RFP_5800_SLW3033_ATT_6_v1.xls
XLS spreadsheet 190 KB Posted
- Solicitation number
- RFP 5800 SLW3033
- Issued by
- Texas
About this file
This is a workers' compensation claims management report for the City of Austin for the fiscal year October 2024 through September 2025. The document presents monthly data tracking new claims opened on the system, inventory of open claims, claim counts by adjuster, total payments, reserves, case management activity, disputes, Department of Workers' Compensation hearings and administrative activity, sub-contractor reporting, medical cost containment services, and utilization management summaries. The report covers claim categories including Incident Only, Medical Only, Indemnity, Fatalities, COVID-19, and Hearing Loss claims, with detailed monthly breakdowns from October 2024 through September 2025 and comparative data for fiscal years 2025, 2026, and 2027.
The report documents significant financial activity across multiple claim types, including indemnity payments ranging from approximately $185,000 to $299,000 monthly and medical payments varying from approximately $288,000 to $569,000 monthly. Medical cost containment services generated substantial savings, with monthly totals ranging from approximately $459,000 to $1.8 million in fee schedule and prescription savings. The claims inventory remained relatively stable, averaging between 788 and 926 total open claims monthly. Utilization management activities included pre-authorizations, peer reviews, and bill audits, with monthly bill audits ranging from 732 to 2,031. The data indicates active administration of workers' compensation claims with comprehensive tracking of reserves, dispute management, and cost containment efforts throughout the fiscal year.
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Other files
| File | Type | Posted |
|---|---|---|
| RFP_5800_SLW3033_ATT_4_v1.docx | DOCX document | |
| CSP_6100_CLMB344_BID_DOC_5_v1.pdf | ||
| RFP_5800_SLW3033_0600_v1.xlsx | XLSX spreadsheet | |
| RFP_5800_SLW3033_ATT_9_v1.pdf | ||
| RFP_5800_SLW3033_ATT_3_v1.xlsx | XLSX spreadsheet | |
| RFP_5800_SLW3033_PAC2_v1.docx | DOCX document | |
| RFP_5800_SLW3033_ATT_10_v1.xlsx | XLSX spreadsheet | |
| RFP_5800_SLW3033_ATT_12_v1.xlsx | XLSX spreadsheet | |
| RFP_5800_SLW3033_ATT_11_v1.xlsx | XLSX spreadsheet | |
| RFP_5800_SLW3033_ATT_2_v1.xlsx | XLSX spreadsheet | |
| RFP_5800_SLW3033_ATT_5_v1.xlsx | XLSX spreadsheet | |
| RFP_5800_SLW3033_ADD_1_v1.pdf | ||
| RFP_5800_SLW3033_PAC1_v1.pdf | ||
| RFP_5800_SLW3033_ATT_8_v1.xlsx | XLSX spreadsheet | |
| RFP_5800_SLW3033_0600_v2.xlsx | XLSX spreadsheet | |
| RFP_5800_SLW3033_ATT_7_v1.xlsx | XLSX spreadsheet | |
| RFP_5800_SLW3033_ATT_1_v1.docx | DOCX document | |
| RFP_5800_SLW3033_PAC1_v2.pdf |
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Text version
FY19
| City of Austin | beginning mo for current FY | 10/1/14 | 9/30/14 | ||||||||||||||||||||||||||||||||
| Executive Summary | Fiscal Year: October 2024 - September 2025 | For the Month: | October 2024 | leap year adjj chng formula in 2013 | 2/29/12 | ||||||||||||||||||||||||||||||
| Contract Year: | October 2024 | ||||||||||||||||||||||||||||||||||
| New Claims Opened on the System during the Month | Date adjustment table | ||||||||||||||||||||||||||||||||||
| Claim Type | Oct-24 | Nov-24 | Dec-24 | Jan-25 | Feb-25 | Mar-25 | Apr-25 | May-25 | Jun-25 | Jul-25 | Aug-25 | Sep-25 | FY25 | FY26 | FY27 | 1 | January | 31 | 31 | ||||||||||||||||
| New Claims Opened on the System during the MonthIncident Only | Incident Only | 2 | february | 31 | 28 | 64 | 41 | 59 | 55 | 75 | 80 | 62 | 78 | 76 | 78 | 59 | 70 | ||||||||||||||||||
| New Claims Opened on the System during the MonthMedical Only | Medical Only | 3 | March | 28 | 31 | 81 | 87 | 76 | 88 | 84 | 124 | 105 | 123 | 126 | 128 | 102 | 99 | ||||||||||||||||||
| New Claims Opened on the System during the MonthIndemnity | Indemnity | 4 | April | 31 | 30 | 17 | 25 | 24 | 12 | 27 | 25 | 30 | 35 | 33 | 24 | 31 | 24 | ||||||||||||||||||
| New Claims Opened on the System during the MonthFatalities | Fatalities | 5 | May | 30 | 31 | - 0 | - 0 | - 0 | - 0 | - 0 | - 0 | - 0 | 1 | - 0 | - 0 | - 0 | - 0 | ||||||||||||||||||
| COVID-19 | |||||||||||||||||||||||||||||||||||
| Hearing Loss | |||||||||||||||||||||||||||||||||||
| Tot | 6 | June | 31 | 30 | 162 | 153 | 159 | 155 | 186 | 229 | 197 | 237 | 235 | 230 | 192 | 193 | |||||||||||||||||||
| 7 | July | 30 | 31 | ||||||||||||||||||||||||||||||||
| Inventory Claims (as of the end of the month) | 8 | August | 31 | 31 | |||||||||||||||||||||||||||||||
| Claim Type | Oct-24 | Nov-24 | Dec-24 | Jan-25 | Feb-25 | Mar-25 | Apr-25 | May-25 | Jun-25 | Jul-25 | Aug-25 | Sep-25 | FY25 | FY26 | FY27 | 1 | January | 31 | 31 | ||||||||||||||||
| Inventory Claims (as of the end of the month)Incident Only | Incident Only | 10 | October | 30 | 31 | - 0 | 1 | 0 | 0 | 0 | 5 | 0 | 5 | 1 | 1 | 19 | 5 | ||||||||||||||||||
| Inventory Claims (as of the end of the month)Medical Only | Medical Only | 11 | November | 31 | 30 | 454 | 446 | 417 | 453 | 417 | 455 | 429 | 467 | 486 | 516 | 456 | 484 | ||||||||||||||||||
| Inventory Claims (as of the end of the month)Indemnity | Indemnity | 12 | December | 30 | 31 | 346 | 357 | 368 | 373 | 357 | 348 | 352 | 377 | 335 | 330 | 401 | 422 | ||||||||||||||||||
| Fatalities | |||||||||||||||||||||||||||||||||||
| COVID-19 | |||||||||||||||||||||||||||||||||||
| Hearing Loss | |||||||||||||||||||||||||||||||||||
| Med Mgmt | |||||||||||||||||||||||||||||||||||
| Total | 814 | 818 | 799 | 840 | 788 | 822 | 795 | 864 | 837 | 862 | 891 | 926 | |||||||||||||||||||||||
| Claim Count by Adjuster (as of the end of the month) | |||||||||||||||||||||||||||||||||||
| Adjuster | Oct-24 | Nov-24 | Dec-24 | Jan-25 | Feb-25 | Mar-25 | Apr-25 | May-25 | Jun-25 | Jul-25 | Aug-25 | Sep-25 | FY25 | FY26 | FY27 | ||||||||||||||||||||
| Claim Count by Adjuster (as of the end of the month)Sisneros | Med Only | ||||||||||||||||||||||||||||||||||
| Claim Count by Adjuster (as of the end of the month)Hernandez | CAT | ||||||||||||||||||||||||||||||||||
| Claim Count by Adjuster (as of the end of the month)Sachse | Senior 1 | ||||||||||||||||||||||||||||||||||
| Non Senior 1 | |||||||||||||||||||||||||||||||||||
| Non Senior 2 | |||||||||||||||||||||||||||||||||||
| Non Senior 3 | |||||||||||||||||||||||||||||||||||
| Asst Team Lead | |||||||||||||||||||||||||||||||||||
| COVID-19 | |||||||||||||||||||||||||||||||||||
| Claim Count by Adjuster (as of the end of the month)Incident Only | Incident Only | ||||||||||||||||||||||||||||||||||
| Total | |||||||||||||||||||||||||||||||||||
| Payments | |||||||||||||||||||||||||||||||||||
| Type | Oct-24 | Nov-24 | Dec-24 | Jan-25 | Feb-25 | Mar-25 | Apr-25 | May-25 | Jun-25 | Jul-25 | Aug-25 | Sep-25 | FY25 | FY26 | FY27 | ||||||||||||||||||||
| PaymentsIndemnity | Indemnity | $ 207,018.08 | $ 197,025.96 | $ 185,144.86 | $ 225,534.23 | $ 228,260.65 | $ 238,448.00 | $ 231,213.47 | $ 274,926.93 | $ 268,253.04 | $ 225,923.88 | $ 299,850.17 | $ 259,746.23 | ||||||||||||||||||||||
| PaymentsMedical | Medical | $ 302,907.63 | $ 569,684.89 | $ 352,230.23 | $ 343,664.28 | $ 545,265.45 | $ 492,432.48 | $ 324,882.75 | $ 481,220.10 | $ 486,823.74 | $ 453,390.44 | $ 295,831.49 | $ 288,435.88 | ||||||||||||||||||||||
| Hearing Loss | |||||||||||||||||||||||||||||||||||
| COVID-19 | |||||||||||||||||||||||||||||||||||
| PaymentsDisbursements | Disbursements | $ 1,348.32 | $ 453.59 | $ 1,085.89 | $ 484.61 | $ 3,869.65 | $ 2,978.26 | $ 1,330.19 | $ 12,491.77 | $ 70.45 | $ 935.31 | $ 1,270.98 | $ 1,186.12 | ||||||||||||||||||||||
| PaymentsLegal | Legal | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ 2,550.00 | $ - 0 | $ - 0 | $ - 0 | ||||||||||||||||||||||
| PaymentsAllocated Exp | Allocated Exp | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ 61.20 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ||||||||||||||||||||||
| Total | |||||||||||||||||||||||||||||||||||
| Total Reserves - All Open Claims | |||||||||||||||||||||||||||||||||||
| Oct-24 | Nov-24 | Dec-24 | Jan-25 | Feb-25 | Mar-25 | Apr-25 | May-25 | Jun-25 | Jul-25 | Aug-25 | Sep-25 | FY25 | FY26 | FY27 | |||||||||||||||||||||
| Total Reserves - All Open ClaimsIndemnity | Indemnity | ||||||||||||||||||||||||||||||||||
| Total Reserves - All Open ClaimsMedical | Medical | ||||||||||||||||||||||||||||||||||
| Hearing Loss | |||||||||||||||||||||||||||||||||||
| COVID-19 | |||||||||||||||||||||||||||||||||||
| Total Reserves - All Open ClaimsLegal | Legal | ||||||||||||||||||||||||||||||||||
| Total Reserves - All Open ClaimsOther | Other | ||||||||||||||||||||||||||||||||||
| Total | |||||||||||||||||||||||||||||||||||
| Total Reserves - All New Claims | |||||||||||||||||||||||||||||||||||
| Oct-24 | Nov-24 | Dec-24 | Jan-25 | Feb-25 | Mar-25 | Apr-25 | May-25 | Jun-25 | Jul-25 | Aug-25 | Sep-25 | FY25 | FY26 | FY27 | |||||||||||||||||||||
| Total Reserves - All New ClaimsIndemnity | Indemnity | ||||||||||||||||||||||||||||||||||
| Total Reserves - All New ClaimsMedical | Medical | ||||||||||||||||||||||||||||||||||
| Hearing Loss | |||||||||||||||||||||||||||||||||||
| Total Reserves - All New ClaimsLegal | Legal | ||||||||||||||||||||||||||||||||||
| Total Reserves - All New ClaimsOther | Other | ||||||||||||||||||||||||||||||||||
| Total | |||||||||||||||||||||||||||||||||||
| Case Management Activity | |||||||||||||||||||||||||||||||||||
| Oct-24 | Nov-24 | Dec-24 | Jan-25 | Feb-25 | Mar-25 | Apr-25 | May-25 | Jun-25 | Jul-25 | Aug-25 | Sep-25 | FY25 | FY26 | FY27 | |||||||||||||||||||||
| Case Management ActivityMCM | TCM | 1 | 1 | 2 | 2 | - 0 | - 0 | - 0 | - 0 | - 0 | - 0 | - 0 | - 0 | ||||||||||||||||||||||
| FCM | |||||||||||||||||||||||||||||||||||
| Case Management ActivityVCM | VCM | - 0 | - 0 | - 0 | - 0 | - 0 | - 0 | - 0 | - 0 | - 0 | - 0 | - 0 | - 0 | ||||||||||||||||||||||
| Number of Disputes | |||||||||||||||||||||||||||||||||||
| Oct-24 | Nov-24 | Dec-24 | Jan-25 | Feb-25 | Mar-25 | Apr-25 | May-25 | Jun-25 | Jul-25 | Aug-25 | Sep-25 | FY25 | FY26 | FY27 | |||||||||||||||||||||
| Number of DisputesFull | Denial | 18 | 18 | 28 | 17 | 25 | 31 | 20 | 15 | 11 | 27 | 36 | 21 | ||||||||||||||||||||||
| Number of DisputesExposure | Exposure | 9 | 6 | 21 | 12 | 14 | 24 | 9 | 13 | 14 | 16 | 15 | 18 | ||||||||||||||||||||||
| Extent | |||||||||||||||||||||||||||||||||||
| Number of Disputes60 day | Rescinded | 50 | 51 | 43 | 50 | 54 | 35 | 38 | 34 | 40 | 75 | 74 | 12 | ||||||||||||||||||||||
| DWC Hearings and Administrative Activity | |||||||||||||||||||||||||||||||||||
| Oct-24 | Nov-24 | Dec-24 | Jan-25 | Feb-25 | Mar-25 | Apr-25 | May-25 | Jun-25 | Jul-25 | Aug-25 | Sep-25 | FY25 | FY26 | FY27 | |||||||||||||||||||||
| DWC Hearings and Administrative ActivityBRC | BRC | 6 | 1 | 2 | 4 | 4 | 3 | 2 | 1 | 10 | 0 | 0 | 3 | ||||||||||||||||||||||
| DWC Hearings and Administrative ActivityCCH | CCH | 1 | 1 | 1 | 2 | 1 | 0 | 1 | 0 | 1 | 1 | 0 | 0 | ||||||||||||||||||||||
| DWC Hearings and Administrative ActivityAPPEAL | APPEAL | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||||||||||||||||||||||
| DWC Hearings and Administrative ActivityIRO | IRO | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | ||||||||||||||||||||||
| DWC Hearings and Administrative ActivityMDR | MDR | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | ||||||||||||||||||||||
| Comp Corres | |||||||||||||||||||||||||||||||||||
| DWC Hearings and Administrative ActivityComp Corres | General Corres | 0 | 0 | 0 | 0 | 1 | 1 | 0 | 1 | 0 | 2 | 1 | 0 | ||||||||||||||||||||||
| DWC Hearings and Administrative ActivityGeneral Corres | General Corres | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||||||
| 5 | May | Apr - Jun | Jan - Mar | Oct - Dec | Jul - Sep | ||||||||||||||||||||||||||||||
| Sub-Contractor Reporting (by contract year) | 6 | June | Apr - Jun | Jan - Mar | Oct - Dec | Jul - Sep | |||||||||||||||||||||||||||||
| Oct-24 | Nov-24 | Dec-24 | Jan-25 | Feb-25 | Mar-25 | Apr-25 | May-25 | Jun-25 | Jul-25 | Aug-25 | Sep-25 | FY25 | FY26 | FY27 | Remaining | ||||||||||||||||||||
| Balance | 7 | July | Jul - Sep | Apr - Jun | Jan - Mar | Oct - Dec | |||||||||||||||||||||||||||||
| Sub-Contractor Reporting (by contract year)Preauthorization | Preauthorization | 8 | August | Jul - Sep | Apr - Jun | Jan - Mar | Oct - Dec | ||||||||||||||||||||||||||||
| Bill Review | |||||||||||||||||||||||||||||||||||
| Sub-Contractor Reporting (by contract year)CM | CM | 9 | September | Jul - Sep | Apr - Jun | Jan - Mar | Oct - Dec | ||||||||||||||||||||||||||||
| Sub-Contractor Reporting (by contract year)RUR | RUR | 11 | November | Oct - Dec | Jul - Sep | Apr - Jun | Jan - Mar | ||||||||||||||||||||||||||||
| Sub-Contractor Reporting (by contract year)Peer Review/RME/DD | Peer Review/RME/DD | 12 | December | Oct - Dec | Jul - Sep | Apr - Jun | Jan - Mar | ||||||||||||||||||||||||||||
| Sub-Contractor Reporting (by contract year)Total | Total | ||||||||||||||||||||||||||||||||||
| Medical Cost Containment Services | |||||||||||||||||||||||||||||||||||
| Oct-24 | Nov-24 | Dec-24 | Jan-25 | Feb-25 | Mar-25 | Apr-25 | May-25 | Jun-25 | Jul-25 | Aug-25 | Sep-25 | FY25 | FY26 | FY27 | |||||||||||||||||||||
| Medical Cost Containment Services# of Bills Audited | # of Bills Audited | 1,087 | 1,749 | 1,264 | 1,146 | 1,591 | 1,558 | 1,183 | 1,509 | 2,031 | 1,252 | 732 | 1,397 | ||||||||||||||||||||||
| Medical Cost Containment Services# of recons | # of recons | 82 | 83 | 83 | 109 | 84 | 48 | 15 | 37 | 91 | 49 | 70 | - 0 | ||||||||||||||||||||||
| Medical Cost Containment ServicesTotal Billed | Total Billed | $ 905,133.63 | $ 1,466,905.29 | $ 776,705.49 | $ 835,573.28 | $ 1,537,867.14 | $ 1,404,170.72 | $ 777,187.75 | $ 1,631,931.70 | $ 2,491,433.67 | $ 1,280,237.00 | $ 1,150,839.09 | $ 1,285,190.13 | ||||||||||||||||||||||
| Medical Cost Containment ServicesRec pay amt | Rec pay amt | $ 378,048.94 | 532,312.01 | 352,648.97 | 353,859.88 | 541,684.42 | 495,602.02 | 324,430.85 | 495,375.28 | 655,640.25 | 379,816.51 | 288,976.91 | 332,580.18 | ||||||||||||||||||||||
| Medical Cost Containment ServicesFee Schedule Savings | Fee Schedule Savings | $ 527,084.69 | $ 934,593.28 | $ 424,056.52 | $ 481,713.40 | $ 996,182.71 | $ 908,568.70 | $ 452,756.90 | $ 1,136,556.42 | $ 1,835,793.40 | $ 900,420.49 | $ 861,862.18 | $ 952,609.95 | ||||||||||||||||||||||
| Medical Cost Containment ServicesRX Savings | RX Savings | $ 32,425.02 | $ 45,480.89 | $ 35,006.08 | $ 23,458.28 | $ 36,545.00 | $ 30,778.47 | $ 36,543.62 | $ 33,708.53 | $ 32,292.50 | $ 40,858.66 | 34,296.50 | $ 32,338.51 | ||||||||||||||||||||||
| Medical Cost Containment ServicesTotal Savings | Total Savings | $ 559,509.71 | $ 980,074.17 | $ 459,062.60 | $ 505,171.68 | $ 1,032,727.71 | $ 939,347.17 | $ 489,300.52 | $ 1,170,264.95 | $ 1,868,085.90 | $ 941,279.15 | $ 896,158.68 | $ 984,948.46 | ||||||||||||||||||||||
| Cypress Care savings is not taken out of total billed amount since the bills are paid at 100% submitted. Savings are taken at the point-of-sale or processing of the paper bill. | |||||||||||||||||||||||||||||||||||
| The total paid amount in this section will not tie back to the payment information in the earlier section because it is taken from the audited monthly financial report and this amount is retrieved from a snapshot report. | |||||||||||||||||||||||||||||||||||
| Utilization Management Summary | |||||||||||||||||||||||||||||||||||
| Oct-24 | Nov-24 | Dec-24 | Jan-25 | Feb-25 | Mar-25 | Apr-25 | May-25 | Jun-25 | Jul-25 | Aug-25 | Sep-25 | FY25 | FY26 | FY27 | |||||||||||||||||||||
| Utilization Management SummaryRME | RME | 1 | 1 | 2 | 2 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | ||||||||||||||||||||||
| Utilization Management SummaryPeer Rvw / ECA | Peer Rvw / ECA | 12 | 26 | 9 | 17 | 11 | 25 | 30 | 28 | 23 | 20 | 18 | 4 | ||||||||||||||||||||||
| RUR | |||||||||||||||||||||||||||||||||||
| Utilization Management SummaryDD | DD | 1 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||||||||||||||||||||||
| Utilization Management SummaryPre-Auths Approved | Pre-Auths Approved | 75 | 68 | 85 | 93 | 91 | 100 | 74 | 112 | 102 | 100 | 84 | 91 | ||||||||||||||||||||||
| Utilization Management SummaryPre-Auths Denied | Pre-Auths Denied | 5 | 7 | 6 | 15 | 2 | 3 | 6 | 6 | 5 | 12 | 8 | 6 | ||||||||||||||||||||||
| Utilization Management SummaryDN | DN | 62 | 63 | 73 | 52 | 52 | 55 | 70 | 66 | 75 | 61 | 64 | 62 | ||||||||||||||||||||||
| CMS Reporting | |||||||||||||||||||||||||||||||||||
| Q1 | Q2 | Q3 | Q4 | CY2025 | CY2026 | CY2027 | |||||||||||||||||||||||||||||
| Query | |||||||||||||||||||||||||||||||||||
| Claims Rpt'd |
&C&"Arial,Bold"&12 RFP - BCR
EXHIBIT 2
&C &R&"Arial,Bold"&9Page &P of &N
Reserve Changes and IR
| Reserve Changes over $20,000.00 | |||||||
| Date | Dept | Claim No | Employee Name | DOI | Ind Res Change | Med Res Change | Explanation |
| Impairment Ratings | |||||||
| Date | Dept | Claim No | Employee Name | DOI | Impairment % | Explanation |
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