RFP_5800_SLW3034_ATT_4_v1.xlsx

3 MB Posted

Attached to
Worker's Compensation Medical Management Service
Solicitation number
RFP 5800 SLW3034
Issued by
Texas

About this file

Written by GovTribe AI ·

This is a bidder information attachment file related to a Worker's Compensation Medical Management Service contract opportunity for a Texas city. The file contains detailed specifications and requirements for offerors seeking to administer an exclusive 504 Physician Panel while providing workers compensation medical cost containment, case management, pharmacy benefits management, and information systems. The scope of work encompasses comprehensive medical management services designed to optimize cost efficiency and clinical outcomes for the city's workers compensation program. The attachment provides supporting documentation and technical specifications necessary for offerors to prepare competitive proposals.

The file serves as a reference document to establish baseline expectations regarding service delivery standards, network adequacy requirements, reporting capabilities, and operational protocols. It includes specifications for the physician panel structure, medical cost containment methodologies, case management procedures, and pharmacy benefit management approaches that successful offerors must implement. This attachment is essential for prospective bidders to understand the technical and operational requirements of the contract and to ensure their proposals align with the city's specific needs and performance expectations for workers compensation medical management services.

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Other files

File Type Posted
RFP_5800_SLW3034_PAC1_v2.pdf PDF
RFP_5800_SLW3034_PAC2_v1.docx DOCX document
RFP_5800_SLW3033_PAC2_v1.docx DOCX document
RFP_5800_SLW3034_PAC1_v1.pdf PDF
RFP_5800_SLW3034_ATT_3_v1.docx DOCX document
RFP_5800_SLW3034_ATT_1_v1.docx DOCX document
RFP_5800_SLW3034_ATT_2_v1.xlsx XLSX spreadsheet
RFP_5800_SLW3034_ATT_6_v1.xlsx XLSX spreadsheet
RFP_5800_SLW3034_ATT_5_v1.pdf PDF
RFP_5800_SLW3034_0600_v1.xlsx XLSX spreadsheet
RFP_5800_SLW3034_ADD_1_v1.pdf PDF
RFP_5800_SLW3034_0600_v2.xlsx XLSX spreadsheet
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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 .