for RO Requested Re-Review Cases Submitted to Regions Cumulative RO Requested

Re-Review Inventory Data as of 4/30/14

Beginning 1,504

Minus submitted to

Regions 1,495

Ending 9

Monthly Inbound Call Analysis (xx/xx/20xx – xx/xx/20xx)

Monthly Inbound Call Wait Time Analysis (xx/xx/20xx – xx/xx/20xx)

The following chart displays the Case Outcomes since February 20xx.

The following table displays WCMSA development rate for Option Year XX.

Total Case Review Activity - Monthly

Month New Receipts Total Developed Percentage Developed

Against New Receipts

Month, 20xx 1540 543 35.26%

Month, 20xx 1686 529 31.38%

Month, 20xx 1780 576 32.36%

Month, 20xx 1597 812 50.85%

Month, 20xx 1794 620 34.56%

Month, 20xx 1395 708 50.75%

Month, 20xx 1843 1388 75.31%

Month, 20xx 1281 1226 95.71%

Month, 20xx 1147 992 86.49%

Month, 20xx 1365 1040 76.19%

Month, 20xx 1370 863 62.99%

Month, 20xx 1510 700 46.36%

YTD Total 18,308 9,997

Avg/Month 1,526 833 56.52%

The following table displays WCMSA receipts by month for Option Year XX.

WCMSA Proposal Receipts

YTD for Option Year One

Month New Proposals Development

Responses

Reopened

Proposals

Re-Review

Proposals

Total

Receipts

Month, 20xx 1,540 294 927 123 2,884

Month, 20xx 1,686 327 872 125 3,010

Month, 20xx 1,780 197 944 67 2,988

Month, 20xx 1,597 353 775 63 2,788

Month, 20xx 1,794 300 768 88 2,950

Month, 20xx 1,395 264 598 70 2,327

Month, 20xx 1,843 471 701 55 3,070

Month, 20xx 1,281 413 850 78 2,622

Month, 20xx 1,147 322 884 51 2,572

Month, 20xx 1,365 237 1,495 46 3,018

Month, 20xx 1,370 298 1,472 30 3,170

Month, 20xx 1,510 244 1,520 34 3,308

YTD Total 18,308 3,720 11,806 830 34,707

Avg/Month 1,526 310 984 69 2,892

The following table displays WCMSA proposal screening data by month for Option Year XX.

Month New Proposals New Proposals Screened

Within 5 Days

Percentage

Screened Timely

Month, 20xx 1,540 1,540 100%

Month, 20xx 1,686 1,686 100%

Month, 20xx 1,780 1,780 100%

Month, 20xx 1,597 1,199 75.08%

Month, 20xx 1,794 430 23.97%

Month, 20xx 1,395 271 19.43%

Month, 20xx 1,843 1,062 57.62%

Month, 20xx 1,281 867 67.68 %

Month, 20xx 1,147 696 60.68 %

Month, 20xx 1,365 576 42.20%

Month, 20xx 1,370 233 17.01%

Month, 20xx 1,510 61 4.04%

YTD Total 18,308 10,401 56%

The following table displays WCMSA proposal outcomes by month for Option Year XX.

WCMSA Proposal Outcomes

Month Proposals

Submitted to ROs

Proposals

Developed Total Outcomes

Month, 20xx 2,986 543 3,529

Month, 20xx 2,749 529 3,278

Month, 20xx 2,152 576 2,728

Month, 20xx 2,340 812 3,152

Month, 20xx 2,542 620 3,162

Month, 20xx 2,149 708 2,857

Month, 20xx 2,631 1,388 4,019

Month, 20xx 2,534 1,226 3,760

Month, 20xx 2,324 992 3,316

Month, 20xx 2,646 1,040 3,686

Month, 20xx 2,371 863 3,234

Month, 20xx 2,570 678 3,248

YTD Total 29,994 12,714 42,669

Avg/Month 2,500 1,060 3,556

The graph below displays the cumulative call analysis for Option Year XX.

SLT SLT