Pharmacy_Bills.xlsx
XLSX spreadsheet 2 MB Posted
- Attached to
- WORKERS’ COMPENSATION THIRD PARTY ADMINISTRATION AND MANAGED CARE COST CONTAINMENT SERVICES RFP
- Solicitation number
- 2026-RFP-00430
- Issued by
- San Mateo County, California
About this file
This file contains pharmacy billing data for the County of San Mateo related to a Workers' Compensation Third Party Administration and Managed Care Cost Containment Services RFP. The spreadsheet documents bill types, claim counts, and financial metrics across three fiscal years (2024, 2025, and 2026), tracking charges, reductions, and allowed amounts for pharmacy-related workers' compensation claims. The County, which covers 744 square miles with approximately 800,000 residents across the San Francisco Peninsula and operates with 7,250 employees across 29 departments, manages a self-insured Workers' Compensation Program with approximately 694 open claims (643 indemnity, 36 medical, and 15 first aid/info only). The County is seeking qualified Third-Party Administrators to manage both new and existing workers' compensation claims with a requested staffing structure of 2 dedicated Claims Supervisors, 4 Senior Claims Examiners, 1 Future Medical Claims Examiner, and 2 Assistant Claims Examiners, though flexibility exists for alternative staffing proposals.
The pharmacy billing data demonstrates significant financial activity across the three-year period, with total charges of $1,275,476.22 for 4,153 bills. In 2024, the County processed 1,555 pharmacy bills totaling $462,766.17 in charges with $407,423.68 in allowed amounts. In 2025, activity decreased to 951 bills worth $370,546.25 with $277,555.70 allowed. In 2026, claims increased to 1,647 bills totaling $442,163.80 with $323,105.80 allowed. The County utilizes the Origami Risk Management Information System with data imported and exported through the TPA's workers' compensation information system. The County also contracts with third-party vendors for bill review, utilization review, and nurse case management services, indicating a comprehensive approach to cost containment and managed care oversight.
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Text version
Sheet1
| Bill Type | Pharmacy | |||||
| FY | Count of Bill Id | Sum of Total Charges | Sum of Bill Review Reductions | Sum of Bill Review Allowance | Sum of PPO/Negotiated Reductions | Sum of Allowed Amount |
| 2024 | 1555 | $462,766.17 | $37,599.99 | $425,166.18 | $17,742.50 | $407,423.68 |
| $0.00 | 116 | $34,669.15 | $34,669.15 | $0.00 | $0.00 | $0.00 |
| $7.50 | 1439 | $428,097.02 | $2,930.84 | $425,166.18 | $17,742.50 | $407,423.68 |
| 2025 | 951 | $370,546.25 | $80,021.52 | $290,524.73 | $12,969.03 | $277,555.70 |
| $0.00 | 11 | $943.53 | $943.53 | $0.00 | $0.00 | $0.00 |
| $7.50 | 940 | $369,602.72 | $79,077.99 | $290,524.73 | $12,969.03 | $277,555.70 |
| 2026 | 1647 | $442,163.80 | $110,484.00 | $331,679.80 | $8,574.00 | $323,105.80 |
| $0.00 | 7 | $943.94 | $943.94 | $0.00 | $0.00 | $0.00 |
| $7.50 | 1487 | $419,823.51 | $106,603.46 | $313,220.05 | $8,233.15 | $304,986.90 |
| $8.50 | 153 | $21,396.35 | $2,936.60 | $18,459.75 | $340.85 | $18,118.90 |
| Grand Total | 4153 | $1,275,476.22 | $228,105.51 | $1,047,370.71 | $39,285.53 | $1,008,085.18 |
File details come from the government source that posted it. Updated .