RFP_5800_SLW3033_ATT_8_v1.xlsx

XLSX spreadsheet 3 MB Posted

Attached to
Worker's Compensation Third Party Administration Service
Solicitation number
RFP 5800 SLW3033
Issued by
Texas

About this file

This file is a workers' compensation claims payment report for the City of Austin, Texas, documenting 2023 fiscal year claim payments across multiple city departments and agencies. The document presents detailed payment data organized by fund codes and agency classifications, along with a sample claims report containing individual claim transactions processed between October and November 2025. The report covers claims spanning multiple City of Austin departments including Emergency Medical Services, Fire Department, Police Department, Austin Energy, Austin Resource Recovery, Public Works, and Aviation, with payment categories including temporary total disability benefits, medical services, death benefits, impairment income benefits, and associated administrative fees.

The grand total of all 2023 claims payments documented in this report is $14,639,579.25, with the largest concentration of payments coded to Fund 1000 at $11,089,621.45 and Agency 8300 (Fire Department) at $6,606,965.68. Individual claim payments range from under $10 to several thousand dollars, covering various service categories such as temporary income benefits, medical examinations, hospital services, pharmacy services, physical therapy, and legal/administrative costs. The claims data reflects actual third-party administration activity including payment processing, claim denials, voided payments, and fee assessments for utilization review and case management services, demonstrating the operational scope of workers' compensation claim management for a major municipal employer.

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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 PDF
RFP_5800_SLW3033_0600_v1.xlsx XLSX spreadsheet
RFP_5800_SLW3033_ATT_9_v1.pdf 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_6_v1.xls XLS 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 PDF
RFP_5800_SLW3033_PAC1_v1.pdf PDF
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 PDF
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Text version

Fund

2023
Row LabelsSum of PayAmt
100011,089,621.45
111010,385.20
41402,726.18
5010513,996.62
5020351,239.38
5030186,229.44
5040484,234.26
506086,579.08
5070292,325.21
50804,653.20
5090124,102.68
510075,434.90
5120768,174.67
512585,509.95
51402,516.18
5150109,608.06
5270986.70
5280253,014.63
543067,271.69
5432857.75
546045,258.42
56103,798.75
7035192.96
705013,101.25
7102177.36
779058,908.82
79603,565.68
100005,108.78
Grand Total14,639,579.25

Agency

2023
Row LabelsSum of PayAmt
1100513,996.62
1500484,234.26
160013,101.25
2200541,034.50
240089,658.70
44003,281.64
46008,034.59
5300123,322.06
56002,516.18
570044,772.00
59007,909.16
600045,258.42
6200826,733.49
630071,457.19
6400986.70
70001,450.99
73005,484.88
750046,107.27
7800261,827.81
8100292,325.21
8200154,124.34
83006,606,965.68
850048,836.80
8600376,310.14
87002,865,619.52
8770(315.35)
910074,406.09
920064,405.65
93001,065,733.46
Grand Total14,639,579.25

Sample report

Prior Claim#Claim #EmpNamePay CatSub CatADJCKTYPEADJCODEStub NotesPayment DescriptionBiller NameTransaction DatePrinted DateCheck#CheckDTPayAmtDate of InjuryORG LVL 0FUNDAGENCYORGInsuredDepartmentSocial Sec#Temporary Income BenefitImpairment Income BenefitTotal IncurredPay From DatePay Through Date
120999999Accidental Falls102ACTVoided payment (VSY)Temporary Total DisabilityAccidental Falls10-03-202510-03-202513095116110-03-2025$ (1,058.00)08-03-2023100093003600100093003600City of Austin0093 - EMERGENCY MEDICAL SERVICESVOIDED - No Duty Status - Active3,174.0009-03-202509-09-2025
120999999Accidental Falls102ACTVoided payment (VSY)Temporary Total DisabilityAccidental Falls10-04-202510-04-202513095116110-04-2025$ (1,058.00)08-04-2023100093003600100093003600City of Austin0093 - EMERGENCY MEDICAL SERVICESVOIDED - No Duty Status - Active3,174.0009-04-202509-10-2025
120999999Accidental Falls102ACTVoided payment (VSY)Temporary Total DisabilityAccidental Falls10-05-202510-05-202513095116110-05-2025$ (1,058.00)08-05-2023100093003600100093003600City of Austin0093 - EMERGENCY MEDICAL SERVICESVOIDED - No Duty Status - Active3,174.0009-05-202509-11-2025
120999999Accidental Falls102ACTVoided payment (VSY)Temporary Total DisabilityAccidental Falls10-06-202510-06-202513095116110-06-2025$ (1,058.00)08-06-2023100093003600100093003600City of Austin0093 - EMERGENCY MEDICAL SERVICESVOIDED - No Duty Status - Active3,174.0009-06-202509-12-2025
13099996Art Collector387System Payment (SYS)Medical Exam-Independent/Agreed (Medical)LAW Practive Chiropracter10-07-202510-07-202513095250910-07-2025$ 350.0008-07-2023100083002100100083002100City of Austin0083 - FIRE DEPARTMENT32,273.0009-07-202509-13-2025
2222222Betty Boop341System Payment (SYS)Freestanding Ambulatory SurgeryCENTRAL PARK New York Surgery10-08-202510-08-202513095250410-08-2025$ 753.5508-08-2023507081006101507081006101City of Austin0081 - AVIATION37,644.7109-08-202509-14-2025
2309878Pelican Brief102ACTSystem Payment (SYS)Temporary Total DisabilityPelican Brief10-09-202510-09-202513095248110-09-2025$ 1,058.0008-09-2023100083002100100083002100City of Austin0083 - FIRE DEPARTMENTNo Duty Status - Active30,780.0009-09-202509-15-2025
3333333Brook Broke Mountain336System Payment (SYS)Medical ClinicsBaley Scott Tissue10-10-202510-10-202513095250210-10-2025$ 223.3708-10-2023100083003302100083003302City of Austin0083 - FIRE DEPARTMENT46,682.6409-10-202509-16-2025
4509999Clair Ide Clair103L40System Payment (SYS)Temporary Partial DisabilityClair Simmons10-11-202510-11-202513095248210-11-2025$ 427.6608-11-2023100087005116100087005116City of Austin0087 - POLICE DEPARTMENT40 Hrs Per Week - Limited Duty Status26,941.1209-11-202509-17-2025
xxx0999Grady Shady301System Payment (SYS)DoctorGeorge Jefferson10-12-202510-12-202513095250710-12-2025$ 318.5408-12-2023100093003110100093003110City of Austin0093 - EMERGENCY MEDICAL SERVICES81,388.3209-12-202509-18-2025
xxx0999Grady Shady301System Payment (SYS)DoctorGeorge Jefferson10-13-202510-13-202513095250710-13-2025$ 318.5408-13-2023100093003110100093003110City of Austin0093 - EMERGENCY MEDICAL SERVICES81,388.3209-13-202509-19-2025
xxx0999Grady Shady301System Payment (SYS)DoctorGeorge Jefferson10-14-202510-14-202513095250710-14-2025$ 318.5408-14-2023100093003110100093003110City of Austin0093 - EMERGENCY MEDICAL SERVICES81,388.3209-14-202509-20-2025
444444Jaime Behind the Counter108System Payment (SYS)Death BenefitsLil Jaime obo Old Jaime10-15-202510-15-202532578410-15-2025$ 393.5008-15-2023100087005201100087005201City of Austin0087 - POLICE DEPARTMENT498,885.1209-15-202509-21-2025
111111Jon the Gutter108System Payment (SYS)Death BenefitsMamie Gutter Downs10-16-202510-16-202532579210-16-2025$ 594.9508-16-2023504015002021504015002021City of Austin0015 - AUSTIN RESOURCE RECOVERY1,078,515.5009-16-202509-22-2025
2x099878Joe CarrierBox306System Payment (SYS)Specialist NECSaint Dans Med Center10-17-202510-17-202513095253110-17-2025$ 41.8208-17-2023501011002213501011002213City of Austin0011 - AUSTIN ENERGY598,149.7009-17-202509-23-2025
2x099878Joe CarrierBox306System Payment (SYS)Specialist NECSaint Dans Med Center10-18-202510-18-202513095253110-18-2025$ 41.8208-18-2023501011002213501011002213City of Austin0011 - AUSTIN ENERGY598,149.7009-18-202509-24-2025
2x099878Joe CarrierBox306System Payment (SYS)Specialist NECSaint Dans Med Center10-19-202510-19-202513095253110-19-2025$ 41.8208-19-2023501011002213501011002213City of Austin0011 - AUSTIN ENERGY598,149.7009-19-202509-25-2025
2x099878Joe CarrierBox388System Payment (SYS)Travel Expense-MedicalProEnamel Inc.10-20-202510-20-202513095252710-20-2025$ 742.4008-20-2023501011002213501011002213City of Austin0011 - AUSTIN ENERGY598,149.7009-20-202509-26-2025
2x099878Joe CarrierBox388System Payment (SYS)Travel Expense-MedicalProEnamelInc.10-21-202510-21-202513095252810-21-2025$ 916.4008-21-2023501011002213501011002213City of Austin0011 - AUSTIN ENERGY598,149.7009-21-202509-27-2025
2x099878Joe CarrierBox646System Payment (SYS)Field Case Management FeeTPA Managed Care Services10-22-202510-22-202532579510-22-2025$ 9.2008-22-2023501011002213501011002213City of Austin0011 - AUSTIN ENERGY598,149.7009-22-202509-28-2025
2x099878Joe CarrierBox646System Payment (SYS)Field Case Management FeeTPA Managed Care Services10-23-202510-23-202532579510-23-2025$ 27.6008-23-2023501011002213501011002213City of Austin0011 - AUSTIN ENERGY598,149.7009-23-202509-29-2025
5555555Juna the LunaPhase102ACTSystem Payment (SYS)Temporary Total DisabilityJuna the LunaPhase10-24-202510-24-202513095249010-24-2025$ 1,242.8208-24-2023512062006070512062006070City of Austin0060 - PUBLIC WORKSNo Duty Status - Active115,647.3709-24-202509-30-2025
5555555Juna the LunaPhase176ACTSystem Payment (SYS)Claimant Legal Expense (Indemnity)Lil Abner Law Officer10-25-202510-25-202513095250310-25-2025$ 414.2808-25-2023512062006070512062006070City of Austin0060 - PUBLIC WORKSAttorney Fees115,647.3709-25-202510-01-2025
8909090909Key Radthelock130System Payment (SYS)Impairment Income Benefits (TX)Key Radthelock10-26-202510-26-202513095249210-26-2025$ 741.0008-26-2023100083002100100083002100City of Austin0083 - FIRE DEPARTMENT111,814.3109-26-202510-02-2025
8909090909Key Radthelock685System Payment (SYS)Peer Review FeeTrend Review Services, Inc10-27-202510-27-202513095252110-27-2025$ 400.0008-27-2023100083004200100083004200City of Austin0083 - FIRE DEPARTMENT46,144.0009-27-202510-03-2025
8888888Kev Chilites648System Payment (SYS)Utilization Review FeeTPA Claims Management Services, Inc10-28-202510-28-202532579410-28-2025$ 103.0008-28-2023100093003600100093003600City of Austin0093 - EMERGENCY MEDICAL SERVICES176,406.0109-28-202510-04-2025
77777777Kristy Brinkley675System Payment (SYS)Defense AttorneyFlat Line Office Latkey10-29-202510-29-202513095252510-29-2025$ 350.0008-29-2023100087005202100087005202City of Austin0087 - POLICE DEPARTMENT70,626.0209-29-202510-05-2025
89076789Lundeny Buckingham308System Payment (SYS)Hospital-OutpatientCOMPLETE BLOOD LOSS10-30-202510-30-202513095250510-30-2025$ 1,021.8808-30-2023100083002100100083002100City of Austin0083 - FIRE DEPARTMENT6,492.3809-30-202510-06-2025
89076789Lundeny Buckingham308System Payment (SYS)Hospital-OutpatientCOMPLETE BLOOD LOSS10-31-202510-31-202513095250510-31-2025$ - 008-31-2023100083002100100083002100City of Austin0083 - FIRE DEPARTMENT6,492.3810-01-202510-07-2025
89076789Lundeny Buckingham335System Payment (SYS)Medical Supplies & EquipmentCOMPLETE BLOOD LOSS11-01-202511-01-202513095250511-01-2025$ - 009-01-2023100083002100100083002100City of Austin0083 - FIRE DEPARTMENT6,492.3810-02-202510-08-2025
89076789Lundeny Buckingham338System Payment (SYS)Freestanding Clinical Lab (Hosp)COMPLETE BLOOD LOSS11-02-202511-02-202513095250511-02-2025$ - 009-02-2023100083002100100083002100City of Austin0083 - FIRE DEPARTMENT6,492.3810-03-202510-09-2025
89076789Lundeny Buckingham358System Payment (SYS)X-Ray/MRI/CT Scan/EMGCOMPLETE BLOOD LOSS11-03-202511-03-202513095250511-03-2025$ 158.3009-03-2023100083002100100083002100City of Austin0083 - FIRE DEPARTMENT6,492.3810-04-202510-10-2025
9999999Robbing Garcent316System Payment (SYS)Physical TherapySan Alamo Bone Crusher11-04-202511-04-202513095252011-04-2025$ 79.4609-04-2023100083002100100083002100City of Austin0083 - FIRE DEPARTMENT102,031.0010-05-202510-11-2025
9999999Robbing Garcent648System Payment (SYS)Utilization Review FeeTPA Claims Management Services, Inc11-05-202511-05-202532579411-05-2025$ 103.0009-05-2023100083002100100083002100City of Austin0083 - FIRE DEPARTMENT102,031.0010-06-202510-12-2025
6666666Stevie Nicks339Refund (REF)AnesthesiologistGhana Anestheis11-06-202511-06-202512685466511-06-2025$ (474.07)09-06-2023100083002100100083002100City of Austin0083 - FIRE DEPARTMENT59,031.7210-07-202510-13-2025

File details come from the government source that posted it. Updated .