120174 O3, ADDENDUM THREE (3) Q&A ROUND2.pdf
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- Solicitation number
- 120174 O3
- Issued by
- Douglas County, Nebraska
About this file
This document is Solicitation Addendum Three (3) for Solicitation Number 120174 O3, issued by the Nebraska Department of Correctional Services (NDCS) on January 07, 2025. The addendum provides clarification and responses to bidder questions regarding a third-party administrator contract for processing medical and dental claims for incarcerated individuals. Key details include the bid opening date of January 22, 2025, at 2 p.m. CST, and guidance on the contractor's responsibilities for claims review and medical necessity determinations.
The addendum specifically addresses three key questions from previous amendments. First, it clarifies that NDCS performs internal preauthorization for outside medical appointments and will not provide consult documents to providers or contractors. Second, it confirms that the vendor will conduct claims reviews for service appropriateness, while NDCS maintains preauthorization utilization review responsibilities. Third, the document outlines that the contractor should independently review inpatient services for medical necessity, with the authority to deny or pend claims that do not meet medical necessity standards, and then notify NDCS of such actions. The addendum will be incorporated into the original solicitation and provides additional clarity on the expected roles and responsibilities of the claims processing contractor.
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Text version
SPB Form 26 Effective 7-19-2024
SOLICITATION ADDENDUM THREE (3) 120174 O3
QUESTIONS AND ANSWERS
Date: January 07, 2025
To: All Bidders
From: Julie Schiltz
NDCS
RE: Addendum for 120174 O3 to be opened January 22, 2025 at 2 p.m. CST
Questions and Answers
Following are the questions submitted and answers provided for the above-mentioned solicitation.
The questions and answers are to be considered as part of the solicitation. It is the responsibility of bidders to check the State Purchasing Bureau website for all addenda or amendments.
BIDDERS MUST REFER TO THE REVISED SCHEDULE OF EVENTS POSTED ON 12/09/2024.
Question Number
Section Reference
Page Number
Question State Response
1.
AMENDMENT 2
Q4 & Q5 p.2 of Amd 2
Within Amendment 2, questions 4 and 5, the NDCS states that providers are given a consult document for outpatient services that are authorized. Is the NDCS performing preauthorization determinations and providing this consult document directly to the provider? Is the contractor to be receiving a copy of the consult document prior to claims being issued?
The preauthorization that NDCS performs is an internal process that is done prior to the incarcerated individual being scheduled for an outside appointment or procedure.
Therefore, this won’t be provided to the provider or the contractor.
This has not been provided to the contractor previously, nor has a copy been given to the provider in all cases. If the contractor would find a copy helpful for payment processing this can be discussed.
2.
Q10 p.4 of
The NDCS’ response to Q10 in Amendment 2 states “the intent is not for the contractor to provide preauthorization services”.
If the contractor will not to be providing utilization review (preauthorization) of services on a pre-service review basis, is the NDCS requesting how bidders review both inpatient and outpatient claims prior to being
The vendor would be doing a claims review for appropriateness of the actual services provided and NDCS would be doing the preauthorization utilization review.
SPB Form 26 Effective 7-19-2024 paid under claim audit programs and procedures? Please explain how the NDCS wishes to have Utilization Review/Preauth vs.
Claim Reviews conducted and who initiates these services.
3.
Q11 p.4 of
Within Amendment 2, question 11, please clarify the response that states, “In the event inpatient services do not appear to be necessary the utilization management nurse will work with the case management to determine medical necessity continued management”.
If the contractor finds that an inpatient stay does not appear to be medically necessary, the response states the contractor should flag the claim and inform NDCS, at which point internal NDCS utilization management and care management will determine medical necessity. Is it the intent of NDCS to have the contractor deny or pend a claim for inpatient services for the NDCS to then review the claim and determine that medical necessity was not met?
The contractor should be doing an independent review of services to determine medical necessity and should deny or pend a claim that is not determined to be medically necessary. Then notify NDCS of said claims.
Yes, it is NDCS intent to have the contractor deny or pend the flagged claims.
This addendum will be incorporated into the solicitation.
Questions and Answers
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