15-236-SOL-00019_Questions_and_Answers_Final.pdf

Questions - RFP 15-236-SOL-00019

Solicitation

Page #

Section #

Section Title

Question

4 B.5 Pricing Tables Please clarify whether exactly 350,000 claims would fit in Tier 1 or Tier 2.

Answer: 350,000 claims is listed under Tier 1

1.3

Workload

This section estimates a monthly call volume of 2,500 calls per month and a written inquiry volume of 700 cases.

However, this number differs significantly from the number of calls and inquiries historically received by the current contractor. For example, in 2014, calls averaged 4,970 per month and written inquiries averaged 3,750 per month.

Please clarify whether a reduction in workload is anticipated.

Answer: A reduction in workload is not anticipated. If a potential respondent believes they have more accurate information based on experience, IHS expects the respondent to answer accordingly.

11 3.1.3 Task 1 - Claims Processing

System

Will IHS continue to approve exceptions to its payer of last resort policy, such as waiving an EOB or in the case of tribal self-insurance?

Answer: The “payor of last resort” is an IHS regulation and not policy. The IHS and all PRC programs operated under the Service are expected to adhere to this regulation including tribal self-insurance programs.

3.1.18

Task 1 - Claims Processing

System

Is it IHS’s intent that the Contractor pay all claims on an interim basis to allow providers to submit additional charges without the approval of IHS? If so, how long would a claim would be left in the interim pay status?

And/or, is it IHS’s intent that late charges are processed and will pend only if the PO is closed, and appear on the

Pended Claims Activity report for a new PO to be issued?

Answer: All PRC claims require authorization from the Service, interim payments may be made to allow providers time to submit all charges associated with a claim. Additional charges incurred after an initial claim requires IHS approval, however, because POs sometimes close as final, new POs are required since UFMS cannot re-open closed/paid POs. When interim payments prematurely close, the claims are listed on the Pended Claims Activity report requiring new POs.

13 3.1.27 Task 1 - Claims Processing

System Does IHS intend to modify the EFT process with banks, but not modify funding?

Answer: IHS intends to implement EFT for vendor payments and does not expect to modify funding.

3.2.1

Task II - Claims Payment and

Recovery

Is it IHS's intent that a non-government agency pay PPA interest with non-government funds?

Please clarify whether the phrase "any error" in this statement refers to all errors or only to errors caused by the contractor: "To the extent any error results in interest penalties owed and paid to the provider or supplier of services, the contract price established herein and paid to Contractor shall be reduced by an amount equivalent to the interest penalty paid."

Answer: It is not the Agency’s intent that a non-government agency pay PPA interest with non-government funds.

The phrase any error refers to errors caused by the contractor.

3.2.6.3

Schedule of Services

Paragraph 1 states that the Dental Schedule of Services is intended as a guide. Does this mean that if a Tribe using the FI wishes to pay for services that the Dental Professional Specialty Group has determined to be a Level 9 exclusion (e.g., resin based composite crowns) because the Tribe has included it in a contract with a Tribal dental provider, the FI could pay it?

Answer: Yes – please see paragraph 2, for those programs with negotiated contracts in place, the Contractor’s system must accommodate the specification of services and incorporate the filed fees of these contracts.

21 3.4.13 Quality of Care Screens Please clarify whether "Quality of Care Screens" is referring to the edits for the Quality of Care Report in section

5.6.2.

Answer: Yes the Quality of Care Screens identified in section 3.4.13 refers to the Quality of Care Report in section 5.6.2.

21 3.4.14.1 Payment Information Please provide the maximum amount required for Overdraft Funding.

Answer: There is no maximum amount required for overdraft funding but historically overdraft funding has reached approximately $2,000,000.

5.7.6

On Request Reports -

Provider Cost Effectiveness

Reports

Please define a "Marketplace plan" (5.7.6.b) and/or explain the difference between an alternate resource and a

"Marketplace" plan.

Answer: A Marketplace plan is a health coverage plan purchased on the Health Insurance Marketplace.

Alternate resources are those health care resources other than the IHS and can be private insurance, Medicare/Medicare, State insurance plans.

3 5 D.1, D.2, D.3 Packaging and Marking Please clarify which deliverables require packaging and mailing.

Answer: Those deliverables identified in section F.3 Delivery Schedule if unavailable electronically or as requested the COR and PRC Programs.

36 E.1 Inspection and Acceptance Paragraph 1: This section references all work described in Section 2; however, Section 2 only contains definitions.

Please clarify whether this is referring to Section 3.

Answer: This section refers to section 3

36 E.1 Inspection and Acceptance Paragraph 4: Please provide a copy of Table 10 referenced in the last sentence.

Answer: See Quality Control Record (copy to be attached).

40, 43 F.4 and G.1.3 Technical Monitoring Please clarify whether section F.4 or G.1.3 is to be used for Technical Monitoring of the contract.

Answer: Both sections apply.

43 G.2 Invoice Submission Please clarify what the "required back-up documentation" includes as referenced in the first sentence under G.2.

Answer: “Back up documentation” includes the number of claims processed for each Area, service unit and tribal PRC program.

45 G.2 Invoice Submission Please provide a working link for (2) Prompt Payment Act 31 U.S.C. 3903.

Answer: An amended version of the solicitation has been provided with a working link.

45 G.3.1 Other Personnel

Replacements Is it the intent of IHS to review resumes for all contractor positions?

Answer: The IHS will review resumes for key personnel.

H.3.b

HHS-Controlled Facilities and Information Systems

Security

Please provide working links for 1. HHS Information Security Program Policy and 2. HHS Office of Security and

Drug Testing, Personnel Security/Suitability Handbook.

Answer:

1. http://www.hhs.gov/ocio/securityprivacy/index.html

2. http://www.governmentattic.org/4docs/HHS-NatnlSecInfoManual_2005.pdf

49 H.5 H.5 Security of Data Please provide a working link for the HHS Departmental Information Security Policies.

Answer: An amended version of the solicitation has been provided with a working link.

H.6

HHSAR 352.239-72 (b)

Electronic and Information

Technology Accessibility

Please provide a working link for (c) Section 508 Product Assessment Template.

50 H.7 Information Security and

Privacy Requirements Please provide a working FISMA link.

52 8.1 Clauses Incorporated by

Reference Please confirm that FAR clause 52.216-31 does not apply to Firm Fixed Price contracts.

Answer: This clause does not apply. An amended version of the solicitation has been provided.

53 8.1 Clauses Incorporated by

Reference Please confirm that the FAR clause referencing Changes - Fixed Price is 52.243-1 instead of 52.242-1.

Answer: Yes. An amended version of the solicitation has been provided.

66, 75 L.1

L.4

General Instructions Price

Volume Instructions Please clarify whether offeror must state the offer is firm for a period of at least 60 days (p. 66) or 120 days (p. 75)

Answer: All proposals must be firm for 120 days

68 L.2 Technical Volume

Instructions Please provide any text missing from the bottom of Technical Criterion-A.

Answer: All text is included in the original document

69 L.2 Technical Volume

Please provide any text missing from the bottom of Technical Criterion-B.

Answer: All text is included in the original document

71 L.2 Technical Volume

Please provide a working link for Section 508 Final Provisions.

72 L.3 Past Performance Volume

Please provide the text missing from the bottom of the “Description” column.

Answer: An amended version of the RFP has been made available to correct the table for this section.

75 L.4 Price Volume Instructions Please clarify whether 1. (F) is required as part of the proposal submission for an Firm Fixed Price contract.

Answer: No this is not, in amendment 001 this has been removed.

75 L.4 Price Volume Instructions Please provide a working link for the "Small Business Subcontracting Plan" model.

Answer: An amended version of the solicitation has been provided with a working link.

1-6 Attachment F Past Performance

Questionnaire

Since the Past Performance Surveys are to be completed by outside references, would IHS consider extending the due date beyond May 21, 2015 submission deadline?

Answer: Per amendment 001 of the solicitation, the new due date for proposals is 4:00pm EST on May 27, 2015

N/A

Previous solicitations have included instructions for assumptions, conditions, and exceptions; however, the current solicitation does not appear to have instructions for these items. How would IHS like the offeror to submit these items in response to the current solicitation?

Answer: All offerors should address assumptions, conditions, and exceptions on as needed basis and note them appropriately in the narrative, tables, etc.

6 Section C 1.3 Workload The annual claims volume is listed at approximately 466,000 for medical and dental annually. How many are medical claims? How many are dental claims?

Answer: The IHS estimates that 1% of processed claims for Federal PRC programs are dental claims.

19 Section C 3.4.0 Task IV

Data/Information/Reporting

(3.4.9)

What percent of claims are received as Paper vs. Electronic?

Answer: Although claims are received in both paper and electronic format, all PDOs, claims and attachments are electronically scanned and digitally stored for processing.

14 Section C 3.2.4.0 Processing, Timeliness & Accuracy

(3.2.4.1.1)

The stated performance goal is to "process and pay all clean claims within 30 days". Assuming this is processing

100% of the claims within the 30 days, what is the penalty for non-compliance?

Answer: The performance goal is to process “clean claims” within 30 days and the performance measure is 97%. If the contractor fails to meet the performance measure, a corrective action plan may be implemented, future option periods may not be exercised or the contract could be terminated.

15 Section C 3.2.6 Dental Claims Specific information is provided for the Dental Benefits, however not so much for Medical. Is there a benefit structure for Medical or is it "pay as presented" similar to Medicaid?

Answer: The IHS follows the Centers for Medicare and Medicaid Services (CMS) prospective payment system and requirements.

15 Section C 3.2.6 Dental Claims (3.2.6.2) The RFP states "the Contractor shall provide a dedicated dental claims processing component to assure adjudication and administration". Does the Contractor have to create a separate unit for dental claims or can the

Contractor have the ability to report the dental claims separately from the Medical claims? There is no mention of a Pharmacy Benefit, is there one?

Answer: The contractor does not have to create a separate unit for dental claims but must have the ability to report dental claims separately from medical claims. Additionally pharmacy Benefits are included in the medical claims.

25 Section C 3.6.8 Transition of Contract

Operations (3.6.8.4) The RFP states "any claims not paid as of the date of termination, shall be transitioned to the successors contractor"? What is the estimated volume of claims that will be transitioned?

Answer: It is estimated that 116,000 could be transferred during transition the period.

25 Section C 3.6.8 Transition of Contract

Operations (3.6.8.5) Six months from being awarded the Contract the succesor contractor will begin receiving, processing, and making payments for all claims from all open fiscal years. What is the estimated number of claims that are incurred but not reported (IBNR)?

Answer: The IHS does not have this information at this time.

25 Section C 3.6.8 Transition of Contract

Operations (3.6.8.5) What is the name of the incumbent contractor?

Answer: Blue Cross and Blue Shield of New Mexico, a division of Health Care Service Corporation, a Mutual Legal

Reserve Company.

Is there a budget for the proposed work? What is the value of the existing contract?

Answer: The awarded amount for the existing contract is $75million over (5) years.

66 Section L L.1 General Instructions Will the submission deadline be extended beyond May 21?

Answer: Per Amendment 001 of the solicitation, the due date for proposals is 4:00pm EST on May 27, 2015

25 Section C 3.6.8 Transition of Contract

Operations (3.6.8.5) Is this a new requirement or a follow-on to the existing work?

Answer: This is a new requirement/contract.

13 Section C 3.2.0 Task II Claims

Payment & Recovery Does the agency have its own medical policy or will they rely on the contractor to provide? If so, will the contractor be expected to use both policies?

Answer: The Agency follows the CMS prospective payment system and requirements for billing and reimbursement which the contractor is required to follow. Medical policies and procedures including the IHS medical priority system is determined by the Agency.

24 Section C 3.6.0 Task VI Management

(3.6.8) Will the contractor have access to claims processed by the previous contractor in order to double check, or adjust as needed?

Answer: Access will be provided to those claims that may need to be adjusted.

15 Section C 3.2.0 Task II Claims

Payment & Recovery (3.2.6) Does the contractor canvas for Cost of Benefit (COB) information or other third party?

Answer: The contractor is responsible for the coordination of benefits to ensure that the IHS is the payer of last resort resolving any discrepancies on purchase orders and provider invoices before exhausting applicable alternate resources and issuing payments.

16 Section C 3.2.6.4 Referrals It would appear that some services require prior authorization. For what services will the contractor be responsible to support?

Answer: The contractor is responsible for processing and paying authorized PRC referrals. Claims can only be paid if they are accompanied by all the appropriation documentation including the purchase delivery order. If claims are submitted without the proper documentation, the contractor will be responsible for contacting the provider, service unit or tribal program to ensure the appropriate documentation is provided.

19 Section C 3.4.0 Task IV

Data/Information/Reporting

(3.4.9)

How often and through what method will the contractor receive enrollment files? Will there be any retroactive changes to enrollment files?

Answer: Enrollment files are updated for each recurring episode. The Resource Patient Management System (RPMS) interfaces through CHSMIS system for patient registration information/enrollment files. Health insurance/alternate resources information are included on purchase orders and transmitted electronically to the contractor. The Contractor is responsible for developing a database to collect and maintain this information.

17 Section C 3.4.0 Task IV

Data/Information/Reporting Will the contractor be expected to provide a full back end solution?

Answer: Yes.

13 Section C 3.2.0 Task II Claims

Payment & Recovery Does the contractor have to provide special investigation services?

Answer: The breadth of special investigative services related to this contract consist of those necessary to conduct coordination of benefits.

?13 Section C 3.2.0 Task II Claims

Payment & Recovery Are there written standard operational procedures to share?

Answer: There are standard operational procedures for filing claims.

13 Section C 3.2.0 Task II Claims

Payment & Recovery Are there any objections to processors or CSR's telecommuting?

Answer: There are no objections to customer service representatives telecommuting as long as security, HIPPA and telecommunication protocols are enforced and all CSRs have access to necessary information to assist customers.

21 Section C 3.4.0 Task IV

Data/Information/Reporting

(3.4.14)

Claims timeliness is calculated when the check is issued, so in the event that the account is suspended as described on page 21, how will the contractor be assured that claims timeliness is not adversely impacted by their funding delay?

Answer: In the situation described above, the contractor must provide overdraft protection for the IHS to ensure all checks presented for payment during the period in question are cleared and paid.