10-Exhibit 4 - Questionnaire.xlsx

XLSX spreadsheet 69 KB Posted Dec 14, 2025

Attached to: Group Medical Insurance Services
Solicitation number: RFP 28-26-NH
Issued by: Bernalillo County, New Mexico

About this file

Written by GovTribe AI · Dec 16, 2025

This file is a comprehensive Medical Questionnaire Exhibit for Bernalillo County's Group Medical Insurance Services RFP, soliciting proposals for claims administration and related medical services for the County's employee population in New Mexico. The questionnaire requires vendors to demonstrate compliance with 21 minimum requirements, including the ability to provide fully integrated medical solutions with comprehensive networks, utilization and cost management services, wellness tools, and full HIPAA compliance. Vendors must be licensed in New Mexico or willing to obtain licensure, agree to guarantee ASO fees for a minimum of two years (with a third year preferred), submit renewal rates and fees 120 days prior to contract renewal, provide Summary Plan Description drafts within 60 days of the effective date, maintain PPACA compliance including three URAC-accredited Independent Review Organizations for claims appeals, and integrate with the County's existing systems including the PBM (Clear Script) and HRIS (Workday). The contract must allow termination with no more than 30-day notice and cannot prohibit group termination at any time, with no penalties for late notification or off-anniversary termination.

The questionnaire requires detailed responses across multiple service categories including general company information, ASO claims administration, provider networks, disease management, utilization management, case management, and wellness programs. Vendors must provide four client references (including one former client and at least two governmental entities) and three self-funded public sector clients located in New Mexico. Pricing must be submitted net of commissions, with insurance premium tax not applicable to public entity employers. The questionnaire mandates that all deviations from RFP requirements be specifically listed on an Exhibits 1 Deviations Page and that all questionnaires and exhibits be completed in full. Vendors must indicate whether their self-funded ASO fees include disease management and wellness programs or whether these services are optional at additional cost, and must provide detailed information regarding claims processing capabilities, system accreditations, performance guarantees, and comprehensive reporting access for both the County and its consultant.

View the file

Other files

File	Type	Posted
8-Exhibit 1 - RFP Deviations.doc	DOC document	Dec 14, 2025
4-Attachment 1 - Presbyterian EPO Plan Certificate.pdf	PDF	Dec 14, 2025
5-Attachment 2 - BCBSNM EPO Plan Certificate.pdf	PDF	Dec 14, 2025
7-Attchement 4 - BCBSNM PPO Plan Certificate.pdf	PDF	Dec 14, 2025
6-Attachment 3 - Presbyterian PPO Plan Certificate.pdf	PDF	Dec 14, 2025
13-RFP 28-26-NH Addendum 1.pdf	PDF	Dec 14, 2025
9-Exhibit 2 - Medical Costs Services.xls	XLS spreadsheet	Dec 14, 2025
1-RFP 28-26-NH APPENDIX C - Submittal Letter Form.pdf	PDF	Dec 14, 2025
2-RFP 28-26-NH APPENDIX D - CAMPAIGN CONTRIBUTION DISCLOSURE FORM.pdf	PDF	Dec 14, 2025
3-RFP 28-26-NH APPENDIX E - Unfair Business Practices Disclosure Form.pdf	PDF	Dec 14, 2025
11-RFP 28-26-NH Group Medical Proposal Document (Final).pdf	PDF	Dec 14, 2025
12-RFP 28-26-NH Letter of Interest.pdf	PDF	Dec 14, 2025

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Minimum Requirements

Bernalillo County

Medical RFP - Medical Questionnaire

INSTRUCTIONS: Please answer all of the following questions, or if a question is not applicable, please indicate " N/A " in the response column. Please do NOT provide any attachments, nor make reference to another document in lieu of providing a response. Please do not add, delete, or re-order any of the questions. If more space is needed to provide an appropriate response, you may add rows directly underneath the question being answered.

Enter Vendor Contact Name and email address:

WHEN RESPONDING TO THE MINIMUM REQUIREMENTS, PLEASE PLACE AN " X " IN THE APPLICABLE AGREE OR DISAGREE COLUMN FOR EACH REQUIREMENT
MINIMUM REQUIREMENTS
MR #	Minimum Requirement	Agree	Disagree
1	You must be able to provide a fully integrated medical solution along with a comprehensive network, utilization/cost management services and wellness tools/resources.
2	You have reviewed and accept the Plan’s eligibility provisions outlined in the RFP.
3	You must be licensed in New Mexico or willing to obtain a license in New Mexico.
4	Self-funded Quotes: ASO fees must be guaranteed for a minimum of two (2) years from the effective date. A third year rate guarantee is preferred. Fees must be the same for Years 1 and 2.
5	The rates/fees/premiums should be calculated NET of commissions.
6	Renewal rates and fees must be submitted 120 days prior to the contract renewal date.
7	You have included detailed plan summaries for all quoted plans.
8	The vendor will be responsible for producing the Summary Plan Description. The client reserves the right to review/revise the SPD prior to finalization.
9	Vendor agrees to provide the SPD draft within 60 days of the effective date.
10	Vendors may be required to attend open enrollment meetings.
11	Vendor agrees to provide all standard reports to the client and its consultant.
12	The client and its consultant must be able to access reports online.
13	You are in compliance with all HIPAA Privacy, Electronic Data Interface (EDI) and Security requirements.
14	With regard to the Patient Protection and Affordable Care Act (PPACA) please confirm your understanding and agreement with the following:
	Vendors must agree to be in compliance with, and able to administer, PPACA’s required administration processes and reporting requirements (e.g., nondiscrimination testing, etc.), as outlined in the law:
	Vendors must agree to be in compliance with, and able to administer, PPACA’s claims appeal process (both internal and external) and must be willing to take the steps necessary to ensure that the client/plan is in full compliance. This includes your agreement to contract with at least three (3) URAC-accredited IROs (Independent Review Organizations).
15	Your contract must require no more than a 30-day notice of termination. Your contract cannot prohibit the group from terminating coverage at any time. There must be no penalties for late notification or for termination off anniversary.
16	Vendor agrees to provide performance guarantees. Provide details within your proposal.
17	You have specifically listed all deviations from the RFP and coverage requirements on Exhibit 1 Deviations Page. NOTE: Deviations MUST be listed; you cannot simply make a “general” reference to section(s) of the proposal.
18	You completed all questionnaires and exhibits in full.
19	Insurance premium tax does not apply to public entity employers including, but not limited to, cities, counties, school districts, etc. If selected, premium tax will not be charged on the Stop Loss coverage.
20	If your medical proposal includes both a SOLE carrier and SLICE carrier quote, you have indicated any costs differences on Exhibits 2A and 2B.
21	You must be able to integrate with the County's current PBM, Clear Script.
22	You must be able to integrate with the County's HRIS system, Workday.

Medical Questionnaire

Bernalillo County

Medical RFP - Medical Questionnaire

Enter Vendor Contact Name and email address:

WHEN RESPONDING TO QUESTIONS THAT REQUIRE YOU TO SELECT FROM THE RESPONSES ALREADY PROVIDED, PLEASE PLACE AN " X " IN FRONT OF THE APPLICABLE ANSWER.

GENERAL QUESTIONS
1	How long has your company been administering medical claims?
2	Do you carry an Errors & Omissions policy?		Yes		No
	What is the coverage amount?
3	Do you carry a comprehensive general liability policy?		Yes		No
	· What is the coverage amount?
4	Does your company carry a fidelity bond?		Yes		No
	· What is the coverage amount?
5	Are you able to provide data that benchmarks the client’s experience against the following :
	· Your book of business		Yes		No
	· National norms		Yes		No
	· Similar sized clients		Yes		No
6	Indicate if you have online reporting access		Yes		No
7	Provide a list of all standard reports available to Self Funded Plans:
	SELF FUNDED REPORTS (List below. Add lines if needed):	Frequency		Indicate any cost for report	Indicate any limitation on availability due to size of client

8	What is the lag time on when reports are provided?
9	Are your reports based on claim INCURRED date, or claim PAID date?		Incurred		Paid
10	What is the normal lead-time required to implement a group?
11	Which of the following tasks can members and plan sponsor representatives perform online? Check all that apply.	Members		Plan Sponsors
	Ø Enrollment (New Hires and Open Enrollment)
	Ø Changes in Status
	Ø Billing (Plan Administrators only)	N/A
	Ø Claim inquiry
	Ø Physician / provider cost and quality comparison
	Ø ID card request
	Ø Terminations
12	Do you offer online eligibility maintenance for all clients?		Yes		No
	· If so, is there a charge?		Yes		No
	· Is there a charge for hard copy maintenance?		Yes		No
13	Provide the location and office hours of your Claim and Member Service center(s).
	Do you provide a toll-free telephone number?		Yes		No
	What are the hours of operation?
14	Indicate all foreign languages offered by your Member Services center(s)
15	On average, how many clients do you service from each of your Claims and/or Member Service site(s)?
16	Does the same person handle both claims processing and customer service functions?		Yes		No
17	Do you currently offer concierge member advocacy services?		Yes		No
	What services are provided?
	Are they included in your proposed administrative fees?		Yes		No
	If not, what is the additional cost?
18	How many trained claim examiners do you employ?
	What is their average length of experience?
	What is the volume of claims paid per day per examiner?
19	What is your average annual employee turnover?
20	Show the number of employer groups you service in each of the size categories below:
	· Under 100 EE’s
	· 100 – 1,000 EE’s
	· 1,000 – 5,000 EE’s
	· 5,000 – 10,000 EE’s
	· 10,000 + EE’s
21	Describe your security, backup and disaster recovery procedures.
22	What claims adjudication system do you use? (If proprietary, describe the staffing and client response capabilities of your IT staff.)
	Is your system leased/owned?		Own		Lease
	When was the system last updated?
23	Concisely identify and comment on any major claim, eligibility, and / or reporting system changes or upgrades planned in the next 12 to 24 months, along with the intended outcome.
24	List the major functions your claim system automatically performs.
25	Describe your system edits for identification of fraudulent claims.
26	Describe the types of physician and hospital fee discount arrangements your claims system can accommodate.
27	What method does your firm utilize to determine Usual and Customary (HIAA, company profile, network contracted rates, RVS, etc.)?
	HIAA, or related data base (identify if not HIAA):
	Other (identify other methods):
	Percentage used?
	Can the client select a different level?		Yes		No
	How often are allowances revised? Check the appropriate response.		Monthly
			Quarterly
			Semi-annually
			Other (Describe)
28	What percentage of claims is currently auto-adjudicated through your system?
29	Can your system accept electronic claims submission?		Yes		No
	On average, what % of claims are submitted electronically?
30	During each of the last two years, what percentage of claims processed by your organization was for services provided by a network provider?
	2024
	2023
31	What was the typical turnaround time for paid claims for the last two years?
	2024
	2023
32	Indicate the claims accuracy / error rate for the last two years?
	2024
	2023
33	Can your system track utilization by CPT code for preventive care claims?		Yes		No
34	Can your system detect unbundling of services?		Yes		No
35	Can your system detect “code creeping”?		Yes		No
	If yes, what action do you take upon discovery?
36	For services not covered or not eligible for reimbursement, describe any discounts that members are eligible to receive (e.g. discounted health club membership).
	Indicate any specific steps necessary on behalf of members to secure these discounts.
37	Describe how your adjudication procedures ensure that claims are paid in accordance with provider network timely payment requirements to ensure that no network discounts are lost.
38	If you fail to meet timely payment requirements for in-network providers, will patients and/or the Plan be liable?		Yes		No
39	Explain in detail your procedures for identification and recovery of third party liability and coordination of benefits claims.
	Do you outsource this service?		Yes		No
	Does your claim system readily identify potential possible subrogation/COB opportunities prior to claim payment?		Yes		No
	Do you pend and pursue, or pay and pursue, these types of claims?		Pend & Pursue		Pay & Pursue
40	Describe your claims quality assurance or review process.
41	Please answer the following regarding Audits:
	What is the frequency of your internal audits?
	What is the frequency of your external audits?
	Who performs the external audits?
	At what “trigger point” do you conduct/require a hospital claim audit?
	Who performs hospital audits?
	Are hospital audits included in your ASO fees?		Yes		No
	If not, what is the additional charge?
42	How do you define a "Paid" claim?
43	Briefly describe how you establish reserves for Incurred But Not Reported (IBNR) claims?
44	In what circumstances would you require a Premium Stabilization Reserve?
45	Does your company offer a Level Funding / Minimum Premium arrangement?		Yes		No
	If yes, briefly describe how you would share any Surplus remaining after the end of the policy year, including how soon after the policy year end the surplus would be made available to the policyholder.
	If yes, how does your company recoup any Deficit remaining after the end of the policy year?
46	Are you ever willing to coexist with another medical carrier?		Yes		No
	If yes, briefly describe on what conditions.
	What information do you require before agreeing to coexist?
47	When a participating provider terminates from your network and a member is in mid-treatment, how is ongoing treatment handled (e.g. maternity, cancer treatment)?
48	Please provide the following:
	Four client references, including one former client, who may be contacted. At least one of these references should be from a client of similar size and at least two should be governmental entities.
	Name of Client
	Contact Name
	Address
	Telephone number
	Approximate number of employees covered by each contract.
	Name of Client
	Contact Name
	Address
	Telephone number
	Approximate number of employees covered by each contract.
	Name of Client
	Contact Name
	Address
	Telephone number
	Approximate number of employees covered by each contract.
	Name of Client
	Contact Name
	Address
	Telephone number
	Approximate number of employees covered by each contract.
49	Name three (3) self-funded public sector clients (list all located in New Mexico) and provide the following:
	Name of Client
	Number of employees /lived covered
	Types of plans (i.e. PPO, EPO, HMO, etc.)
	Pharmacy benefit included or carved-out
	How long have you been servicing each public sector client?
	Contact information for each
	Name of Client
	Number of employees /lived covered
	Types of plans (i.e. PPO, EPO, HMO, etc.)
	Pharmacy benefit included or carved-out
	How long have you been servicing each public sector client?
	Contact information for each
	Name of Client
	Number of employees /lived covered
	Types of plans (i.e. PPO, EPO, HMO, etc.)
	Pharmacy benefit included or carved-out
	How long have you been servicing each public sector client?
	Contact information for each
50	Briefly describe all Support/Educational tools that are available for the County HR department as well as employees

ASO / TPA CLAIMS ADMINISTRATION QUESTIONS

1	Do ASO fees paid while the contract is active cover the cost of run-out administration, or are additional fees due during run-out administration?	Covered by fee paid when contract is active.	Additional fees are due during run-out administration.
2	If additional fees are due during run-out administration, precisely identify how run out fees will be calculated, and for what time period fees will be charged.
3	How long after contract termination will you perform claim run-out administration?
4	Will you administer run-out longer than your standard time, if requested by the client?	Yes	No
5	At termination, after the run-out period, how will you handle the following claims incurred prior to termination date:
	• Claims in house before end of run-out period, but not processed?
	• Claims submitted after the run-out period?
6	When acting as the claims administrator, do you agree that the claims and accompanying eligibility data produced in connection with all the claim payment activities on behalf of the client is the property of the client?	Agree	Disagree
7	Do you agree to provide access to all files on request (e.g., a claims audit) and to not assess any fee for such access?	Agree	Disagree
8	Please briefly describe how claims incurred outside of the U.S. are processed.
	· Is any type of pre-authorization required for non-emergency services occurring outside of the U.S.?	Yes	No
9	Do you maintain separate bank accounts for each client?	Yes	No
10	Are you willing to agree that you are a fiduciary under ERISA with respect to the services provided under the Agreement?	Yes	No
	· What type of limitations would be imposed on the employer’s decision-making process through such an arrangement?
	· Is there an additional fee for these services?	Yes	No
	· If you are unwilling to serve as fiduciary, please describe why you would be unwilling to make this representation.
11	Do you maintain a record for all checks issued, but not cashed?	Yes	No
	How often will you provide this record to the client (monthly, quarterly, annually)?
	Who is responsible for follow-up of uncashed checks?
12	If you are responsible for reconciliation of the Plan's bank account, would you agree to complete the final reconciliation, including finalizing any uncashed/unclaimed checks?	Yes	No
	If yes, please describe your process for finalizing uncashed / unclaimed checks.

PROVIDER NETWORK QUESTIONS

1	Do you own your provider network, or do you lease an outside network(s)?	Own	Lease
	If you lease your network(s), list the rental networks used.
2	Do you own the provider network you offer out of state?	Yes	No
	If you rent any out of state provider network(s), list the rental networks used, by location.
3	Do your HMO and Point of Service network plans require a referral from the PCP to a specialist?	Yes	No
4	How are network physicians reimbursed? Check all that apply.
	Salary
	Per Capita
	Discounted Fee for Service
	Other? (describe)
5	How are network hospitals reimbursed? Check all that apply.
	Salary
	Per Capita
	Discounted Fee for Service
	Other? (describe)
6	Do you offer a separate “high value” provider network? If no, skip to question #8. If yes, please answer the following:	Yes	No
	• Is participation optional for the client?	Yes	No
	• Are there quality / cost of care measurements that participating providers must meet?	Yes	No
	• What is your timeframe for deployment?
	• What are the PMPM care coordination payments, and how are they calculated?
	• What is the average amount of Shared Savings payments, and how will they be calculated?
	• What reports will be provided to the client and consultant to substantiate the calculation of Care Coordination and Shared Savings fees and bonuses? When, and how frequently, will such reports be provided?
	• How will a self-funded client’s share of costs for any shared savings bonuses be calculated?
	• What mechanism will be used for self-funded clients pay for the program?
	Separate bill?
	Billed as a claim charge?
	Other? (describe)
	• When will Shared Savings charges be assessed to the client?
	• Regarding self funded plans, what discounts will be applied to stop loss rates quoted by your firm, for participating in the program?
	• Are provider bonuses calculated on the performance of the individual group, or are they based on a “pooled” book of business?	The individual group	Pooled book of business
	• Identify performance metrics used to measure provider success.
7	How are physicians who are part of your “high value” network reimbursed? Check all that apply.
	Salary
	Per Capita
	Discounted Fee for Service
	Other? (describe)
8	Do you currently offer Accountable Care Organizations / Patient Centered Medical Homes?	Yes	No
	If yes, how is patient data captured and shared between providers participating in the ACO / Patient Centered Medical Home?
	• If no, are you developing one, and when will it be offered to clients?
9	Does your network have current NCQA accreditation?	Yes	No
10	Does your network have current URAC accreditation?	Yes	No
11	Does your network have any other accreditation?	Yes	No
	If yes, identify.
12	When the patient is referred outside of your provider network, are claims paid at In-Network or Out-of-Network levels?	Yes	No
13	Do you anticipate network expansion or contraction to occur in 2026?	Yes	No
	▪ If yes, briefly describe.
14	Is the use of Centers of Excellence required by your plan?	Yes	No
	If yes, do you own or lease the Centers of Excellence network?	Own	Lease
15	When a participating provider terminates from your network, what steps do you take, if any, to notify members and plan sponsors of such terminations?
16	How quickly is your website updated with a change to the network status of a provider?
17	How quickly is your website updated when a provider begins or stops accepting new patients?
18	Do your HMO / EPO / POS / PPO / CDHP networks include the same providers and hospitals, our does each network include different provider and hospitals?	Network of Providers and hospitals is the same for all	Network of Providers and hospitals are different
19	Briefly describe the minimum criteria for providers and hospitals to be selected as network providers.
20	Are you willing to add providers that are specifically requested by the client?	Yes	No
21	Briefly describe the processes / procedures you have in place to communicate with your network providers and hospitals.
22	Briefly described how you monitor provider compliance with policies and protocols.
23	Are provider network discounts applied to all portions of a claim that are the member's responsibility (deductible and coinsurance)?	Yes	No
24	During each of the last two years, what was your provider retention rate?
	2024
	2023
27	How many providers were added to your network in each of the following time periods?
	2024
	2023

Disease Management

Bernalillo County

Medical RFP - Disease Management Questionnaire

Enter Vendor Contact Name and email address:

WHEN RESPONDING TO QUESTIONS THAT REQUIRE YOU TO SELECT FROM THE RESPONSES ALREADY PROVIDED, PLEASE PLACE AN " X " IN FRONT OF THE APPLICABLE ANSWER.

1	Does your organization offer DM (disease management) programs? If no, you may skip the rest of the questionnaire.	Yes		No
2	Is your DM program administered internally, or is it provided through an outside vendor?	Internal		Outside vendor
	If offered by outside vendor, identify vendor.
3	Are your services local, national or international? (check any that apply)
		Local
		National, some states
		National, all states
		National, all states + international
	· From what location(s) are services provided?
4	Do your self funded ASO fees automatically include some level of DM program, or is DM always optional at an additional cost?	Always included		Always optional at additional cost
	If automatically included in self funded ASO fees, does the client have the option to not include any DM program?	Yes		No
	If yes, what is the effect on ASO fees if the client elects not to include DM?
		Fees are increased
		Fees are decreased
		No change to fees
	If you quote Stop Loss along with ASO services, does your Stop Loss contract require the client's Plan to include a DM program?	Yes		No
5	Does your DM program have accreditation separate from your provider network? If yes, check all that apply, and include expiration date of each accreditation.	Yes		No
			Accreditation Expiration Date?

URAC

		NCQA
		Other (describe)
6	If your DM program is not accredited, are steps being taken to obtain accreditation?	Yes	No
7	Briefly describe how you identify potential DM candidates, including sources of data used.
8	How are candidate stratified to determine priorities?
		By disease
		By utilization of resources?
		By readiness to change?
		Other? (describe briefly)
9	Do you proactively contact potential DM candidates without waiting for them to contact you?	Yes	No
	If so, by: (check all that apply)	Telephone
		Email
		Letter
		Text
10	Briefly describe what tools and methods you use to maximum the member's engagement in your DM program.
11	What DM interventions does your organization propose to provide (check all that apply)?
		Written Communication
		Group Education
		One-on-One interventions
		Telephone monitoring
		Clinical Interventions
		Other (describe)
12	How will outcomes be measured and reported for each intervention?
13	What is the frequency of your program reports?
		Monthly
		Quarterly
		Semi-annually
		Annually
		Other (describe)
14	Are the following DM reports available at no additional cost to the client? If so, indicate frequency next to your response.
	Cost savings reports:	Yes	No
	Frequency provided?
	Utilization Reports:	Yes	No
	Frequency provided?
15	Has your DM program been audited by any outside firm for effectiveness?	Yes	No
	If yes, by whom and what date?
16	How do you measure the cost-effectiveness of your DM program?
17	Are you willing to guarantee ROI (Return on Investment) for your DM program?	Yes	No
	If yes, describe.
18	Briefly describe your process for managing co-morbidities
19	Briefly describe how you interact / coordinate with the member's physician(s) in order to maximize the effectiveness of the DM program.
20	Do your DM efforts include monitoring the appropriate use of applicable prescription drugs?	Yes	No
	If yes, describe how you would interface with an ASO client's third-party Prescription Benefit Manager (PBM).

Utilization Management

Bernalillo County

Medical RFP - Utilization Review Questionnaire

Enter Vendor Contact Name and email address:

WHEN RESPONDING TO QUESTIONS THAT REQUIRE YOU TO SELECT FROM THE RESPONSES ALREADY PROVIDED, PLEASE PLACE AN " X " IN FRONT OF THE APPLICABLE ANSWER.

1.	Are your services local, national or international? (check any that apply)
		Local
		National, some states
		National, all states
		National, all states + international
	· From what location(s) are services provided?
2.	Does your UM management program have accreditation separate from your provider network?	Yes	No
3	Does your UM program have NCQA accreditation?	Yes	No
4	Does your UM program have URAC accreditation?	Yes	No
5	Does your UM program have any other accreditation?	Yes	No
	If yes, identify.
6	Do you have a standard pre-certification requirement for any of the following? (check all that apply)
		Hospitalizations

Outpatient Surgery

Durable Medical Equipment

Corrective Appliances /Prosthetics

Skilled Nursing Facility

Home Health Care

		Hospice Facility
		Medical Services (e.g., physical therapy)
		Inpatient Mental Health / Substance Abuse
		Outpatient Mental Health / Substance Abuse
7	Please list all Diagnostic procedures requiring pre-certification.
8	Please list any other Outpatient procedures requiring pre-certification that are not listed above.
9	Assuming you have a standard pre-certification requirement, can the client customize the list of procedures requiring pre-certification, if desired?	Yes	No
10	Does your firm perform concurrent review services?	Yes	No
11	Regarding staff who perform concurrent review, are they employees of your firm, or do you subcontract to an outside firm?	Employees	Subcontract to outside firm
12	Within the past twelve months, in what % of all precertification cases did you issue a letter of noncertification (denial), due to lack of Medical Necessity/Appropriateness for the procedure/service requested?
		Less than 1%
		1 to 2%
		3 to 4%
		5 to 6%
		7 to 8%
		More than 8%
		Not applicable
13	Indicate the types of staff who are allowed to make final disapproval of a preservice request (check all that apply):
		Clerical
		LPN / LVN
		RN
		Physician
14	On average, what % of all preservice reviews require your physician advisor to review for final decision?
		Less than 1%
		1-10%
		11-19%
		12-30%
		31-40%
		41 to 50%
		Greater than 50%
15	Indicate your standard method of reporting savings from the review of INPATIENT hospitalization.
		IP hospital savings reports not available
		Basically as the difference between days requested and days approved/certified
		Basically as a comparison of days or LOS utilized vs. normative or case mix adjusted days or LOS
		Other (describe)
16	Indicate your standard method of reporting savings from the review of OUTPATIENT surgery.
		OP surgical review not available
		OP surgical available but specific reporting not delineated
		$ value times the # of cases determined not to be medically necessary
		Other (describe)

Case Management

1	Do you subcontract catastrophic case management services?	Yes	No
	• If yes, identify vendor.
2	During case management, does your staff negotiate fee reductions with providers and vendors?	Yes	No
3	Describe your system and capabilities with respect to claims and case management, including information input tracked and collected.

Wellness

Bernalillo County

Medical RFP - Wellness Questionnaire

Enter Vendor Contact Name and email address:

WHEN RESPONDING TO QUESTIONS THAT REQUIRE YOU TO SELECT FROM THE RESPONSES ALREADY PROVIDED, PLEASE PLACE AN " X " IN FRONT OF THE APPLICABLE ANSWER.

1	Do your self funded ASO fees automatically include some level of wellness program, or is wellness always optional at an additional cost?	Always included	Always optional at additional cost
	If automatically included in self funded ASO fees, does the client have the option to not include any wellness program?	Yes	No
	If yes, what is the effect on ASO fees if the client elects not to include wellness?
		Fees are increased
		Fees are decreased
		No change to fees
2	Is your wellness program administered internally, or is it provided through an outside vendor?	Internal	Outside vendor
	If offered by outside vendor, identify vendor.
3	List any accreditations or certifications that your wellness program currently has.
4	Please indicate if you offer the following wellness services:
	Health Coaching (telephonic and/or online)	Yes	No
	Health Risk Assessment	Yes	No
	Premium Web Content and Tools	Yes	No
	Advanced Communication Materials	Yes	No
	Discounted Gym Memberships	Yes	No
	Outbound Calling to Top 5% of High Risk Population	Yes	No
	Comprehensive reporting, including incentive reporting	Yes	No
	Comprehensive Promotion and Communications Materials and Campaign Support	Yes	No
	Nurse Line medical resource	Yes	No
	Incentive Programs	Yes	No
	Online Incentive Tracking	Yes	No
5	If your program offers biometric screenings, are you able to aggregate data and provide consolidated reports to clients that include results of tests administered by both your firm and any outside contractors hired by your firm?	Yes	No
6	Is any onsite biometric screening done by an outside vendor?	Yes	No
	If yes, please identify the vendor.
7	Please indicate if your Biometric Screening Services include the following:
	Onsite Screening Events	Yes	No
	Clinical and Educational Staff	Yes	No
	All Travel Considerations & Costs	Yes	No
	Educational Materials and Resources	Yes	No
	All Reports and Data	Yes	No
	Integrates with Coaching and HRA	Yes	No
	Measures taken include Cholesterol, Blood Glucose, Blood Pressure, Body Fat and Tobacco Use	Yes	No
8	List all foreign languages that your wellness program and materials are offered in.
9	Do you have wellness program participation requirements?	Yes	No
	· If yes, what are they?
10	What methods do you employ to encourage and maximize participation in the wellness program? Provide details.
11	Do you provide an employer incentive or underwriting credit for meeting a participation threshold?	Yes	No
	· If yes, provide details.
12	Are you able to provide the following program measurement and reporting metrics?
	Ongoing participant tracking	Yes	No
	Utilization metrics	Yes	No
	Clinical outcome measurements	Yes	No
	Risk stratification	Yes	No
	Executive analysis and recommendations	Yes	No
	Self-administered prevention and maintenance programs (e.g. smoking cessation)	Yes	No
	Quantifiable ROI analysis	Yes	No
	Ad-hoc / customized "drill down" capabilities	Yes	No
13	If reports can be customized, what are the options and associated costs?
	If there are additional fees, are the fees generated on a fixed cost per report or billed on an hourly basis?
14	What is the lag time on reports from your firm?

File details come from the government source that posted it. Updated Dec 16, 2025.