HHSC FINANCIAL STATISTICAL REPORT (FSR) MCO Name: FirstCare Health Plans / SHA State Fiscal Year: 2014 Program: Submission Date: 3/31/2014 Service Area: Submission Type: Quarterly Rptg Period End Date: Part 1: All All 2/28/2014 Administrative Expenses Incurred Months: HHSC Managed Care contract costs 1 Salaries, wages, and benefits (excl. bonuses) 2 Bonuses 3 Rent, Lease, or Mortgage Payment for Office Space 4 Utilities (if not incl. in rent), excl. Phone/Telecom 5 Phone / Telecom / Cell phones / T1 / Broadband 6 Equipment Lease or Rent, excl. Phone/Telecom 7 Computer hardware/Software purch., uncapitalized 8 Furniture, Fixtures, and other Equipment Purchased, uncapitalized 9 Maintenance, Repairs, Custodial, and Security 10 Supplies, Postage, Freight, Printing 11 Legal & Prof. Services, incl. External Audit, Tax, Consulting 12 Travel Expenses 13 Marketing, PR, and Outreach (excl. Salaries) 14 Taxes (excl. income taxes & premium taxes) & Licensing 15 Insurance 16 Depreciation & Amortization 17 Other Adminstrative Expenses 18 Subtotal (specified in-house services) 19 Outsourced services (Non-Capitated Arrangements) 20 Outsourced services (Capitated Arrangements) 21 PBM Admin Fees - Fees based on $PMPM 22 PBM Admin Fees - Fees based on transaction volume 23 PBM Fees - Other 24 Corporate Allocations 25 Total Administrative Expenses Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 $235,527 $252,498 $243,915 $262,168 $394,281 $237,124 8,709 3,963 3,974 4,004 3,748 4,456 4,897 3,138 4,534 5,213 1,560 4,386 168 55,552 27,439 119 33,749 16,718 56 40,399 41,857 104 63,562 25,451 121 34,409 5,000 11 58,998 16,819 13,948 216 106 16,175 215 105 15,702 212 105 14,543 220 106 35,783 255 86 19,117 251 117 346,562 37,281 73,091 171,382 326,680 39,308 72,368 186,214 350,754 39,941 73,102 157,929 375,371 34,041 72,477 169,080 475,243 5,310 70,436 165,611 341,279 1,715 70,355 185,302 1,922,540 $2,550,856 2,023,897 $2,648,467 1,915,652 $2,537,378 1,587,447 $2,238,416 1,785,392 $2,501,992 1,784,064 $2,382,715 616 3,112 9,175 60 2,096 Not Included in Total Administrative Above: 26 Total Administrative Value Added Services Mar-14 Apr-14 May-14 Jun-14 Jul-14 YTD Aug-14 0 0 0 0 0 0 $0 $0 $0 $0 $0 $0 $1,625,513 0 28,854 0 23,728 0 0 0 579 286,669 133,284 0 0 115,268 1,369 625 0 2,215,889 157,596 431,829 1,035,518 0 0 11,018,992 $14,859,824 15,059 Identify outsourced services included in Line 19 "Non-Capitated Arrangements" of this part by 27 vendor and YTD dollar amount. Availity $130,679, Axiom Systems $99, Susana Torres Translations $4,095, Texas Mailhouse $5,309, Cynthia Rowlett $388; Allocation $16,823, Mindy Wiggins $190; Kim Tippen $10; Identify outsourced services included in Line 20 "Capitated Arrangements" of this part by 28 vendor and YTD dollar amount. Magellan $644,808 Note: Unless an item is specifically stated otherwise, reporting of all amounts in the Admin expenses FSR is on an incurred basis (that is, reported in the period corresponding to dates the services were incurred, rather than to date paid). All prior quarters' data must be updated to reflect the most recent actuals. Part 1 Administrative Expenses 4/24/2014
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