12-EXHIBIT C - Questionnaire - FINAL.xlsx

EXHIBIT C | QUESTIONNAIRE

Additional items uploaded shoud refer to the corresponding number within the Questionaire.

*** Please note that ALL responses to this Questionnaire will form part of the Proposer's Submittal for Scope of Services. The Selection Committee will review these responses, and they may, at BSO's discretion, be incorporated into the contract for services. ***

QUESTION/REQUEST *YES,

Proposer currently provides.

***Indicate under response/explanation how Proposer meets this criteria.* *NO, Proposer does not currently provide.

***Indicate under response/explanation how Proposer can meet this criteria.* RESPONSE/EXPLANATION

2 Please provide the office that would serve as the principal place of business for this account and the other offices and locations that would service this account and the functions they will perform.

3 Demonstrate your expertise and experience in claims handling that would relate directly to BSO’s operation.

4 List all external providers/vendors your company’s partners with to provide adjusting, managed care, bill review, or other required services on an ongoing or occasional basis. Describe these services and the exact relationship between your company and those providers vendor.

7 Describe in detail the training provided to your examiners in regards to recent regulations, including American Medical Association (AMA) and American College of Occupational and Environmental Medicine (ACOEM). Describe in detail the training to be provided to the members of BSO regarding claims procedures and other pertinent areas of workers' compensation.

8 Describe any services not otherwise covered herein which you believe may be of particular value to BSO.

9 If necessary, can Proposer transfer data claims from current TPA within 30 days?

10 Has Proposer previously integrated with Workday? If so, please provide details on whether you have any built-in integrations with Workday or have utilized Workday APIs for integration in past projects, as well as estimated costs associated to this type of implementation.

CLAIMS REPORTING

BSO desires twenty-four (24) hour, seven (7) days-a-week, telephonic claims reporting service. Demonstrate your company’s ability to meet the following criteria, detail how your company would meet the criteria, and any qualification or stipulation that applies to any response to the following:

11 Ability to answer a call routed from the BSO provided 1-877-5-SHERIF number or other dedicated phone line with a customized BSO script.

12 Capability for internet, phone, and fax reporting. Telephonic claims reporting will be available twenty-four (24) hours per day, seven (7) days a week.

13 Ability to electronically send claim data to adjuster and nurse, no later than two hours after entry/receipt of the claim, by any of the reporting methods outlined above.

14 Ability to provide automatic First Reports of Injury via e-mail, immediately after system entry to BSO designated recipients.

15 Ability to customize the intake screen to automatically inform the interviewer of the location’s physician panel or recommended injury clinic, so the interviewer can inform the caller (Note: BSO may wish to contract separately or select a different provider).

16 Please provide details on the capabilities to various scheduled reports along with custom client-define reports.

17 Please provide details on the Client access to create additional reports and standard reports.

COMMUNICATIONS WITH BSO AND EMPLOYEES

Excellent communications between BSO, its employees and the TPA regarding reporting and process requirements, rights under worker’s compensation, and recommended primary care providers are paramount to an effective claims management program. Please demonstrate your company’s ability to meet the following criteria, and detail how your company would meet the requirement, and any qualification or stipulation that applies to any response to the following:

18 Please provide an effective process and framework for communication supported by state of the art technology.

19 Please provide a process to provide and disseminate to BSO and its locations, claims to report media (i.e., posters, telephone stickers, employee cards, etc.) to best communicate how to report claims under varying circumstances.

20 Please describe the process of production and delivery of statutory posters for each location (New locations and changes in preferred providers would require new communications).

21 Outline and provide samples of communication materials your company has used to promote and facilitate injury management (i.e., posters, website, etc.). Upload documents in "Exhibit C - Questionnaire and Checklist" area in Bonfire and label question #21.

CLAIMS MANAGEMENT

Please respond to the following requests for information, demonstrate your company’s ability to meet the outlined criteria, detail how your company would meet the criteria, and any qualification or stipulation that applies to any response:

22 Provide a flowchart of your company’s claims management process, indicating in detail, the flow of information, decision points, supervisor intervention, etc.

23 Specifically, detail the locations of your company’s claim operations that would be handling BSO claims, the number of employees in each office, the overall organizational structure of the office, and when the respective offices were established.

24 Outline normal work hours and workdays, provide a list of your company’s holidays, and discuss any optional/flexible work arrangements currently in use in your offices, or contemplated for administering BSO’s claims.

34 Can your company’s adjusters initiate three-point (3) contact within twenty-four (24) hours?

35 Describe how your company currently monitors compliance, and how the monitoring will be done to assure compliance to this standard on an ongoing basis.

Provide an example of a management report that measures this requirement. Upload documents in "Exhibit C - Questionnaire and Checklist" area in Bonfire and label question # 35.

36 Provide your company’s definition of an Indemnity case and Medical Only case. Detail how, and when, a Medical Only claim would escalate to an indemnity case, and any fast track claims handling alternatives. Once a claim escalates from a Medical only to an indemnity claim, advise how BSO is able to see, and track the change.

37 Describe the current subrogation process. Provide sample reports of how your company monitors subrogation/SITF activity and recovery.

40 Please provide a copy of your company’s claim handling practices (Best Practices). These Best Practices should at a minimum, include your company’s standard on:

a) Initial Contact (3-point on WC):

b) Recorded statements, including scripts that have been designed for various types of statements to be taken;

c) Claim Investigation;

d) Scene Investigation;

e) Follow-up Contact, including requirements for all parties;

f) Diary requirements and requirements for the completion of claim strategy/action/resolution plans;

g) SITF/Subrogation;

h) Indexing;

i) Reserving practices;

j) Explain your reserving philosophy, policies, and practice. (i.e. ultimate probable exposure v. worst case);

k) Outline the specific deadlines applicable to appropriate reserving;

l) Describe any reserving software or modules that are used;

o) Outline your company’s controls to achieve consistent and appropriate reserving among various adjusters. Describe how your company’s monitor reserving performance and overall reserving trends;

p) Pre-Settlement/Settlement procedures;

q) Confirm your company’s agreement to obtain settlement authority prior to any settlement;

r) Confirm your company’s agreement to provide BSO with a reserve advisory/consult on all claims that have a reserve set at $25,000 or greater or are changed/increased by $25,000 or greater and category claims with quarterly updates;

s) Confirm your company’s willingness to allow BSO to select and/or approve defense counsel;

t) Confirm your company’s agreement to allow audits by BSO or consultants with appropriate notice. Outline your company’s audit protocol;

u) Confirm your company’s willingness to provide regular stewardship/report cards to the City measuring your company’s performance on their services and outcomes of their services. Provide a sample stewardship report;

A. General - Please include the following in your response for Managed Care Services:

44 How does your company’s claims administrator services differ from and provide a competitive advantage over those of your major competitors?

45 Describe how your company ensures compliance with workers' compensation newly enacted statutes and rules and regulations promulgated by the Department of Industrial Relations.

46 Describe in detail the training provided to your examiners in regards to recent regulations, including AMA and ACOEM. Describe in detail the training to be provided to the members of BSO regarding claims procedures and other pertinent areas of workers' compensation.

MANAGED CARE SERVICES

B. Medical Management - Provide answers in the order of the listed questions in regards to telephonic and on-site case management.

47 Describe your medical case management services including interaction with workers' compensation medical and service providers, employers, and patients.

48 What are the specific red flags, triggers, or other criteria that you use to identify cases for telephonic and on-site case management?

49 Describe activities and time frames for telephonic case management and on-site case management.

50 Describe the case manager's role and interaction with the injured person, the providers of medical care, the claims administrator and employer.

51 What criteria are used to establish maximum medical improvement (MMI), and return to work time frames?

54 What is the hardware, software, and network architecture that you use to provide services and to interface with external sources such as BSO?

55 Explain how nurse reviewers, physician reviewers, adjusters and other parties’ access and input information.

56 Describe your company's standard and ad hoc reporting capabilities. Does your software program provide the following: Reports on percentage of network "hits"? Comparison of billed costs, cost reduction, and net savings?Upload documents in "Exhibit C - Questionnaire and Checklist" area in Bonfire and label question # 56.

57 Outline your company’s philosophy on field medical case management versus telephonic case management.

58 Upload a sample of quarterly reports detailing realized savings as a result of your company’s cost containment/medical management programs. Upload documents in "Exhibit C - Questionnaire and Checklist" area in Bonfire and label question # 58.

63 How will you assist BSO in promoting the Network, providing notice to the employees regarding the Network, and providing employees with provider information prior to and within twenty-four (24) hours of an injury?

64 Describe how you will assist employees in navigating the Network during the dispute process and the Independent Medical Review.

65 Do you have the ability to allow additions or deletions from the network? If so, is there a charge and what is the turnaround time?

66 What type of provider profiling has been completed for the Network?

67 What type of access to the network do you provide to injured workers and BSO?

69 Describe your staffing plan to demonstrate your capability to be adequately staffed with trained personnel to handle BSO bill review needs.

75 What review procedures do you have in place for medical bills with missing or invalid International Classification of Diseases (ICD) 9 codes and missing or invalid procedure codes?

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Please provide a description and upload samples of reports that may include hard and soft savings, as well as, turnaround time of reviews. Upload documents in "Exhibit C - Questionnaire and Checklist" area in Bonfire and label question # 95.

96 Describe your recommended protocol for TPA's to use to approve medical treatment requests. When should treatment requests be sent to your firm for review?

97 Describe how your system handles requests for reconsiderations. What is the timeline for completion of medical reviews?

98 What tracking mechanisms do you have in place for Peer Reviews, Referrals, and Appeals?

RISK MANAGEMENT INFORMATION SERVICES (RMIS)

Google Chrome-compatible, Firefox-compatible, or Microsoft Edge-compatible claims management system platform providing real-time interactive communication and claims management between nurses, adjusters, BSO, and its business units. BSO will determine the number of accesses by level of use dependent on your company’s system capabilities in coordination with your company during this RLI process. Please respond in detail to the following:

104 Confirm your company’s ability to establish an interface with a risk management information system (RMIS) vendor of BSO’s choice with no fee to implement.

105 Identify the access your company provides to the database; Internet, 1-800 or local call access. An absence of any one of these could cause BSO to incur unreasonable costs for long distance calls for access. Please describe alternatives to direct long distance charges if applicable.

107 Please confirm that your company’s system has scanning capability for all mail/correspondence pertaining to the claim file.

a) If so, state whether the images can be accessed real-time by the client.

b) If there is a delay, provide details of such delays.

108 Outline your company’s system abilities to report on each specific claim line as opposed to gross reporting on the incident.

109 State your company’s policy on the ability of any outside entity to enter notes into your company’s system and described how this is managed.

110 Outline how notes are categorized in your company’s system (i.e., by type or subject) and your company’s ability to select, or identify those notes pertaining to a particular category for review). Please explain the difference, if any, between Client access to notes vs. Adjuster access notes.

111 Please confirm that nurse’s notes are included in the same system as the adjuster notes within your company’s system.

a) Confirm if client has access to all nurse notes.

b) If so, indicate whether or not the notes are readable in real- time.

c) If there is a delay, provide details of such delays.

112 Confirm that your company’s system incorporates e-mail for easy communication between uses, permitting an email to be launched from the claim pages.

113 Confirm your company’s agreement to providing tapes or EDI transfer of data; loss runs, weekly transaction registers, claim updates, and 1099 reports on a timely basis and detail any additional charge.

Upload documents in "Exhibit C - Questionnaire and Checklist" area in Bonfire and label question # 117.

124 Please confirm your company’s agreement to provide a designated support/contact and backup for BSO.

125 Please detail any ongoing technical service assistance that would be provided to BSO that is included in your company’s fees as well as outlining costs for additional services.

126 Please confirm your company’s agreement to provide loss information to Gallagher Benefits Services (or other parties assigned by client) as requested.

If so, please provide the name of the individual who would be responsible for providing this information and working with Gallagher Benefits Services (or other parties assigned by client) on that information.

127 Please confirm your ability to automatically notify BSO regarding reserve updates that breach the Administrator’s reserve level.

If so, please provide details on how BSO is automatically notified.

128 Please provide details how your System can accommodate the use of form letters composed with input and direction from BSO.

129 Please provide details on the ability to customize data fields as per BSO requirements.

130 Provide a detailed overview of the technology infrastructure supporting your company’s initial reporting system, including components such as claims intake processes, database management systems, programming languages used for applications, hardware specifications, telephony systems, network switches, and other relevant technologies.

ACCOUNT MANAGEMENT

BSO believes coordination of service would best be accomplished with an empowered Account Executive. This individual should have excellent service management skills; analytical skills with strong spreadsheet, graphics, and database experience; a background in claims and risk management; and tenure within your organization. The Account Executive would need to have clear authority and lines to operation authority within your company’s organization so that required changes in service could be readily accomplished. We envision the Account Executive would have responsibilities to include:

a) Working cooperatively with BSO and its partners and/or vendors;

b) Monitoring and reporting on compliance to agreed Quality standards;

c) Using your company’s Claims/RMIS to analyze and report on performance, with a view towards discovering and communicating potential for continuous improvement;

d) Educating Successful Proposer’s team members regarding their performance and BSO expectations;

e) Developing satisfaction surveys, and survey reports on BSO satisfaction with various services;

f) Providing BSO with ongoing assistance in using your RMIS/claims management system and analyzing data in a pro-active manner;

g) Troubleshooting all problems related to service delivery/claims management, in coordination with the Successful Proposer’s claims office(s), BSO, business units, and locations;

h) Studying the potential benefits of new or revised services, and making recommendations for such; and

i) Assisting BSO and Marsh with special projects requests.

Please respond to the following:

131 Confirm your company’s agreement to ensure that the assigned Account Executive will be available to BSO 24/7.

137 Please confirm the availability of the Account Executive to travel, at no cost to BSO, and participate in meetings and training at a minimum of (4) times per year.

138 Should it become necessary, please describe the process for the replacement of the Account Executive and/or claims adjusters.

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