Schedule F - Provider Cost Claims Data Final.XLSX

This is a Schedule F Cost and Claims Data spreadsheet for the 2018 MCSC Vision RFP No. 180000001030, submitted by the Montgomery County Collaborative Services Consortium (MCSC). The document serves as a pricing submission template requiring vendors to provide network reimbursement rate fee schedules for vision care services across two fiscal years (FY16 and FY17). The spreadsheet includes comprehensive procedure codes covering ophthalmological examinations, contact lens services, spectacle lenses, frames, and vision care enhancements. Vendors are instructed to populate reimbursement rates for each procedure code and provide total claims amounts to determine average costs for entry into the pricing matrix (Schedule B). The document also requests vendors to specify the percentage of their members utilizing in-network providers versus out-of-network providers within their Book of Business.

The spreadsheet presents detailed claims data with procedure code descriptions, number of services provided, rate per service, and total claims amounts for both FY16 and FY17. Currently, all rate per service and total claims amount fields are populated with $0.00, indicating this is a blank template awaiting vendor completion. The data encompasses a wide range of vision services with varying service volumes, such as comprehensive ophthalmological examinations (ranging from 454 to 21,147 services annually), spectacle lens options (from single vision to progressive lenses with multiple material indices), contact lens types (PMMA, gas permeable, and hydrophilic), and optional lens enhancements (photochromic tints, anti-reflective coatings, and polycarbonate materials). This pricing framework enables the consortium to evaluate vendor proposals based on historical claims data and establish competitive reimbursement rates for vision care services.