DEAND\50000.10103\50162926.1
WC PROGRAM TEAM
COMPENSATION CHANGES
(FY 19 THRU FY 25)
FY 25 CHANGES
INCREASES IN RED
DECREASES IN BLUE
ADMINSURE
COMP ITEM FY 19 FY 20 FY 21 FY 22 FY 23 FY 24 FY 25
Flat Fee $222,000 $222,000 $226,440 $230,968.80 $235,624.20 $240,300 $247,509 ANNUAL INCREASE ALLOWED: LESSER OF CPI OR 2%; 3% BEGINNING FY 26
LIEN ON ME
COMP ITEM FY 19 FY 20 FY 21 FY 22 FY 23 FY 24 FY 25
Routine Bill Fee $6 $6 $6 $6 $6 $6 $6.12
Hospital Bill Fee 5% Savings
$5K Cap
5%
Savings
$5K Cap
5%
Savings
$5K Cap
5%
Savings
$5K Cap
5%
Savings
$5K Cap
5%
Savings
$5K Cap
5%
Savings
$5.5K Cap
Non-Blue Cross PPO
Bills
21%
Savings
21%
Savings
21%
Savings
21%
Savings
21%
Savings
21%
Savings
21.2%
Savings
Blue Cross PPO Bills 24%
Savings
24%
Savings
24%
Savings
24%
Savings
24%
Savings
24%
Savings
24.5%
Savings
PPA Bills
10%
Savings
$7,500K
Cap
10%
Savings
$7,500K
Cap
10%
Savings
$7,500K
Cap
10%
Savings
$7,500K
Cap
10%
Savings
$7,500K
Cap
10%
Savings
$7,500K
Cap
10.2%
Savings
$7,500K
Cap
Appearances &
Testimony Free Free Free Free Free Free Free
Duplicates &
Reconsiderations Free Free Free Free Free Free Free
Lien Defense Fee
25%
Savings
$5K Cap
$125 Min
25%
Savings
$5K Cap
$125 Min
25%
Savings
$5K Cap
$125 Min
25%
Savings
$5K Cap
$125 Min
25%
Savings
$5K Cap
$125 Min
25%
Savings
$5K Cap
$125 Min
25%
Savings
$5K Cap
$125 Min
ANNUAL INCREASE ALLOWED: LESSER OF CPI OR 2% (Routine Bill Fee Only) DEAND\50000.10103\50162926.1
GENEX (FKA EXCEL)
COMP ITEM FY 19 FY 20 FY 21 FY 22 FY 23 FY 24 FY 25
UR Fee
RN
$79/ea
Phys
$215/ea
RN
$79/ea
Phys
$215/ea
RN
$79/ea
Phys
$215/ea
RN
$79/ea
Phys
$215/ea
RN
$79/ea
Phys
$215/ea
RN
$79/ea
Phys
$215/ea
RN
$79/ea
Phys
$215/ea
Nurse CM Fee Tel = $90/hr
Field = $95/hr
Tel = $90/hr
Field =$95/hr
Tel or Field
$96.90/hr
Tel or Field
$96.90/hr
Tel or Field
$96.90/hr
Tel or Field
$96.90/hr
Tel or Field
$98.90/hr
RTW Fee Tel
$105/hr
Tel
$105/hr
Tel
$105/hr
Tel
$105/hr
Tel
$105/hr
Tel
$105/hr
Tel
$105/hr
ANNUAL INCREASE ALLOWED: LESSER OF CPI OR 2%
MYMATRIXX
COMP ITEM FY 19 FY 20 FY 21 FY 22 FY 23 FY 24 FY 25
Pharmacy cards
✓ Formulary management
✓ Automated/ customized billing
✓ 24/7/365 customer service
✓ Paper bill review
✓ Web portal access (unlimited)
✓ Pharmacy BMreports
✓ Compliance w/ State Reporting
✓ New program implementation
✓ Training
Free Free Free Free Free Free Free
Retail Pharmacy Network:
Prescription Fill
Brands
AWP12%
+ $3 DF
Generic
AWP45%
+ $3 DF
Brands
AWP12%
+ $3 DF
Generic
AWP45%
+ $3 DF
Brands
AWP12%
+ $3 DF
Generic
AWP45%
+ $3 DF
Brands
AWP12%
+ $3 DF
Generic
AWP45%
+ $3 DF
Brands
AWP12%
+ $3 DF
Generic
AWP45%
+ $3 DF
Brands
AWP12%
+ $3 DF
Generic
AWP45%
+ $3 DF
Brands
AWP17%
+$3 DF
Generic
AWP80%
+ $3 DF
Mail Service Pharmacy:
Prescription Fill
Brands
AWP14%
+ $1 DF
Generic
AWP50%
+ $1 DF
Brands
AWP14%
+ $1 DF
Generic
AWP50%
+ $1 DF
Brands
AWP14%
+ $1 DF
Generic
AWP50%
+ $1 DF
Brands
AWP14%
+ $1 DF
Generic
AWP50%
+ $1 DF
Brands
AWP14%
+ $1 DF
Generic
AWP50%
+ $1 DF
Brands
AWP14%
+ $1 DF
Generic
AWP50%
+ $1 DF
Brands
AWP19%
+$1 DF
Generic
AWP82%
+ $1 DF
Clinical Pharmacy Program
Drug
Regimen
Review
$150/hr
(3 hr min)
One
Drug
Review
$250 flat
Consul
w/
Pharm
$250 flat
Drug
Regimen
Review
$150/hr
(3 hr min)
One
Drug
Review
$250 flat
Consul
w/
Pharm
$250 flat
Drug
Regimen
Review
$153/hr
(3 hr min)
One
Drug
Review
$255 flat
Consul
w/
Pharm
$255 flat
Drug
Regimen
Review
$153/hr
(3 hr min)
One
Drug
Review
$255 flat
Consul
w/
Pharm
$255 flat
Drug
Regimen
Review
$153/hr
(3 hr min)
One
Drug
Review
$255 flat
Consul
w/
Pharm
$255 flat
Drug
Regimen
Review
$153/hr
(3 hr min)
One
Drug
Review
$255 flat
Consul
w/
Pharm
$255 flat
CASE RX
Program
$1,200
flat
One Drug
Review
$255 flat
(SAME AS
ABOVE)
ANNUAL INCREASE ALLOWED: LESSER OF CPI OR 2% (Routine Bill Fee Only)