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CITY OF AUSTIN
EXHIBIT A - CITY OF AUSTIN ACCOUNT DATA
The following provides historic City of Austin data associated with the services requested in this RFP.
| Claims Administration Services |
| FY23 |
| FY24 |
| FY 25 |
| Incident/Record Only New Claims |
| 368 |
| 459 |
| 532 |
| Incident/Record Only Inventory Claims |
| 0 |
| 0 |
| 0 |
| Medical Only New Claims |
| 1553 |
| 1317 |
| 1104 |
| Medical Only Inventory Claims |
| 890 |
| 616 |
| 418 |
| Indemnity New Claims |
| 479 |
| 311 |
| 311 |
| Indemnity Inventory Claims |
| 533 |
| 532 |
| 686 |
| Fatalities New Claims |
| 3 |
| 2 |
| 0 |
| Fatalities Inventory Claims |
| 22 |
| 22 |
| 22 |
| Hearing Loss New Claims Filed ((# included in I/O; Med & Ind)) |
| 58 |
| 23 |
| 26 |
| Cancer New Claims Filed (# included in I/O; Med & Ind) |
| 15 |
| 12 |
| 6 |
| COVID-19 & Vaccine New Claims Filed (# included in I/O; Med & Ind) |
| 397 |
| 1 |
| 0 |
| Compensability Denials # of PLN-1’s filed (incl in above counts; does not include Exposure Claims) |
| 70 |
| 102 |
| 102 |
| Extent of Injury Disputes # of PLN-11’s filed (incl in above counts; does not include Exposure claims) |
| 132 |
| Exposure Claims |
| 132 |
| 206 |
| 144 |
| Subsequent Injury Funds # of claims referred (# included in I/O; Med & Ind) |
| 5 |
| Benefits Review (BRC) / Pre-hearing Conferences |
| 37 |
| 99 |
| 90 |
| Contested Case Hearings (CCH) |
| 34 |
| 48 |
| 51 |
| Medical Dispute Resolution (MDR) Hearings |
| 0 |
| 3 |
| 3 |
| State Office of Administrative Hearings (SOAH) |
| 0 |
| 0 |
| 0 |
| Compliance & Practices Inquiries |
| 5 |
| 9 |
| Dedicated TCM/CCM -- # of cases referred |
| 350 |
| 327 |
| 146 |
| Field Case Management # of cases referred |
| 3 |
| 0 |
| 10 |
| Vocational Rehab Services # of cases referred |
| 4 |
| 2 |
| 1 |
| Number of Cases Assigned for Surveillance |
| 6 |
| 4 |
| 10 |
Medical Cost Containment Services
| Pharmacy Bill Amounts (without savings) |
| Inc in pharm |
| Inc in pharm |
| Inc in pharm |
| # of Medical Bills Audited |
| 15,514 |
| 18,720 |
| 18,626 |
| # of Reconsiderations |
| 1043 |
| 1002 |
| 1050 |
| Total Billed amounts |
| $23,945,598 |
| $26,449,738 |
| $28,871,738 |
| Recommended Pay Amounts |
| $8,932,416 |
| $8,932,416 |
| $9,399,416 |
| Fee Schedule Savings |
| $14,144,445 |
| $16,678,096 |
| $16,053,844 |
| RX Savings |
| $266,735 |
| $216,456 |
| $243,547.30 |
| Total Savings |
| $14,422,181 |
| $16,894,552 |
| $16,297,391 |
| Medical Bills (CMS 1500) |
| 12,565 |
| # of Pharmacy Bills |
| 3,368 |
| # of Hospital Bills (UB-92) |
| 624 |
| # of Reconsiderations |
| 1,043 |
| 1,002 |
Utilization Review Services
| Pre-Authorization |
| 1,537 |
| 2,157 |
| 1,586 |
| Independent Review Organization (IRO) |
| 0 |
| 0 |
| Required Medical Exam (RME) |
| 10 |
| 20 |
| Designated Doctor Exam (DD) Summary |
| 0 |
| 0 |
| 2 |
| Required Utilization Reviews (RUR) |
| 0 |
| 1 |
| EDI/INDEX BUREAU/MEDICARE QUERIES |
| FY 23 |
| FY 24 |
| FY 25 |
| EDI Medical Bills |
| 16,333 |
| 16,169 |
| EDI Claims—FROI/SROI |
| 3,421/2,747 |
| 3,339/3,320 |
| Index Bureau Records |
| 3,366 |
| 2,180 |
| Medicare Queries |
| 6,557 |
| 8,254 |
| Medicare Claims Reported |
| 19 |
| 28 |
| Medicare Conditional Letters |
| 1 |
| 8 |