240000001469 WC Questions Answers.pdf

Michigan.gov/MiProcurement

BIDDER QUESTIONS & ANSWERS

Version 2021-2

Request for Proposal No. 240000001469 Workers Compensation Insurance Administration Services

Bidders who submitted questions for the above Solicitation by the deadline have answers below.

Q # Document and Section

Page # Bidder Question Answer

1 What is the impetus for marketing your program? Current Contract is ending.

Who is the incumbent TPA?

This information is publicly available on the State’s website: Current contractor:

Sedgwick Claims Management Services, Inc.

https://www.michigan.gov/dtmb/procureme nt/contractconnect/contract-list Search Contract No. 071B7700115

3 Who is/are the insurance carrier(s) for the excess?

The State of Michigan is Self-Insured for Workers’ Compensation.

Would you provide a copy of the current TPA Contract?

This information is publicly available on the State’s website: Current contractor:

Sedgwick Claims Management Services, Inc.

https://www.michigan.gov/dtmb/procureme nt/contractconnect/contract-list Search Contract No. 071B7700115 https://www.michigan.gov/dtmb/procurement/contractconnect/contract-list https://www.michigan.gov/dtmb/procurement/contractconnect/contract-list https://www.michigan.gov/dtmb/procurement/contractconnect/contract-list

5 Would you provide the current claim fees for each Workers' Compensation minor line of coverage?

The current contract is not structured by minor line of coverage.

6 Does State of Michigan have an SIR or Deductible program?

No.

7 What is the State of Michigan’s retention limit? N/A 8 Schedule B -

Pricing

Workers' Comp.

Pricing

Is "Maintenance Fee (Open > 36 Months)" the current open claim inventory across the last 5 years?

Maintenance fee is based upon the length of time an individual claim is open.

Schedule B - Pricing

Workers' Comp.

Pricing

Will the new TPA assume the management of current open claims from the incumbent TPA (Y/N)?

If yes, please provide the volume of all open claims by the following minor line of coverage.

a. Workers’ Compensation Indemnity?

b. Workers’ Compensation Medical Only?

c. Workers’ Compensation Report Only (Record Only Incidents)?

Yes, the new Contractor assumes the management of current open claims from the incumbent Contractor. See also Schedule A, Section 5.2.1.6.

a. Indemnity: 630

b. Medical: 209

c. N/A

Schedule B - Pricing

Workers' Comp.

Pricing

How are Record Only (No payment required) incidents managed?

In general, each State Agency would handle a record only incident. If the Contractor received a claim that was record only, it would be deferred to the State Agency.

Schedule B - Pricing

Workers' Comp.

Pricing

If there are Record Only incidents, are they part of the existing Medical Only Claim Counts provided (Y/N)?

If not, please provide the Record Only incidents expected to be provided to the TPA over the last 5 years (by year).

Only if a claim was filed and later determined to be record only.

12 What is working well with your program? Claims processing.

13 What challenges do you have with your current program?

N/A

What are your key objectives for your new program?

Timely and accurate claims processing at a reasonable cost.

15 What concerns do you have on moving the program to another TPA?

Continuity of claim handling and customer service.

Would you provide a list of all TPAs that plan to participate in this RFP?

No, there is no list and this is a competitive solicitation process where vendor/bidder names are not shared amongst vendors/bidders until an Award Recommendation and Synopsis is publicly posted.

Claim First Notice of Loss Intake (FNOL) Reporting.

a. What is the preferred method for reporting new claims/incidents to the TPA?

i. Data Feed to TPA from in-house system (Y/N)?

1. Please describe the system?

ii. TPA FNOL Web Portal (Y/N)?

iii. Email (Y/N)?

iv. Fax (Y/N)?

v. Mail (Y/N)?

vi. Other (Y/N)?

(Please explain.)

b. Who will be reporting claims/incidents/events?

i. In-house (Y/N)?

ii. External (Y/N)?

(Please describe.)

a. The filing of Workers’ Compensation claims is centralized and managed through the Plan Sponsor for the majority of the State Agencies. For the most part, the claims are filed electronically and a data file is provided to the Contractor on a continuous basis. See also Schedule A, Section 1.5 and 1.6.2.

For the remaining State Agencies, they use a combination of email and fax.

The claims are reported by each State Agency or by the centralized process.

18 Schedule A Statement of Work 5.4.10

66 Will OSHA determination of recordability be managed by the TPA (Y/N)?

The initial determination of recordability is managed by the Contractor subject to additional information that may change the determination.

Schedule A Statement of Work 5.4.10

66 Please detail the expectations of the TPA regarding OSHA?

The expectation is for the Contractor to make the initial determination and any subsequent change in the claim file. The Contractor must timely provide the claim log when requested.

Schedule A Statement of Work 1.5.3

13 Who is the Long Term Disability (LTD) administration partner?

This information is publicly available on the State’s website: Current contractor:

Sedgwick Claims Management Services, Inc.

https://www.michigan.gov/dtmb/procureme nt/contractconnect/contract-list Search Contract No. 071B7700116

21 Schedule A Statement of Work 1.2

4 Please describe your Light Duty Program if any.

The Contractor does not administer a centralized light duty program.

Risk Management Information System (RMIS).

a. Do you have an in-house 3rd party RMIS platform or do you use the current TPA RMIS?

i. What is working well with your RMIS?

ii. Are there any challenges with your RMIS?

b. If you are using a 3rd party RMIS for data consolidation, will you require a claim data extract file from the new TPA to ingest into your current

RMIS (Y/N)?

i. What is the name of the 3rd party RMIS?

ii. At what cadence will you require the claim

a. We use the current Contractor’s RMIS, ViaOne.

i. Once training was provided, the system has been working well and there are no challenges to report.

ii. No

b. N/A – not in-house.

files (i.e. Monthly, Weekly, Daily, Other)?

iii. What types of files will be required?

1. Claim Summary Level Records (Y/N)?

2. Payment Record Details (Y/N)?

3. Adjusters’ Notes (Y/N)?

Risk Management Information System (RMIS) Access.

a. How many total users will have on-line access to the new TPA RMIS?

(Excluding claim/event first notice of loss intake only users.)

i. How many RMIS users will be required to have Claim View Only (including Notes & Financials)?

1. What are the roles of these users (i.e.

Claim Managers, Risk Manager, Safety Manager, etc.)?

ii. How many RMIS users will require the ability to Run Reports?

1. What are the roles of these users (i.e.

Claim Managers, Risk Manager, Safety Manager, etc.)?

a. Up to 6 users

i. Up to 6 users

1. Program manager, Assistant

Program Manager, Safety Manager, Litigation Specialist, Case Managers

ii. Up to 6 users

1. Program manager, Assistant

Program Manager, Safety Manager, Litigation Specialist, Case Managers

Can you provide examples of current RMIS Reports and Dashboards?

i. Are these reports satisfactory?

ii. If not, please advise on Key Performance Indicators important to State of Michigan.

Examples are not available. Please refer to the Schedule A, Section 5.4 Reporting for all required reporting fields and content.

Please also refer to Schedule A, Section 10 for Service Level Agreements.