RFP_5800_SLW3033_ATT_1_v1.docx

This document is Exhibit A to an RFP issued by the City of Austin, Texas for Workers' Compensation Third Party Administration Services. The exhibit provides historical performance data for the City's workers' compensation claims administration operations spanning fiscal years 2023 through 2025. The data encompasses claims administration services including new claims, inventory claims, and various claim types such as medical-only, indemnity, fatalities, hearing loss, and cancer claims. In FY25, the City projects 532 new incident/record-only claims, 1,104 new medical-only claims, and 311 new indemnity claims, along with 22 fatality inventory claims. The claims administration scope includes dispute resolution services, with projected FY25 activity including 90 benefits review conferences, 51 contested case hearings, and 3 medical dispute resolution hearings. Additionally, the City anticipates referring 146 cases for dedicated case management and 10 cases for field case management services in FY25.

The exhibit documents significant medical cost containment activity, with 18,626 medical bills audited in FY25 resulting in total billed amounts of $28,871,738 and recommended pay amounts of $9,399,416, generating fee schedule savings of $16,053,844 and pharmacy savings of $243,547.30 for total savings of $16,297,391. Utilization review services include pre-authorizations (1,586 projected in FY25), peer reviews, required medical exams, and designated doctor exams. The data also reflects EDI medical bill processing, claims reporting to the Index Bureau, and Medicare coordination activities, with 8,254 Medicare queries and 28 Medicare claims reported projected for FY25. This historical performance data establishes the baseline volume and complexity of services required under the RFP and provides bidders with essential information regarding the scope and scale of the third-party administration engagement.