2-RFP 26-0028-5 Health Claims Audit.pdf

Purchasing &

Contracting Department

1117 Eisenhower Drive, Suite C, Savannah, Georgia 31406

(912) 790-1618

REQUEST FOR PROPOSALS

RFP NO. 26-0028-5

ANNUAL CONTRACT TO PROVIDE HEALTH CLAIMS AUDIT

WEBEX PRE-PROPOSAL CONFERENCE: 11:00A.M., MARCH 12, 2026

PROPOSALS RECEIVED BY: 5:00 P.M., APRIL 2, 2026

CHATHAM COUNTY, GEORGIA

OFFICE OF THE PURCHASING DIRECTOR

1117 EISENHOWER DRIVE, SUITE C

SAVANNAH, GEORGIA 31406

(912) 790-1619

DATE: March 6, 2026 RFP NO.: 26-0028-5

GENERAL INFORMATION FOR REQUEST FOR PROPOSALS

This is an invitation to submit a proposal to supply Chatham County with services as indicated herein. Proposals shall be submitted on-line on the County’s procurement portal https://chathamcountyga.bonfirehub.com/portal up to 5:00 P.M., APRIL 2, 2026. The

Purchasing Director reserves the right to reject any and all proposals and to waive formalities.

Instructions for preparation and submission of a qualification proposal are contained in the Request for Proposal package. Please note that specific forms for submission of a proposal are required.

A Pre-Proposal Conference has been scheduled to discuss the specifications and to resolve any questions and/or misunderstandings that may arise. The Pre-Proposal Conference will be held via WebEx only, on March 12, 2026 at 11:00A.M. You are encouraged to attend.

Meeting link:

https://chathamcountyga.webex.com/chathamcountyga/j.php?MTID=m4c1a996d931c76af187ca

6dc1e3abcde

Meeting number: 2303 821 0592

Meeting password: jPRmspDM873

Join from a video system or application

Dial 23038210592@chathamcountyga.webex.com

You can also dial 173.243.2.68 and enter your meeting number.

Join by phone

+1-415-655-0001 Toll

Access code: 23038210592

Global call-in numbers https://chathamcountyga.webex.com/chathamcountyga/globalcallin.php?MTID=m190f4193b91d

1572ed0e8ddc997a6945

Any changes to the conditions and specifications must be in the form of a written addendum to be valid; therefore, the Purchasing Director will issue a written addendum to document approved changes.

https://chathamcountyga.bonfirehub.com/portal

Chatham County has an equal opportunity procurement policy. Chatham County seeks to ensure that all segments of the business community have access to providing services needed by County programs. The County affirmatively works to encourage utilization of disadvantaged and minority business enterprises in our procurement activities. The County provides equal opportunity for all businesses and does not discriminate against any persons or businesses regardless of race, color, religion, age, sex, national origin or handicap. The County expects its consultants to make maximum feasible use of minority businesses and qualified minority employees. The terms "disadvantaged business", "minority business enterprise", and "minority person" are more specifically defined and explained in the Chatham County Purchasing Ordinance.

SECTION I

INSTRUCTIONS TO PROPOSERS

1.1 PURPOSE: The purpose of this document is to provide general and specific information for use in submitting a qualification proposal to supply Chatham County with services as described herein. All proposals are governed by the Code of Chatham County, Chapter 4, Article IV, and the laws of the State of Georgia.

1.2 HOW TO PREPARE PROPOSALS: All proposals shall be:

A. Proposers are encouraged to review carefully all provisions and attachments of this document prior to submission. Each proposal constitutes an offer and may not be withdrawn except as provided herein.

1.3 HOW TO SUBMIT PROPOSALS: All proposals shall be:

A. Submitted on-line on the County’s procurement portal at:

https://chathamcountyga.bonfirehub.com/portal.

** In submitting their proposal, the proposer certifies that he/she has carefully read all related Request for

Proposal documents and agrees to comply with all provisions.

B. If a proposer is unable to submit their proposal on-line, they should notify the procurement contact for the solicitation at least one week prior to proposals being due to receive instructions. The County is seeking to conduct all solicitations on-line. The phone number for Purchasing and Contracting is 912-790-1618.

1.4 HOW TO SUBMIT AN OBJECTION: Objections from Offerors to this Request for

Proposals and/or these specifications should be brought to the attention of the County

Purchasing Director in the following manner:

A. When a pre-proposal conference is scheduled, the Proposer may object in writing any time prior to or at the pre-proposal conference.

B. When a pre-proposal conference is not scheduled, the Proposer shall object in writing not less than five (5) days prior to the Date for submission.

C. The objections contemplated must pertain to both form and substance of the

Request for Proposal documents. Failure to object in accordance with the above procedure will constitute a waiver on the part of the business to protest this Request for Proposal.

1.5 ERRORS IN PROPOSALS: Proposers or their authorized representatives are expected to fully inform themselves as to the conditions, requirements, and specifications before submitting proposals. Failure to do so will be at the Proposer's own risk.

1.6 STANDARDS FOR ACCEPTANCE OF PROPOSERS FOR CONTRACT AWARD:

The County reserves the right to reject any or all Proposals and to waive any irregularities or technicalities in Proposals received whenever such rejection or waiver is in the best interest of the County. The County reserves the right to reject the Offer of a Proposer who has previously failed to perform properly or complete on time contracts of a similar nature, whom investigation shows is not in a position to perform the contract.

1.7 PROPOSER: Whenever the term "Proposer" is used, it shall encompass the "person", "business", "firm", or other party submitting a proposal to Chatham County in such capacity before a contract has been entered into between such party and the County.

1.8 COMPLIANCE WITH LAWS: The Proposer shall obtain and maintain all licenses, permits, liability insurance, workman's compensation insurance and comply with any and all other standards or regulations required by Federal, State or County statute, ordinances and rules during the performance of any contract between the Proposer and the County.

Any such requirement specifically set forth in any contract document between the Proposer and the County shall be supplementary to this section and not in substitution thereof.

1.9 CONSULTANT: Consultant or subconsultant means any person, firm, or business having a contract with Chatham County. The Consultant certifies that the firm will follow equal employment opportunity practices in connection with the awarded contract as more fully specified in the contract documents.

1.10 LOCAL PREFERENCE: The Consultant agrees to follow the local preference guidelines as more fully specified in the contract documents.

1.11 DEBARRED FIRMS AND PENDING LITIGATION: Any potential proposer/firm listed on the Federal or State of Georgia Excluded Parties Listing (Barred from doing business) will not be considered for contract award. It is the proposer’s responsibility to inform the County should the proposer/firm be placed on the Federal or State of Georgia

Excluded Parties Listing during the proposal process. Proposers shall disclose any record of pending criminal violations (Indictment) and/or convictions, pending lawsuits, etc., and any actions that may be a conflict of interest occurring within the past five (5) years. Any proposer/firm previously defaulting or terminating a contract with the County will not be considered. Successful proposers with whom the County enters into a contract with for goods or services will notify the County if they become debarred during the course of the contract.

** All bidders or proposers are to read and complete the Disclosure of Responsibility

Statement. Failure to do so may result in your solicitation response being rejected as non-responsive.

Bidder acknowledges that in performing contract work for the Board, bidder shall not utilize any firms that have been a party to any of the above actions. If bidder has engaged any firm to work on this contract or project that is later debarred, Bidder shall sever its relationship with that firm with respect to Board contract.

1.12 PERFORMANCE EVALUATION: On April 11, 2008, the Chatham County Board of

Commissioners approved a change to the County Purchasing Ordinance requiring

Contractor/Consultant Performance Evaluations, at a minimum, annually, prior to contract anniversary date.

Should Contractor/Consultant performance be unsatisfactory, the appointed County

Project Manager for the contract may prepare a Contractor/Consultant Complaint Form or a Performance Evaluation to the County Purchasing Director.

SECTION II

PROPOSAL CONDITIONS

2.1 SPECIFICATIONS: Any obvious error or omission in specifications shall not inure to the benefit of the bidder but shall put the Proposer on notice to inquire of or identify the same to the County.

2.2 MULTIPLE PROPOSALS: No Proposer will be allowed to submit more than one offer.

Any alternate proposals must be brought to the Purchasing Director's attention during the

Pre-proposal Conference or submitted in writing at least five (5) days preceding the date for submission of proposals.

2.3 OFFERS TO BE FIRM: The Proposer warrants that terms and conditions quoted in his offer will be firm for acceptance for a period of sixty (60) days from bid date submitted, unless otherwise stated in the proposal. When requested to provide a fee proposal, fees quoted must also be firm for a sixty-day period.

2.4 COMPLETENESS: All information required by the Request for Proposals must be completed and submitted to constitute a proper proposal.

2.5 LIABILITY PROVISIONS: Where Proposers are required to enter or go into Chatham

County property to take measurements or gather other information in order to prepare the proposal as requested by the County, the Proposer shall be liable for any injury, damage or loss occasioned by negligence of the Proposer, his agent, or any person the Proposer has designated to prepare the Offer and shall indemnify and hold harmless Chatham County from any liability arising therefrom. The contract document specifies the liability provisions required of the successful Proposer in order to be awarded a contract with

Chatham County.

2.6 CERTIFICATION OF INDEPENDENT PRICE DETERMINATION: By submission of this Offer, the Proposer certifies, and in the case of a joint offer, each party thereto certifies as to its own organization, that in connection with this procurement:

(1) The prices in this offer have been arrived at independently, without consultation, communication, or agreement, for the purpose of restricting competition, as to any matter relating to such prices with any other competitor;

(2) Unless otherwise required by law, the prices which have been quoted in this offer have not been knowingly disclosed by the Proposer and will not knowingly be disclosed by the Proposer prior to opening, directly or indirectly to any other competitor; and

(3) No attempt has been made or will be made by the Proposer to induce any other person or firm to submit or not submit an offer for the purpose of restricting competition.

2.7 AWARD OF CONTRACT: The contract, if awarded, will be awarded to that responsible Proposer whose proposal will be most advantageous to Chatham County, price and other factors considered. The Board of Commissioners will make the determination as to which proposal best serves the interest of Chatham County.

2.8 PROCUREMENT PROTESTS: Objections and protests to any portion of the procurement process or actions of the County staff may be filed with the Purchasing

Director for review and resolution. The Chatham County Purchasing Ordinance – Part 9

– Vendor Disputes shall govern the review and resolution of all protests.

2.9 QUALIFICATION OF BUSINESS (RESPONSIBLE PROPOSER): A responsible

Proposer is defined as one who meets, or by the date of the acceptance can meet, all requirements for licensing, insurance, and service contained within this Request for

Proposals. Chatham County has the right to require any or all Proposers to submit documentation of the ability to perform the service requested.

Chatham County has the right to disqualify the proposal of any Proposer as being unresponsive or unresponsible whenever such Proposer cannot document the ability to deliver the requested service.

2.10 COUNTY TAX CERTIFICATE REQUIREMENT: A current Chatham County or municipal business license (within the State of Georgia) is required unless otherwise specified. A firm need not have a Chatham County Business License prior to submitting a proposal. However, a license must be obtained by the successful vendor prior to award of contract.

Please contact the Chatham County Department of Building Safety and Regulatory Services at (912) 201-4300 for additional information.

NOTE: No contract shall be awarded unless all real and personal property taxes have been paid by the successful consultant and/or subconsultant as adopted by the Board of

Commissioners on 8 April 1994.

2.11 INSURANCE PROVISIONS, GENERAL: The selected Contractor shall be required to procure and maintain for the duration of the contract insurance against claims for injuries to persons or damages to property, which may arise from or in connection with the performance of the work, hereunder by the Consultant, his agents, representatives, employees or subconsultants. The cost of such insurance shall be included in the Bid.

It is every Consultant’s responsibility to provide the County Purchasing and Contracting

Division current and up-to-date Certificates of Insurance and Declaration Sheets for multiple year contracts before the end of each term. Failure to do so may be cause for termination of contract.

2.11.1 General Information that shall appear on a Certificate of Insurance:

I. Name of the Producer (Consultant’s insurance Broker/Agent).

II. Companies affording coverage (there may be several).

III. Name and Address of the Insured (this should be the Company or Parent of the firm Chatham County is contracting with).

IV. Summary of all current insurance for the insured (includes effective dates of coverage).

V. A brief description of the operations to be performed, the specific job to be performed, or contract number.

VI. Certificate Holder (This is to always include Chatham County).

Chatham County as an “Additional Insured”: Chatham County invokes the defense of “sovereign immunity.” In order not to jeopardize the use of this defense, the County is not to be included as an “Additional Insured” on insurance contracts.

2.11.2 Minimum Limits of Insurance to be maintained for the duration of the contract:

A. Commercial General Liability: Provides protection against bodily injury and property damage claims arising from operations of a Consultant or Tenant. This policy coverage includes: premises and operations, use of independent consultants, products/completed operations, personal injury, contractual, broad form property damage, and underground, explosion and collapse hazards. Minimum limits: $1,000,000 bodily injury and property damage per occurrence and annual aggregate.

B. Worker's Compensation and Employer’s Liability: Provides statutory protection against bodily injury, sickness or disease sustained by employees of the Consultant while performing within the scope of their duties.

Employer’s Liability coverage is usually included in Worker’s

Compensation policies, and insures common law claims of injured employees made in lieu of or in addition to a Worker’s Compensation claim.

Minimum limits: $500,000 for each accident, disease policy limit, each employee and Statutory Worker’s Compensation limit.

C. Business Automobile Liability: Coverage insures against liability claims arising out of the Consultant’s use of automobiles. Minimum limit:

$1,000,000 combined single limit per accident for bodily injury and property damage. Coverage should be written on an “Any Auto” basis.

2.11.3 Special Requirements:

Claims-Made Coverage: The limits of liability shall remain the same as the occurrence basis, however, the Retroactive date shall be prior to the coincident with the date of any contract, and the Certificate of Insurance shall state the coverage is claims-made. The Retroactive date shall also be specifically stated on the

Certificate of Insurance.

A. Extended Reporting Periods: The Consultant shall provide the County with a notice of the election to initiate any Supplemental Extended

Reporting Period and the reason(s) for invoking this option.

B. Reporting Provisions: Any failure to comply with reporting provisions of the policies shall not affect coverage provided in relation to this request.

C. Cancellation: Each insurance policy that applies to this request shall be endorsed to state that it shall not be suspended, voided, or canceled, except after thirty (30) days prior to written notice by certified mail, return receipt requested, has been given to the County.

D. Proof of Insurance: Chatham County shall be furnished with certificates of insurance and with original endorsements affecting coverage required by this request. The certificates and endorsements are to be signed by a person authorized by the insurer to bind coverage on its behalf. All certificates of insurance are to be submitted prior to, and approved by, the County before services are rendered. The Consultant must ensure Certificate of Insurance are updated for the entire term of the County contract.

E. Insurer Acceptability: Insurance is to be placed with an insurer having an

A.M. Best’s rating of A and a five (5) year average financial rating of not less than V. If an insurer does not qualify for averaging on a five year basis, the current total Best’s rating will be used to evaluate insurer acceptability.

F. Lapse in Coverage: A lapse in coverage shall constitute grounds for contract termination by the Chatham County Board of Commissioners.

G. Deductibles and Self-Insured Retention: Any deductibles or self-insured retention must be declared to, and approved by, the County. At the option of the County, either: the insurer shall reduce or eliminate such deductibles or self-insured retention as related to the County, its officials, officers, employees, and volunteers; or the Consultant shall procure a bond guaranteeing payment of related suits, losses, claims, and related investigation, claim administration and defense expenses.

2.11.4 Additional Coverage for Specific Procurement Projects:

a. Professional Liability: Insure errors or omission on behalf of architects, engineers, attorneys, medical professionals, and consultants.

Minimum Limits: $1 million per claim/occurrence

Coverage Requirement: If claims-made, retroactive date must precede or coincide with the contract effective date or the date of the Notice to Proceed. The professional must state if tail coverage has been purchased and the duration of the coverage.

b. Builder’s Risk: (For Construction or Installation Contracts) Covers against insured perils while in the course of construction.

Minimum Limits: All-Risk coverage equal 100% of contract value

Coverage Requirements: Occupancy Clause - permits County to use the facility prior to issuance of Notice of Substantial Completion.

2.12 INDEMNIFICATION: The PROPOSER agrees to protect, defend, indemnify, and hold harmless Chatham County, Georgia, its commissioners, officers, agents, and employees from and against any and all liability, damages, claims, suits, liens, and judgments, of whatever nature, including claims for contribution and/or indemnification, for injuries to or death of any person or persons, or damage to the property or other rights of any person or persons caused by the PROPOSER or its subproposers. The PROPOSER’s obligation to protect, defend, indemnify, and hold harmless, as set forth herein above shall include, but not be limited to, any matter arising out of any actual or alleged infringement of any patent, trademark, copyright, or service mark, or any actual or alleged unfair competition, disparagement of product or service, or other business tort of any type whatsoever, or any actual or alleged violation of trade regulations. PROPOSER further agrees to investigate, handle, respond to, provide defense for, and to protect, defend, indemnify, and hold harmless Chatham County, Georgia, at his sole expense, and agrees to bear all other costs and expenses related thereto, even if such claims, suits, etc., are groundless, false, or fraudulent, including any and all claims or liability for compensation under the Worker's

Compensation Act arising out of injuries sustained by any employee of the PROPOSER or his subconsultant or anyone directly or indirectly employed by any of them.

The PROPOSER’s obligation to indemnify Chatham County under this Section shall not be limited in any way by the agreed-upon contract price, or to the scope and amount of coverage provided by any insurance maintained by the PROPOSER.

2.13 COMPLIANCE WITH SPECIFICATION - TERMS AND CONDITIONS: The

Request for Proposals, Legal Advertisement, General Conditions and Instructions to

Proposers, Specifications, Special Conditions, Proposers Offer, Addendum, and/or any other pertinent documents form a part of the Offeror's proposal and by reference are made a part hereof.

2.14 SIGNED RESPONSE CONSIDERED AN OFFER: The submitted Response shall be considered an offer on the part of the Proposer, which offer shall be deemed accepted upon approval by the Chatham County Board of Commissioners, Purchasing Director or his designee. In case of a default on the part of the Proponent after such acceptance, Chatham

County may take such action, as it deems appropriate, including legal action for damages or lack of required performance.

2.15 NOTICE TO PROCEED: The successful proposer shall not commence work under this

Request for Proposal until a written contract is awarded and the Purchasing Director or his designee issues a Notice to Proceed. If the successful Proposer does commence any work or deliver items prior to receiving official notification, he does so at his own risk.

2.16 PAYMENT TO CONTRACTOR: Instructions for invoicing the County for service delivered to the County are specified in the contract document.

A. Questions regarding payment may be directed to the Finance Department at (912)

652-7905 or the County’s Project Manager as specified in the contract documents.

B. Contractor will be paid the agreed upon compensation upon satisfactory progress or completion of the work as more fully described in the contract document.

C. Upon completion of the work, the Contractor will provide the County with an affidavit certifying all suppliers, persons or businesses employed by the Contractor for the work performed for the County have been paid in full.

D. Chatham County is a tax-exempt entity. Every contractor, vendor, business or person under contract with Chatham County is required by Georgia law to pay State sales or use taxes for products purchased in Georgia or transported into Georgia and sold to Chatham County by contract. Please consult the State of Georgia, Department of Revenue, Sales and Use Tax Unit in Atlanta (404) 656-4065 for additional information.

2.17 LICENSES, PERMITS, AND TAXES: The price or prices for the service shall include full compensation for all fees that the proponent is or may be required to pay. Chatham

County is Tax Exempt. The Purchasing & Contracting Office upon request (912) 790-

1623 will provide a Tax Exemption Certificate.

2.18 MINORITY – WOMEN BUSINESS ENTERPRISE PARTICIPATION: It is the desire of the County Board of Commissioners to increase the participation of minority (MBE) and women-owned (WBE) business in its contracting and procurement programs.

The County is committed to a policy of equitable participation for these firms by setting goals for each contract. Bidder/proposers are requested to include in their proposals a narrative describing their past accomplishments and intended actions in this area. If bidder/proposers are considering minority or women owned enterprise participation in their proposal, those firms, and their specific duties must be identified in their proposal along with the percentage(s) and dollar amount awarded to the MBE/WBE firm. Proposers may also provide demographic information regarding their employees to show their commitment to equal opportunity. If a bidder/proposer is considered for award, he/she will be asked to meet with the County Staff so that the intended MBE/WBE participation goals can be formalized and included in the subsequent contact.

For information on the program or MBE/WBE contractors/vendors please contact the

Chatham County Minority and Women Business Office, 1117 Eisenhower Drive, Suite

101, Savannah, Georgia 31406, (912) 652-7828 phone, (912) 652-7951 fax.

REQUEST FOR PROPOSALS

GENERAL CONDITIONS

SECTION III

3.1 DESCRIPTION AND OBJECTIVES: Chatham County Board of Commissioners is soliciting proposals from qualified companies to provide health claims audit of the

County’s medical and prescription drug plan claims. The contract will be for one (1) year with renewal options for four (4) additional one (1) year terms. This RFP seeks to identify potential providers for the above-mentioned services. All respondents to this RFP are subject to instructions communicated in this document and are cautioned to completely review the entire RFP and follow instructions carefully. Chatham County reserves the right to reject any or all RFP’s and to waive technicalities and informalities at the discretion of Chatham County.

3.2 METHODOLOGY: The procurement described herein may be conducted in a two-step process.

STEP ONE- ACCEPTANCE AND EVALUATION OF QUALIFICATION

PROPOSALS: All technical requirements, unless otherwise specified, must be met by the proponent or such proposal may be disqualified as being non-responsive. Proposals that are deemed incomplete as to substance and content may be returned without consideration. A shortlist of qualified firms will be developed and ranked.

In the interest of a fair, objective and competitive process, Chatham County intends to accept all qualified proposals and give them complete and impartial consideration.

Any proposal which does not meet all technical requirements may be disqualified as being non-responsive.

Proposals which are deemed to be incomplete as to substance and content may be returned without consideration. Proponents whose proposals are not accepted will be promptly notified that they are not being further considered and why.

Recommending proponents that best qualify for the short list will be done through a committee evaluation process based on established technical criteria as described herein.

Final decision on the staff’s recommendation is made by the Board of Commissioners.

STEP TWO-INTERVIEWS: The evaluation committee may request an interview with short-listed firms. If interviews are conducted, they will be scored. It will be at the discretion of the evaluation committee on the number of firms that will interview/present.

3.3 PRE-PROPOSAL CONFERENCE: A Pre-Proposal Conference has been scheduled to discuss the specifications and to resolve any questions and/or misunderstandings that may arise. The Pre-Proposal Conference will be held via WebEx only, on March 12, 2026 at

10:00A.M.

3.4 PROPOSAL DEADLINE: The response to this ‘Request for Proposal” must be received on-line on the County’s procurement portal no later than 5:00 P.M., March 31, 2026.

http://chathamcountyga.bonfirehub.com/portal

For good and sufficient reason, up to 24 hours before the advertised deadline, the County may extend the response schedule. An addendum will be issued setting forth the new date and time.

3.5 CONFIDENTIALITY OF DOCUMENTS: Upon receipt of a proposal by the County, the proposal shall become the property of the County without compensation to the proponent, for disposition or usage by the County at its discretion (except for as provided by Georgia law for proprietary information). The details of the proposal documents will remain confidential until final award or rejection of proposals and/or protected under the restraints of law. Only final points and ranking of proposals will be openly disclosed prior to approval by the Board of Commissioners. Proponent shall have no contact with any

Department Representative or Evaluation Committee Member during and after the evaluation process. Any information contained in the proposal that is considered by the

Proponent as “proprietary” to remain confidential shall be clearly identified and justified.

3.6 CONE OF SILENCE: Lobbying of Procurement Evaluation Committee members, County Government employees, and elected officials regarding this product or service solicitation, Invitation to Bid (ITB) or Request for Proposal (RFP) or contract by any member of a proposer’s staff, or those people employed by any legal entity affiliated with an organization that is responding to the solicitation is strictly prohibited. Negative campaigning through the mass media about the current service delivery is strictly prohibited. Such actions may cause your proposal to be rejected.

3.7 COMPENSATION: The County has attempted in SECTION V to provide as much information about the project as possible to enable firms to structure their offer.

3.8 REJECTING PROPOSALS: The County reserves the right to reject any or all proposals and is not bound to accept any proposal if that proposal is contrary to the best interest of Chatham County. Similarly, the County is not bound to accept the lowest dollar proposal if the offer is not considered in the County's best interest.

3.9 COST TO PREPARE RESPONSES: The County assumes no responsibility or obligation to the respondents and will make no payment for any costs associated with the preparation or submission of the proposal.

3.10 INQUIRIES: Direct any questions related to this RFP to Ms. Jean Fleming, Asst.

Purchasing Director, and submit all questions through the County’s procurement portal https://chathamcountyga.bonfirehub.com/portal Q&A section. Include the RFP number, page, and paragraph number as a reference to each question. DEADLINE FOR ALL

QUESTIONS IS LISTED ON THE BONFIRE PORTAL.

THE ONLY OFFICIAL ANSWER OR POSITION OF CHATHAM COUNTY WILL BE

THE ONE STATED IN WRITING.

3.11 METHOD OF SOURCE SELECTION: Chatham County is using the Competitive

Sealed Proposal method of source selection, as authorized by Part 3 of the Chatham

County Purchasing Ordinance for this procurement.

An award, if made, will be made to the responsible offeror whose proposal is most advantageous to Chatham County, taking into consideration price and other factors set forth in this Request for Proposal (RFP). The County will not use any other factors or criteria in the evaluation of the proposals received.

3.12 EQUAL EMPLOYMENT OPPORTUNITY: During the performance of this contract, the COMPANY agrees as follows:

The COMPANY will not discriminate against any employee or applicant for employment because of race, creed, color, sex, age, national origin, place of birth, physical handicap, or marital status.

SECTION IV

SPECIAL CONDITIONS

4.1 PENDING LITIGATION: Proposals will not be accepted from any company, firm, person, or party, parent subsidiary, against which Chatham County has an outstanding claim, or a financial dispute relating to prior contract performance. If the County, at any time, discovers such a dispute during any point of evaluation, the proposal will not be considered further.

4.2 EVALUATION FACTORS: Factors such as proponents overall capability, specialized experience, reputation, past performance on similar projects, technical competence, financial stability, ability to meet program goals, delivery under the contract terms, and fee schedule will be considered in the award recommendation. Commitment in the level of MBE/WBE firms, consultants and employees will also be considered in the evaluation of proposals.

4.3 SELECTION PROCESS: Proposals will be evaluated initially on the basis of the written document. Thus, the proposal must be complete, concise and clear as to the intent of the respondent. Further evaluation may include an oral presentation, which will be scheduled after receipt of the written proposal and approval of the shortlist.

4.4 CONTRACT: The contract will be for one (1) year with renewal options for four (4) additional one (1) year terms.

4.5 PROPOSALS MUST BE RESPONSIVE TO:

4.5.1 INTRODUCTION/COVER LETTER (SECTION A): You should provide no more than a two (2) page letter of introduction. The letter should highlight or summarize whatever information you deem appropriate as a cover letter, as a minimum, this section should include the name, address, email address, telephone number of one (1) contact to whom any correspondence should be directed. This section should include a clear statement of the Proposer’s understanding of this RFP and the contract requirements, and how the Proposer intends to meet the RFP requirements.

4.5.2 QUALIFICATIONS AND EXPERIENCE - TOTAL POSSIBLE POINTS: 25

(SECTION B): Respond to each section listed below and identify your responses using the section headers (e.g., Contact Information, About Your

Organization, etc.).

A. Contact Information: Provide the name, title, address, and telephone number of the person (s) who will be assigned to perform service under the proposal.

B. About Your Organization: Provide details about your organization including the structure and an organizational chart. Limit this information to 2 pages.

C. Resumes/credentials: Provide the Resumes/credentials of the person(s) who will perform the services required and state how long they have been with your firm. For each key staff person that will participate in the program, attach a resume. Highlight key and relevant experience. Credentials may be subject to verification.

Limit resumes to one page per person.

D. Experience: Provide adequate information to describe the scope of the offeror’s previous experience in providing Insurance medical claim audit services to public entities and any direct experience auditing United Healthcare. Include the name(s) and qualifications of the personnel that provided this service. Limit your experience information to 2 pages.

E. Firm’s Operations: State if your firm has operated under a different name within the past 10 years and provide that name that your firm previously operated under.

F. Client Terminations: Provide complete details of any contract that your firm has been fired during the last five (5) years.

4.5.3 METHODOLOGY AND IMPLEMENTATION PLAN - TOTAL POSSIBLE

POINTS: 30 (SECTION C): Respond to each section listed below and identify your responses using the section and subsection headers (e.g., Understanding the Scope of Work, Approach, Medical Claims Audit, etc.).

A. Scope of Work: Discuss your approach to rendering the services outlined in the Scope of Work. Any special techniques, strategies, software and capabilities should be discussed here. The items below should be included in your approach. Your approach should be separated for a medical and prescription drug claims audits. Chatham County will decide, at a later date, whether to conduct both medical and/or prescription drug claims audits.

i. Medical Claims Audit:

1. Discuss your process for performing medical claims audits.

Include a description of the procedures, software, and equipment to be used.

2. Identify your expectations regarding Chatham County’s responsibilities and contributions as it pertains to medical claims audits.

ii. Prescription Drug Claims Audit:

1. Separately discuss your process for auditing prescription drug claims. Include a description of the procedures, software, and equipment to be used.

2. Identify your expectations regarding Chatham County’s responsibilities and contributions as it pertains to prescription drug claims audits.

B. Medical Audit Specifications: Confirm the following or indicate your proposed deviation. Provide yes/no responses. If your response is "no", provide an explanation (not more than 1 paragraph) for each no response.:

i. Your random sample audit will include statistical confidence of at least 95%.

ii. You will provide 100% electronic screening with at least 15 targeted samples. Provide examples of the types of targeted screenings which will be included in the services your provide.

iii. You will benchmark the audit findings for Chatham County against at least 100 of your most recent audits which were completed in the past 3 years.

iv. Do you include an operational assessment in your audit results. If yes, describe your results in one paragraph.

C. Limitations: Identify any limitations you foresee in delivering all of the required services. Identify any potential problem areas that might impede the successful implementation of the contract.

D. Reporting: Provide sample summary reports of both medical and prescription drug claim audit results/findings which you will share with Chatham County.

E. Timeline: Provide a sample timeline to complete Scope of Work.

F. Distinguishing Characteristics: State additional information regarding your services that distinguishes your firm from your competition. Limit your response to 1 page.

G. Other Services: Identify any other information not specifically required elsewhere in this RFP which is considered pertinent by the offeror. Limit your response to 1 page.

4.5.4 MBE/WBE PARTICIPATION - TOTAL POSSIBLE POINTS: 15

(SECTION D):

Commitment in the level of local MBE/WBE firms, subcontractors, consultants and employees. Approach to meeting and exceeding the MBE/WBE requirements.

History of Minority-owned, Women-owned business utilization. Narrative describing past accomplishment in this area. Proposers may also provide their company’s employee demographic information regarding their company’s commitment to equal opportunity.

4.5.5 FEE PROPOSAL - TOTAL POSSIBLE POINTS: 25 (SECTION E):

A. All fees will be based on an annual fixed fee. Fees provided must be all inclusive and cover any item which may normally be regarded as reimbursable. Please use the Fee Proposal Form to provide your proposed pricing.

B. You should provide separate fees for the medical and prescription drug claims audit. Chatham County will decide, at a later date, whether to conduct both medical and/or prescription drug claims audits. Therefore, your fees should be provided as follows:

i. One fee to audit medical claims only.

ii. One fee to audit prescription drug claims.

iii. One fee to audit both medical and prescription drug claims.

4.5.6 REFERENCES – TOTAL POSSIBLE POINTS: 5 (SECTION D): Please provide at least five (5) current or past government clients for whom you furnish(ed) health claims auditing services of similar scope and content requested in this RFP. Please provide the client’s name, address, phone number and the name of a contact person. Chatham County is interested in how long that reference has been your client.

4.5.7 INTERVIEWS/PRESENTATIONS (IF REQUIRED) – TOTAL POSSIBLE

POINTS: 30. If interviews are requested, they will tentatively be held the last week of April.

4.6 CONTRACT: The successful respondent will be expected to execute a contract within

30 days of notice of award. No work shall be performed under the contract until a contract has been fully executed by both parties. A notice to proceed will be issued by Chatham County.

4.7 PERFORMANCE AND APPROVAL OF SUB-CONSULTANTS: The proponent will perform the project as an independent contractor and not as an agent or employee of the County. Joint ventures and sub-consultant arrangements are not prohibited;

however, the proponent shall secure written permission from Chatham County before subcontracting any part of this service. Such permission should be obtained during the proposal evaluation stage. Proponents are encouraged to use Minority/Woman Business Enterprises and are reminded of reporting requirements when utilizing these arrangements.

4.8 ASSIGNMENT: The PROPOSER shall not assign or transfer any interest of the contract without prior written consent of the County.

4.9 CONTRACT AWARD:

4.9.1 Successful Proponent will be asked to submit his/her firms’ contractual issues for consideration in the Chatham County contract. Proposals will become part of the contract.

4.9.2 No work shall be performed under the contract until a contract has been fully executed by both parties. A notice to proceed will be issued by Chatham County.

SECTION V

SCOPE OF SERVICES

5.1 GENERAL DESCRIPTION/BACKGROUND:

The purpose of this Request for Proposal is to solicit proposals from qualified Service

Providers interested in providing health claim audit services. Chatham County’s health plan has 1,994 subscribers and 3,913 members. It serves active employees, retirees and their dependents with health and pharmacy coverage. Participants currently have the choice of a low option and a high option Point of Service Plan. All plans offer the same pharmacy coverage. All plans are administered by United Healthcare. General population and claims statistics are provided below:

Chatham Enrollment As of December 2025 Subscribers Members

Active Employees:

POS High 838 1,624

POS Low 893 1,817

Total 1,731 3,441

Pre-65 retirees:

POS High 188 309

POS Low 75 163

Total 263 472

Total (Active & Pre-65 Retirees)

POS High 1,026 1,933

POS Low 968 1,980

Total 1,994 3,913

Claims Medical Pharmacy

Calendar Year 2024

POS High $14,200,471 $6,979,630

POS Low $7,168,759 $3,197,526

Total $21,369,231 $10,177,156

Calendar Year 2025

POS High $17,833,320 $8,207,802

POS Low $8,660,832 $4,455,886

Total $26,494,152 $12,663,687

5.1.1 At age 65 retirees and their Medicare eligible spouses leave the Pre-65 retiree health plan for coverage with a Medicare Advantage Plan, also provided by

UnitedHealthcare. We do not seek audit services for this plan.

5.1.2 The self-funded coverage, provided by United Healthcare, is the only coverage available to employees and pre-65 retirees, and has been in place since 2023.

United Healthcare provides all administrative services for the medical and prescription drug plans, as well as stop loss coverage.

5.1.3 A low option and a high option POS plan are offered.

5.1.4 Claims are paid from various locations.

5.1.5 The most recent audit conducted was for the period beginning January 1, 2024, and ending December 31, 2024.

5.1.6 The audit period covered by this request for proposal will cover calendar year

2025 (i.e., January 1, 2025 – December 31, 2025). The term of the contract will be for one (1) year with renewal options for four (4) additional one (1) year terms.

See Fee Proposal Form for full details on years available for renewal options.

5.2 PURPOSE:

5.2.1 Review the agreement with United Healthcare regarding healthcare and pharmacy benefit administration and financial settlements. Copies of the current administrative services agreement and plan summaries will be provided at the time of award.

5.2.2 Review the POS Plan Documents.

5.2.3 Discover any potential claim subrogation opportunities resulting from overpayment of claims.

5.2.4 Determine and segregate claim adjudication errors that are systematic in nature versus ad-hoc or non-systematic.

5.2.5 Calculate the impact of errors and various statistics on sample findings.

5.2.6 Submit audit findings to Chatham County.

5.3 OBJECTIVES:

5.3.1 The overall objective of the Claims Audit will be to assess the adequacy and effectiveness of United Healthcare’s internal controls relating to the processing of medical and prescription drug claims.

5.3.2 Audit claims based on the following objectives:

A. Verify that claim recipients were eligible for coverage at the time the claim was paid in conjunction with other coverage available to the recipient. Examples would include coordination of benefits and subrogation.

B. Confirm that provider submissions include necessary documentation to support the claim.

C. Verify that contractual provisions between United Healthcare with doctors and medical facilities were followed and appropriate discounts applied.

D. Validate that claims that require reviews, including pre-certification and utilization review for example, received appropriate evaluation.

E. Confirm that provider discounts were applied accurately and appropriately.

F. Confirm that claims were paid in accordance with the proper benefit classification and diagnostic and procedure codes.

G. Validate coordination of benefits to include Medicare and third-party liability provisions as appropriate.

H. Confirm that appropriate benefit limitations, deductibles, co-payments, coinsurance and out of pocket maximums were applied.

I. Corroborate that payments were made to the correct party.

J. Measure claim processing time and compare to industry standards, United

Healthcare published standards and any performance guarantee goals outlined in the ASO agreement.

K. Determine whether claims charged by United Healthcare were properly adjudicated, paid out to providers and charged back to Chatham County.

L. Verify that any duplicate request for payment was denied.

The undersigned proposer certifies that he/she has carefully read the preceding list of instructions and all other data applicable hereto and made a part of this invitation; and, further certifies that the prices shown in his/her proposal are in accordance with all documents contained in this

Request for Proposals package, and that any exception taken thereto may disqualify his/her proposal.

This is to certify that I, the undersigned Proposer, have read the instructions to Proposer and agree to be bound by the provisions of the same.

This________________day of____________________20__.

BY: ______________________________________________

SIGNATURE

TITLE

COMPANY

ADDRESS

PHONE NUMBER

EMAIL

EVALUATION AND AWARD

EVALUATION: Each response to this RFP shall be subject to the same review and assessment process. Proposals will be evaluated and ranked on the basis of points awarded by a technical review panel. A description of the factors which will be analyzed, and the relative weight accorded each factor follows.

STEP 1: PROPOSAL SUBMITTAL (TOTAL POSSIBLE POINTS: 100).

Evaluating Factor: Points Possible:

Qualifications and Experience 25

Methodology and Implementation Plan 30

MBE/WBE Participation 15

References 5

Fee Proposal 25

STEP 2- INTERVIEWS/PRESENTATIONS- IF REQUIRED (TOTAL POSSIBLE

POINTS: 30)

REQUEST FOR PROPOSAL

FEE PROPOSAL FORM

ANNUAL CONTRACT TO PROVIDE HEALTH CLAIMS AUDIT

I have read and understand the requirements of this proposal, RFP No. 26-0028-5, and agree to provide the required services in accordance with this proposal, and all other attachments, exhibits, etc. I agree to furnish the Services as described in the RFP for the fee listed below. I understand that the County will not be responsible for the reimbursement of any costs not specifically set forth in this proposal. In addition, the

County reserves the right to accept any part or all of the fee schedule and to negotiate any charges contained herein unless qualified otherwise. THIS FORM MUST BE USED

WHEN SUBMITTING PROPOSAL.

YEAR 1 January 1, 2025 - December 31, 2025:

Medical claims audit: /TOTAL

Prescription drug claims audit: /TOTAL

Medical and prescription drug claims audit: /TOTAL

YEAR 2 January 1, 2026 - December 31, 2026:

YEAR 3 January 1, 2027 - December 31, 2027:

YEAR 4 January 1, 2028 - December 31, 2028:

YEAR 5 January 1, 2029 - December 31, 2029:

FIRM NAME:

PROPOSER:

SIGNATURE:

ADDRESS:

CITY/STATE/ZIP:

TELEPHONE:

E-MAIL: