Attachment 5 Requirements Traceability Matrix_Amendment 2.xlsx
XLSX spreadsheet 98 KB Posted
- Attached to
- Postal Service Health Benefits System (PSHBS)
- Solicitation number
- 24322623R0004
- Issued by
-
Office of Personnel Management
About this file
This solicitation seeks proposals for a Postal Service Health Benefits System. Key requirements include developing and delivering a scalable IT system to support enrollment, eligibility determinations, and premium reconciliation for 1.7 million USPS enrollees. The system must utilize flexible, scalable technology to potentially support additional federal employees and annuitants enrolled in FEHB. A customer support center is also required to provide enrollment support and other services. Additional services involve documentation, operations, deployment, cybersecurity, configuration management, training, COTS product management, technology refresh, data/information services, and business analysis for IT programs. Proposals are due by the specified date, and the agency is the Office of Personnel Management.
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Data Validation
| Functional | Non-Functional | Agency Use |
| Turnkey | Supported | Yes |
| Configured | Partially Supported | Partial |
| Custom Code (Easy) | Not Supported | No |
| Custom Code (Moderate) | ||
| Custom Code (Difficult) | ||
| Custom Code (Complex) | ||
| Does Not Meet |
Instructions
| Postal Services Health Benefits System Requirements Traceability Overview and Matrix |
| Instructions |
| The Respondent must include a completed Requirements Traceability Matrix in the Technical Response. The Respondent shall complete all tabs in this workbook according to the instructions below. |
Instructions: For each tab in the workbook, the Respondent shall complete each column that is highlighted in Orange. Columns in Grey should not be edited.
| Column Description : | Definition/Instructions: | ||
| REQ ID | Requirement ID. Formatted as follows: "Requirement Type-Category Name-Requirement Number". For example, "PSHBS-Eligibility Determination-Requirement #1" will be listed as (PSHBS-ED-1). | ||
| Component | = | Respondent to Complete | |
| Rule / Requirement | Descriptive narrative of the requirement | = | Agency Use Only |
| Solution Support - Functional Requirements | Respondents to select amongst options to reflect how they will be able to address the Functional Requirement: |
- Turn-key
- Configured
- Custom Code (Easy, Moderate, Difficult, Complex)
- Does Not Meet
The definitions for Custom designations can be found below.
Solution Support - Non-Functional Requirements Respondents to select among options to reflect how they will be able to address the Non-Functional Requirement:
- Supported (proposed technical solution supports this requirement)
- Partially Supported (proposed technical solution partially supports this requirement)
- Not Supported
| Section / Reference | Identify the specific section or reference (verbatim text) from the Respondents's submission which addresses this requirement. |
| Respondent comments | Add any additional relevant information which is not covered in the other columns. |
| Requirement Met? | FOR AGENCY USE ONLY: Fill in with "Yes" or "No" |
| Reviewer Comment | FOR AGENCY USE ONLY: Any agency comments or notes |
| Custom Development Categories for -Functional Requirements: | Definition: |
| Easy | Straightforward development of a single object (e.g. screen, tables, reports, interfaces, etc), which is easy to test. |
| Moderate | Development of a single more complicated object, or fewer than three interdependent object, which is easy to test. |
| Difficult | Development of multiple interdependent objects with a higher degree of complexity, requiring more complicated testing scenarios. |
| Complex | Development required to many complicated system objects with many dependencies between them, requiring significant effort to develop and test the functionality. |
| Turnkey | Offeror is able to provide stated functionality "out-of-the-box", with little to no development required. |
| Configured | Offeror is able to provide stated functionality with minimal development required (e.g., less than 40% of requirements). |
| Custom Code | Offeror is able to develop custom software, including designing, creating, deploying and maintaining said software for PSHBS users and functions eneumerated in the RTM. |
| Sheet: | Instructions: |
| Functional Reqs | Respondent will submit responses for all functional requirements corresponding to the PSHBS Components |
| Non Functional Reqs | Respondent will submit responses for all non-functional requirements corresponding to the PSHBS Components |
Functional Reqs
| RESPONDENT TO COMPLETE | AGENCY USE ONLY | |||||||||||
| REQ ID | Component | Rule / Requirement | MVP (Y/N) | Solution Support | Section / Reference | Respondent Notes | Requirement Met? | Reviewer Comments | Working Session Comments | HI Comments | CIO Comments | RS Comments |
| PSHBS-AN-1 | Alerts and Notifications | The system shall have the ability to send a status summary report to a user via the system after data processing or uploads acknowledging all accepted and/or rejected files. The summary report shall include the parameters as of totals processed, number accepted/rejected, number of errors, error ID, error description, error severity level. | Yes | |||||||||
| PSHBS-AN-2 | Alerts and Notifications | The system shall notify Authorized Users when validated data is loaded through methods including, but not limited to, email notifications. | Yes | |||||||||
| PSHBS-AN-3 | Alerts and Notifications | The system shall notify Authorized Users of any handled or unhandled system errors that occur during the loading of data files. | Yes | |||||||||
| PSHBS-AN-4 | Alerts and Notifications | The system shall generate notifications to a user regarding data acceptance, rejection, and the need for additional information or corrections. | Yes | |||||||||
| PSHBS-AN-5 | Alerts and Notifications | The system shall display alerts via a Dashboard view, based on triggers and user roles defined by OPM. | Yes | |||||||||
| PSHBS-BRM-1 | Business Rules Management | The system shall provide and maintain, error codes that area human-readable with enough information to troubleshoot the error | Yes | |||||||||
| PSHBS-BRM-2 | Business Rules Management | The system shall have the ability to apply Data Quality business rules. | Yes | |||||||||
| PSHBS-BRM-3 | Business Rules Management | The system shall have the ability to ingest data files and modify them based on business rules. | Yes | |||||||||
| PSHBS-BRM-4 | Business Rules Management | The system shall have a configurable Business Rules Engine (system) to support 's Business Processes and policies. | Yes | |||||||||
| PSHBS-BRM-6 | Business Rules Management | The system shall have the ability to allow role-based users to update, configure, and maintain Business Rules without coding changes to meet defined business needs. | Yes | |||||||||
| PSHBS-BRM-7 | Business Rules Management | The system shall have the ability to debug a Business Rules at rule execution. | Yes | |||||||||
| PSHBS-BRM-8 | Business Rules Management | The system shall have the ability to rollback to prior versions of a Business Rules. | Yes | |||||||||
| PSHBS-BRM-9 | Business Rules Management | The system shall have the ability to produce a business rules traceability report detailing the execution path for a Business Rules for all relevant data. | Yes | |||||||||
| PSHBS-BRM-10 | Business Rules Management | The system shall leverage its own distinct Business Rules repository to maintain a history of all changes to Business Rules. | Yes | |||||||||
| PSHBS-BRM-11 | Business Rules Management | The contractor shall maintain a reference guide of configurable Business Rules. | Yes | |||||||||
| PSHBS-BRM-12 | Business Rules Management | The system shall have the ability to be configured, developed, updated, and maintain Business Rules. | Yes | |||||||||
| PSHBS-DAR-1 | Data Analytics & Reporting | The contractor must provide robust analysis of data to include reporting and analytical tools that ensure the establishment of the data strategy, governance, and architecture for PSHBS. | Yes | |||||||||
| PSHBS-DAR-2 | Data Analytics & Reporting | The system shall conduct data matching with outside reference tables and databases. | Yes | |||||||||
| PSHBS-DAR-3 | Data Analytics & Reporting | The system shall generate standard reporting. | Yes | |||||||||
| PSHBS-DAR-4 | Data Analytics & Reporting | The system shall provide capability to store, maintain, and modify reports. | Yes | |||||||||
| PSHBS-DAR-5 | Data Analytics & Reporting | The system shall provide capability to schedule and rerun reports. | Yes | |||||||||
| PSHBS-DAR-6 | Data Analytics & Reporting | The system shall provide the capability to display data and reports in self-configurable dashboards that require no hard coding | Yes | |||||||||
| PSHBS-DAR-7 | Data Analytics & Reporting | The contractor must be able to add and ingest the appropriate data fields and values for the purpose of report generation. | Yes | |||||||||
| PSHBS-DAR-8 | Data Analytics & Reporting | The system shall have the ability to identify patterns, pattern match or identify data anomalies | No | |||||||||
| PSHBS-DAR-9 | Data Analytics & Reporting | The system shall provide the ability for specified users to dynamically build ad hoc reports based on their permissions. | Yes | |||||||||
| PSHBS-DAR-10 | Data Analytics & Reporting | The system shall have the abiliity to transition data from its database to OPM specified data warehouses, BI platforms, cloud-based data storage mechanisms, etc. | Yes | |||||||||
| PSHBS-DAR-11 | Data Analytics & Reporting | The system shall ensure all data stored within its database is owned by OPM and provides a means by which this data can be tranfered to OPM as and when requested to OPM specified systems. | Yes | |||||||||
| PSHBS-DAR-12 | Data Analytics & Reporting | The system shall have the ability to analyze enrollment data using BI capabilites, including standard reporting, query building capability, and (for certain analysts) open access using preferred analytic software. | No | |||||||||
| PSHBS-DS-1 | Decision Support | The system shall be a COTS product with customization that provides information to assist enrollees in making informed health plan selection decisions. | Yes | |||||||||
| PSHBS-DS-2 | Decision Support | The system shall have the ability to collect, process, and transform various datasets supplied by OPM and/or external stakeholder to display provider network data in the DST. The contractor will be responsible for cleansing, validating, displaying the data in the DST, and returning the final data set to OPM. | No | |||||||||
| PSHBS-DS-3 | Decision Support | The system shall seamlessly interface with PSHBS enrollment platform: transmit the user's selected health plan information from the DST to the PSHBS enrollment portal to facilitate enrollment. | No | |||||||||
| PSHBS-DS-4 | Decision Support | The system shall provide capability to query and display in-network pharmacy geographic locations. The data will be supplied by OPM and/or external stakeholders. The contractor is responsible for analyzing, cleansing the data and returning the final data set to OPM. | No | |||||||||
| PSHBS-DS-5 | Decision Support | The system shall provide the capability to query pharmacy drug prices from data provided by OPM and/or external stakeholders. The contractor is responsible for analyzing and cleansing the data, displaying the results in the DST, and returning the final data set to OPM. | No | |||||||||
| PSHBS-DS-6 | Decision Support | The system shall display a comparison of pharmacy drug prices from data provided by OPM and/or external stakeholders. The contractor is responsible for analyzing and cleansing the data, displaying the results in the DST, and returning the final data set to OPM. | No | |||||||||
| PSHBS-DS-7 | Decision Support | The system shall display a comparison of health plan RX formulary information with data provided by OPM. The contractor is responsible for analyzing, cleansing, displaying the results in the DST, and returning the final data set to OPM. | No | |||||||||
| PSHBS-DS-8 | Decision Support | The system shall have the ability to ingest plan provider network data supplied by OPM and/or other external stakeholders. The contractor will be responsible for collecting, cleansing, vaidating, displaying the data in the DST and returning the final data set to OPM. | No | |||||||||
| PSHBS-DS-9 | Decision Support | The system shall allow users to search and compare plan options. | Yes | |||||||||
| PSHBS-DS-10 | Decision Support | The system shall integrate with CEP Enrollment Processing to allow the user to select a plan within the comparison results and seamlessly enroll in that plan via CEP Enrollment Processing | No | |||||||||
| PSHBS-DS-11 | Decision Support | The system shall have the ability to compare plan information. | Yes | |||||||||
| PSHBS-DS-12 | Decision Support | The system shall display a comparison of at least three health plan benefits. | Yes | |||||||||
| PSHBS-DS-13 | Decision Support | The system shall display a comparison of PSHB plan premiums with data supplied by OPM. | Yes | |||||||||
| PSHBS-DS-14 | Decision Support | The system shall display a comparison of PSHB plan out-of-pocket co-pays, co-insurance and deductible member cost sharing. Data will be supplied by OPM. | Yes | |||||||||
| PSHBS-DS-15 | Decision Support | The system shall display a comparison of PSHB plan quality measures with data supplied by OPM. | Yes | |||||||||
| PSHBS-DS-16 | Decision Support | The system shall provide capability to query PSHB plan customer service measures with data supplied by OPM. | Yes | |||||||||
| PSHBS-DS-17 | Decision Support | The system shall display a comparison of PSHB plan customer service measures supplied by OPM. | Yes | |||||||||
| PSHBS-DS-18 | Decision Support | The system shall have the ability for customers to search and compare key health plan characteristics including premium, cost sharing (including for those with Medicare), with link to health plan brochure for more detailed information. | Yes | |||||||||
| PSHBS-DS-19 | Decision Support | The system shall have the ability for customers to search and compare total cost (using customer provided condition and usage information). | No | |||||||||
| PSHBS-DS-20 | Decision Support | Design should follow industry best practices for modern, intuitive, similar decision support tools. | Yes | |||||||||
| PSHBS-DS-21 | Decision Support | The system shall allow for anonymous use of general functionality of the decision support tool (i.e. search and view of health plans and associated content) | Yes | |||||||||
| PSHBS-DS-22 | Decision Support | The system shall allow for account-based usage (i.e. eligible users can create an account, log in, and search and view health plans and associated content). | No | |||||||||
| PSHBS-DS-23 | Decision Support | The system shall have the ability for users to shop for, compare, and select plans on same site or via seamless transfer to PSHB plan enrollment site. | No | |||||||||
| PSHBS-DS-24 | Decision Support | The system shall include the ability to ingest and process carrier-specific information from OPM Systems (e.g., Carrier Connect). | Yes | |||||||||
| PSHBS-DS-25 | Decision Support | The system shall allow the information displayed in the results to be unique and tailored to an enrollee based on user-provided information. | Yes | |||||||||
| PSHBS-DS-26 | Decision Support | The system shall allow the enrollee to enter optional information (e.g. number of physician visits, anticipated surgery, prescriptions, FSA and HSA annual contributions), then display estimated annual total cost of care based on both enrollee and OPM supplied data as well as contractor supplied state/regional standards/benchmarks of costs. | No | |||||||||
| PSHBS-DS-27 | Decision Support | The system shall display the PSHB health benefits in coordination with Medicare Part A and B primary coverage based on data provided by OPM. | Yes | |||||||||
| PSHBS-DS-28 | Decision Support | The system shall allow users to compare health plans and benefits based on health benefit program and eligible population type (e.g., Postal employee employee, annuitant, etc.) with data supplied by OPM. | Yes | |||||||||
| PSHBS-DS-29 | Decision Support | The system shall display plan and benefit data based on health benefit program type with data supplied by OPM. | Yes | |||||||||
| PSHBS-DS-30 | Decision Support | The system shall display plan and benefit data based on eligible population type with data supplied by OPM. . | Yes | |||||||||
| PSHBS-DS-31 | Decision Support | The system shall allow users to search for available health plans based on where the user lives or works. | Yes | |||||||||
| PSHBS-DS-32 | Decision Support | The system shall provide capability to query health plan benefits. | Yes | |||||||||
| PSHBS-DS-33 | Decision Support | The system shall provide capability to display member costs with Medicare parts A and B primary. | Yes | |||||||||
| PSHBS-DS-34 | Decision Support | The system shall provide capability to dispay plan premiums with data supplied by OPM. | Yes | |||||||||
| PSHBS-DS-35 | Decision Support | The system shall provide capability to display plan out-of-pocket e.g. co-payments, co-insurance and deductibles with data supplied by OPM then display in the DST. | Yes | |||||||||
| PSHBS-DS-36 | Decision Support | The system shall provide capability to display quality measures data supplied by OPM. | Yes | |||||||||
| PSHBS-DP-1 | Direct Pay | The system shall have the ability to perform enrollment set up for new direct pay enrollees. | No | |||||||||
| PSHBS-DP-2 | Direct Pay | The system shall provide capability to allow designated agency/RS users to identify individuals joining the direct-pay enrollee population. There will be at least two types of individuals being added to the direct pay enrollee population, (1) current PSHB enrollees transitioning into direct pay status, and (2) family members of PSHB enrollees becoming a new primary enrollee (eg. temporary continuation of coverage). | No | |||||||||
| PSHBS-DP-3 | Direct Pay | The system shall have the ability to display an additional element in the enrollee-facing account page, unique for direct pay enrollees, that displays premium payment information (account balance, due date, auto-pay status, etc.) | No | |||||||||
| PSHBS-DP-4 | Direct Pay | The system shall allow direct pay enrollees to make ACH payments as well as allow enrollee to indicate paper check payment option (enrollee would mail the check to PSHB customer service). | No | |||||||||
| PSHBS-DP-5 | Direct Pay | The system shall maintain an account for each direct pay enrollee that tracks premiums due and paid for enrollees with and without government contributions | No | |||||||||
| PSHBS-DP-6 | Direct Pay | The system shall generate communications to enrollees for a variety of situations (unsuccessful automated payment, overdue balance, disenrollment for non-payment, appeal rights, etc.) and in a variety of formats (printed letter, email, sms, etc.) | No | |||||||||
| PSHBS-DP-7 | Direct Pay | The system shall calculate the government contributions, aggregate by payroll office, and communicate to each applicable payroll office the government contributions due | No | |||||||||
| PSHBS-DP-8 | Direct Pay | The system shall have the ability to transfer funds to OPM OCFO and accompanying data necessary for OCFO to accept the funds transfer. | No | |||||||||
| PSHBS-DP-9 | Direct Pay | The system shall have the ability to maintain multiple types of direct pay enrollees (negative net annuitants, temporary continuation of coverage, etc). The type of direct pay enrollee will be determined by Agency/RS and entered into the system during the direct pay set-up process. The type of enrollee will impact various aspects of account management (government contribution, term of enrollment, administrative fees, etc) based on PSHB rules/regulations. | No | |||||||||
| PSHBS-DP-10 | Direct Pay | The system shall accept government contribution funds transferred from payroll offices and post to applicable direct pay enrollee accounts. | No | |||||||||
| PSHBS-DP-11 | Direct Pay | The system shall have the ability to track and aggregate direct pay premiums in a variety of ways (enrollee share, government contribution, 1% admin fee, 3% contingency reserve, etc.) | No | |||||||||
| PSHBS-ED-1 | Eligibility Determination | The system shall have the capability to process selected demographic data elements received from USPS and OPM provided data to access the PSHB eligibility file (PSHBS-ED-1) to set up an account to enroll in a PSHB plan. | Yes | |||||||||
| PSHBS-ED-2 | Eligibility Determination | The system shall have the ability to receive, ingest, and process necessary data from USPS to determine employee eligibility status. | Yes | |||||||||
| PSHBS-ED-3 | Eligibility Determination | The system shall have the ability to receive, ingest, and process necessary information from OPM RS systems in the form of ASCII flat files to determine current annuitant status | Yes | |||||||||
| PSHBS-ED-4 | Eligibility Determination | The system shall have the ability to export data into ASCII Flat Files to exchange with other OPM systems on predetermined schedule using secure means of transmission. | Yes | |||||||||
| PSHBS-ED-5 | Eligibility Determination | The system shall have the capability to, according to OPM rules, routinely receive, validate, and process enrollment and eligibility data from OPM and external stakeholders (e.g. USPS, DOL, SSA, VA, and IHS) to determine PSHB program eligibility according to OPM provided rules. | ||||||||||
| No | ||||||||||||
| PSHBS-ED-6 | Eligibility Determination | The system shall identify enrollees who are Postal Service annuitants approaching age 65 that are subject to the Medicare Part B enrollment requirement and it shall inform them of the exceptions to the Medicare Part B enrollment requirement. | No | |||||||||
| PSHBS-ED-7 | Eligibility Determination | The system shall have the ability to exchange data electronically and securely with other OPM and external systems on predetermined schedules leveraging industry best practices to include, but not limited to, API integration, etc. | No | |||||||||
| PSHBS-ED-8 | Eligibility Determination | System shall have the ability to accept and process OPM and/or external stakeholder supplied data, attestation, and other supporting documentation | Yes | |||||||||
| PSHBS-ED-9 | Eligibility Determination | The system shall have the capability to identify those who are not eligible, send standardized termination letters, and terminate coverage in PSHB based on OPM provided rules. | Yes | |||||||||
| PSHBS-EM-1 | Enrollment Management | The system shall track the Member's Enrollment and all supporting program information including, but not limited to: Enrollment records and Eligibility segments (as applicable). | Yes | |||||||||
| PSHBS-EM-2 | Enrollment Management | The system shall provide a mechanism by which approved Admin users are able to change the enrollment status or plan assignment of a Member (e.g. Plan A to Plan B, enrolled to suspended). | Yes | |||||||||
| PSHBS-EM-3 | Enrollment Management | The system shall have the ability to configure parameters including, but not limited to, employee category, geographic location, and enrollment type. | Yes | |||||||||
| PSHBS-EM-4 | Enrollment Management | The system shall provide approved Admin users the ability to enroll, add, or update enrollments, based on exceptions to OPM provided rules | Yes | |||||||||
| PSHBS-EP-1 | Enrollment Processing | The system shall have the capability of capturing enrollee selection data and sending to Carriers participating in PSHBP, using OPM's current processes and systems via the Data Hub (vendor to connect to Data Hub and not to all carriers). | Yes | |||||||||
| PSHBS-EP-2 | Enrollment Processing | The system shall permit/disallow specific activities, based on data provided by the user and established business rules (e.g. the system will not allow the user to proceed with a QLE enrollment if supporting documentation has not yet been uploaded) | Yes | |||||||||
| PSHBS-EP-3 | Enrollment Processing | The system shall provide an enrollment portal with a review, approve and verify workflow for enrollment actions. | Yes | |||||||||
| PSHBS-EP-4 | Enrollment Processing | The system shall transmit enrollment data to internal and external entities, as required. | Yes | |||||||||
| PSHBS-EP-5 | Enrollment Processing | The system shall have the ability to transfer daily files sent directly to carriers from the enrollment portal. | ||||||||||
| No | ||||||||||||
| PSHBS-EP-6 | Enrollment Processing | The system shall provide account-based user interfaces for a variety of user groups (i.e. enrollees, carriers, administrators, super-users, etc.). | Yes | |||||||||
| PSHBS-EP-7 | Enrollment Processing | The system shall allow for a single user to establish more than one role under the same user credentials. | Yes | |||||||||
| PSHBS-EP-8 | Enrollment Processing | The system shall permit Temporary Continuation of Coverage (TCC) enrollments based on regulations and OPM guidance and transmit enrollment and payment files with the appropriate premium contribution adjustments. | No | |||||||||
| PSHBS-EP-9 | Enrollment Processing | The system shall provide role-based permissions for each user group. | Yes | |||||||||
| PSHBS-EP-10 | Enrollment Processing | The system shall have a database of all enrollees and family members (covered lives). | Yes | |||||||||
| PSHBS-EP-11 | Enrollment Processing | The system shall integrate with the Decision Support Tool (DST). | No | |||||||||
| PSHBS-EP-12 | Enrollment Processing | The system must provide data and reporting capabilities including (but not limited to) enrollment transaction history, demographic information, enrollment actions, premium payments information, and enrollment trends. | Yes | |||||||||
| PSHBS-EP-13 | Enrollment Processing | The system shall have the ability to remove ineligible enrollees and family members during enrollment processing | Yes | |||||||||
| PSHBS-EP-14 | Enrollment Processing | The system shall have the ability to identify enrollees subject to auto enrollment (includes first year auto enrollments and terminating plans). | Yes | |||||||||
| PSHBS-EP-15 | Enrollment Processing | The system shall have the ability to auto enroll (includes first year auto enrollments and terminating plans) and enroll those individuals in the appropriate plan. Note: that will include first year auto enrollments and terminating plans in subsequent years. After the first year individuals who make no selection during open season remain enrolled in the same plan. | Yes | |||||||||
| PSHBS-EP-16 | Enrollment Processing | The system shall address actions resulting from the electronic completion of enrollment forms (similar to the SF/OPM 2810 and SF/OPM 2809 forms). | Yes | |||||||||
| PSHBS-EP-17 | Enrollment Processing | The system shall provide automated notifications for users during the enrollment process. | Yes | |||||||||
| PSHBS-EP-18 | Enrollment Processing | The system shall communicate user action required. | Yes | |||||||||
| PSHBS-EP-19 | Enrollment Processing | The system shall provide notifications to users of required actions. | Yes | |||||||||
| PSHBS-EP-20 | Enrollment Processing | The system shall have the ability to exchange transaction information with internal and external stakeholders such as OPM Retirement Services, USPS and NFC for withholdings and contributions to premiums. | Yes | |||||||||
| PSHBS-EP-21 | Enrollment Processing | The system shall have the capability to accept uploaded supporting program eligibility documentation. | Yes | |||||||||
| PSHBS-EP-22 | Enrollment Processing | The system shall have the ability to make supporting documentation machine readable, provide text analytics from the scanned eligibility documents, extract data elements based on the annotation and provide ability for pattern matching. | No | |||||||||
| PSHBS-EP-23 | Enrollment Processing | The system shall identify exceptions based on pre-defined criteria during enrollment process. | Yes | |||||||||
| PSHBS-EP-24 | Enrollment Processing | The system shall have auditing, reporting, and historical tracking for enrollment processing capabilities. | Yes | |||||||||
| PSHBS-EP-25 | Enrollment Processing | The system shall have the ability to provide enrollment processing data analytics to OPM systems and databases. | Yes | |||||||||
| PSHBS-EP-26 | Enrollment Processing | The system shall have the capability to access, read & print on-demand enrollee historical data from enrollment processing for legal purposes. | Yes | |||||||||
| PSHBS-EP-27 | Enrollment Processing | The system shall give authorized users access and view capability for specific historical enrollment data | Yes | |||||||||
| PSHBS-EP-28 | Enrollment Processing | The system shall have the ability to capture data elements similar to the SF/OPM 2809 and SF/OPM 2810 information | Yes | |||||||||
| PSHBS-EP-29 | Enrollment Processing | The system shall have the ability to validate user-entered data for errors (e.g. address validation) | Yes | |||||||||
| PSHBS-EP-30 | Enrollment Processing | The system shall have the capability for enrollees to address validation errors | Yes | |||||||||
| PSHBS-EP-31 | Enrollment Processing | The system shall have the capability for administrative users to access enrollment forms in order to review and/or complete them | Yes | |||||||||
| PSHBS-EP-32 | Enrollment Processing | The system shall provide the workflow capability to process all enrollment transactions based on program rules and enrollee and family member eligibility. | Yes | |||||||||
| PSHBS-EP-33 | Enrollment Processing | The system shall identify eligible population types and process enrollments appropriately. | Yes | |||||||||
| PSHBS-EP-34 | Enrollment Processing | The system shall use the data in the employee's account to make available a rendering of the SF/OPM 2809/SF/OPM 2810 in the user's portal. The form(s) shall be available for download in PDF format by the customer, employing agency, and other approved stakeholders. | Yes | |||||||||
| PSHBS-EP-35 | Enrollment Processing | The system shall retain a minimum 5 years of historical enrollment data of enrollees and all dependents | Yes | |||||||||
| PSHBS-EP-36 | Enrollment Processing | The system shall have the ability to produce communications/notices in multiple languages | Yes | |||||||||
| PSHBS-EP-37 | Enrollment Processing | The system shall permit Qualifying Life Event (QLE) enrollments based on regulations and OPM guidance, and verify those events by providing the option to upload supporting documentation that verifies the QLE. | No | |||||||||
| PSHBS-EP-38 | Enrollment Processing | The system shall have the ability to import enrollment datam in the form of ASCII flat files or via an API interface into a new or existing system | Yes | |||||||||
| PSHBS-EP-39 | Enrollment Processing | The system shall have the ability to transmit enrollment data to Insurance providers via OPM Data Hub, a SFTP data sharing platform, AND to both OCFO and Retirement Services systems via ASCII Flat files. | Yes | |||||||||
| PSHBS-EP-40 | Enrollment Processing | The system shall have the ability to process acknowledgement from Insurance provider and update enrollment form details with ID and other details | Yes | |||||||||
| PSHBS-EP-41 | Enrollment Processing | The system shall have the ability to send notification to Customer with ID and other details received from Insurance | Yes | |||||||||
| PSHBS-EP-42 | Enrollment Processing | The system shall process enrollment corrective actions required for retroactive termination. | Yes | |||||||||
| PSHBS-EP-43 | Enrollment Processing | The system shall have the ability to regularly exchange various types of data from carriers and agencies with multiple external stakeholders (e.g., enrollment, payroll offices, Carriers, eligibility, and others) | Yes | |||||||||
| PSHBS-EP-44 | Enrollment Processing | The system shall have the ability to accept and provide data in the HIPAA 834 standard format. | Yes | |||||||||
| PSHBS-EP-45 | Enrollment Processing | The system shall generate the required reports, upon request, that facilitates enrollment reconcilation with a mechanism for the carriers to access this data (either through roles / privileges in PSHB System or exporting the reports into the Carrier Connect). | Yes | |||||||||
| PSHBS-EP-46 | Enrollment Processing | The system shall generate the required reports, on a pre-determined schedule, that facilitates enrollment reconcilation that includes automation to support identifying descrepancies and routing them to the appropriate OPM staff. | No | |||||||||
| PSHBS-EP-47 | Enrollment Processing | The system shall have the ability to allow individuals to create an account, view available plans and enroll in a plan. | Yes | |||||||||
| PSHBS-ER-1 | Enrollment Reconciliation | The system shall have an enrollment reconciliation dashboard for administrative users. | No | |||||||||
| PSHBS-ER-2 | Enrollment Reconciliation | The system shall identify and process enrollment corrective actions (e.g., belated enrollments, retroactive enrollments/terminations, etc.). | Yes | |||||||||
| PSHBS-ER-3 | Enrollment Reconciliation | The system shall identify dual enrollments of enrollees and family members. | Yes | |||||||||
| PSHBS-ER-4 | Enrollment Reconciliation | The system shall have the ability to identify enrollees on interim pay (e.g. it may be a file with the Interim Pay Identifier). There are approximately 5,460 postal annuitants on interim pay. | Yes | |||||||||
| PSHBS-ER-5 | Enrollment Reconciliation | The system shall aggregate enrollees into various groups based on identifiers (e.g., enrollment code, payroll office). | Yes | |||||||||
| PSHBS-ER-6 | Enrollment Reconciliation | The system shall identify discrepancies between enrollment, eligibility, and payroll data supplied by external stakeholders. | Yes | |||||||||
| PSHBS-ER-7 | Enrollment Reconciliation | The system shall have the ability to translate data in the HIPAA 834 standard format. | Yes | |||||||||
| PSHBS-ER-8 | Enrollment Reconciliation | The system shall have the ability to send data in the HIPAA 834 standard format. | Yes | |||||||||
| PSHBS-ER-9 | Enrollment Reconciliation | The system shall have the ability to process data in the HIPAA 834 standard format. | Yes | |||||||||
| PSHBS-ER-10 | Enrollment Reconciliation | The system shall have the ability to track enrollees in special pay statuses such as leave without pay and interim pay (enrollees who have retired but have not yet been fully integrated in to OPM’s retirement systems). | Yes | |||||||||
| PSHBS-ER-11 | Enrollment Reconciliation | The system shall have the ability to term ineligible enrollees and family members during enrollment reconciliation. | Yes | |||||||||
| PSHBS-ER-12 | Enrollment Reconciliation | The system shall have the capability to handle enrollee processing for retirement interim pay during open-season and final file adjudication. | Yes | |||||||||
| PSHBS-HPM-1 | Health Plan Management | The system shall have the ability to capture, view, update, and maintain configurable Health Plan information received from Federal sources, including an initial conversion load. | Yes | |||||||||
| PSHBS-HPM-2 | Health Plan Management | The system shall track changes made to Health Plan information including, but not limited to, date of change, author, and the details of the change. | Yes | |||||||||
| PSHBS-HPM-3 | Health Plan Management | The system shall provide a centralized version-controlled repository to store all current and historical Health Plan information. | Yes | |||||||||
| PSHBS-HPM-4 | Health Plan Management | The system shall maintain existing and newly added Health Plans based on changes in policies and Health Benefits. | Yes | |||||||||
| PSHBS-PR-1 | Premium Reconciliation | The system shall, as part of each enrollee account, maintain a premium balance amount that will be impacted by several data elements and will serve as the core premium reconciliation data element for each enrollee. | No | |||||||||
| PSHBS-PR-2 | Premium Reconciliation | The system shall update an enrollees premium balance amount whenever an enrollment action takes effect that impacts the enrollee's premium (change in plan, option, or type) | No | |||||||||
| PSHBS-PR-3 | Premium Reconciliation | The system shall have the ability to account for unique premium balance situations (interim pay, government shutdown, etc) | No | |||||||||
| PSHBS-PR-4 | Premium Reconciliation | The system shall have the ability to calculate and communicate prorated premiums for a variety of situations (transfer payroll office mid pay cycle, change plans mid pay cycle, etc) | No | |||||||||
| PSHBS-PR-5 | Premium Reconciliation | The system shall have the ability to produce and send a report of expected premiums for each payroll office, on a schedule that alligns with the payroll office pay cycle. | No | |||||||||
| PSHBS-PR-6 | Premium Reconciliation | The system shall accept data transfers from each payroll office that provides enrollee-level premium and enrollment data. | No | |||||||||
| PSHBS-PR-7 | Premium Reconciliation | The system shall accept data transfers from OPM OCFO financial management system that provides enrollment-code level funds distribution information to PSHB carriers. | No | |||||||||
| PSHBS-PR-8 | Premium Reconciliation | The system shall compare and identify discrepancies between expected premiums from each payroll office, enrollee-level premium data from each payroll office, and actual funds transferred from each payroll office to OPM OCFO. Once reconciled, the CEP must post the premium payments and update individual enrollee records accordingly. | No | |||||||||
| PSHBS-PR-9 | Premium Reconciliation | The system shall, upon sucessful reconciliation of premiums transfered from payroll offices to OPM OCFO, post the premiums to each enrollee account. | No | |||||||||
| PSHBS-PR-10 | Premium Reconciliation | The system shall have the ability to produce a report of expected premium payments (distributions) from OPM OCFO to PSHB carriers. | No | |||||||||
| PSHBS-PR-11 | Premium Reconciliation | The system shall compare and identify discrepancies between expected and actual premium distributions to PSHB carriers. | No | |||||||||
| PSHBS-PR-12 | Premium Reconciliation | The system shall have the ability to produce, accept, process, and send data in the HIPAA 820 standard format to support the reconcilliation of premiums by individual. | No | |||||||||
| PSHBS-PR-13 | Premium Reconciliation | The system shall have the ability to produce at least two versions of a modified HIPAA 820 report. Two versions will be needed because of differences in how premiums will be reconciled and distributed to community-rated carriers and experience-rated carriers. | No | |||||||||
| PSHBS-PM-1 | Printing and Mailing | The system shall retain digital copies of mailed Correspondences in accordance with the record retention schedule. | Yes | |||||||||
| PSHBS-PM-2 | Printing and Mailing | The system shall produce and reconcile final counts of each Correspondence type to validate postage charges and send a final report daily. | Yes | |||||||||
| PSHBS-PM-5 | Printing and Mailing | The system shall maintain a log of returned mail and make it available at a cadence. | Yes | |||||||||
| PSHBS-PM-7 | Printing and Mailing | The system shall have the capability to track and record process activities associated with each piece of Correspondence required to be mailed from generation, print, folding, envelope insertion, delivery to the mail service, and in-home delivery. | Yes | |||||||||
| PSHBS-PM-8 | Printing and Mailing | The system shall have the capability to update addresses as directed by OPM. | Yes | |||||||||
| PSHBS-PM-11 | Printing and Mailing | The system shall allow Authorized Users to print the Correspondence with sensitive PII and PHI data redacted or unredacted, as approved by an OPM offical . | Yes | |||||||||
| PSHBS-PM-15 | Printing and Mailing | The system shall ensure that Correspondence-related errors triggered during the batch-print process do not prevent the completion of the batch-print process. | Yes | |||||||||
| PSHBS-GR-1 | PSHBS General Requirements | The system shall serve as the knowledge repository to consolidate and maintain disparate policies and guidance to enable ease of access to relevant eligibility and enrollment information. | Yes | |||||||||
| PSHBS-GR-2 | PSHBS General Requirements | The system shall contain a communications module to enable user communications with a messaging system. | Yes | |||||||||
| PSHBS-GR-3 | PSHBS General Requirements | The system shall enable push notifications to a user's email address. | Yes | |||||||||
| PSHBS-GR-4 | PSHBS General Requirements | The system shall be mobile responsive. | Yes | |||||||||
| PSHBS-GR-5 | PSHBS General Requirements | The contractor shall provide in-person training and training materials for administrative and system users as needed, including but not limited to videos, manuals and explanatory documents. | Yes | |||||||||
| PSHBS-GR-6 | PSHBS General Requirements | The system shall comply with HI Business Rules engine / Custom Workflows. | Yes | |||||||||
| PSHBS-GR-7 | PSHBS General Requirements | The system shall have the capability to integrate (i.e., HI databases) with existing OPM enterprise systems and databases to interface with both existing OPM systems and other vendor solutions that complement enrollment functionality. | Yes | |||||||||
| PSHBS-GR-8 | PSHBS General Requirements | The system shall have a Privacy Act statement to include notice of computer matching with SSA pop-up window for all users after login. | Yes | |||||||||
| PSHBS-GR-9 | PSHBS General Requirements | All System Interfaces shall display privacy act and burden statement with control number at the collection point. | Yes | |||||||||
| PSHBS-GR-10 | PSHBS General Requirements | The system shall have the ability to track and maintain data records according to applicable NARA retention schedules and the abliity to destroy records as directed by OPM. | Yes | |||||||||
| PSHBS-GR-11 | PSHBS General Requirements | The system shall have auditing capabilities. | Yes | |||||||||
| PSHBS-GR-12 | PSHBS General Requirements | The system shall have the capability to grant access and remove access for users by Admin users. | Yes | |||||||||
| PSHBS-GR-13 | PSHBS General Requirements | The system shall have the capability to account for disclosures of individuals’ records as required by 5 USC 552a(c)(1-4). | Yes | |||||||||
| PSHBS-GR-14 | PSHBS General Requirements | The system shall have the capability to notify and sign off users after a specified period of inactivity. | Yes | |||||||||
| PSHBS-GR-15 | PSHBS General Requirements | The system shall have the capability to notify individuals who may be adversely affected by a computer matching program regarding the adverse findings and providing information on how to contest those findings, per 5 U.S.C. 552a(p). | Yes | |||||||||
| PSHBS-GR-16 | PSHBS General Requirements | The system shall provide account-based user interfaces for a variety of user groups (i.e. enrollees, administrators, super-users, etc.). | Yes | |||||||||
| PSHBS-GR-17 | PSHBS General Requirements | The system shall allow for a single user to establish more than one role under the same user credentials. | Yes | |||||||||
| PSHBS-GR-18 | PSHBS General Requirements | The system shall provide role-based permissions for each user group. | Yes | |||||||||
| PSHBS-GR-19 | PSHBS General Requirements | The Contractor must provide detailed progress reports to OPM on a weekly basis through the development and implementation phases. | Yes | |||||||||
| PSHBS-GR-20 | PSHBS General Requirements | The system shall be in compliance with HIPAA (Health Insurance Portability and Accountability Act). | Yes | |||||||||
| PSHBS-GR-21 | PSHBS General Requirements | The system shall serve as the knowledge repository to consolidate and maintain disparate policies and guidance to enable ease of access to relevant eligibility and enrollment information. | Yes | |||||||||
| PSHBS-GR-22 | PSHBS General Requirements | The system shall the ability to automate OPM business processes via a business rules engine. | Yes | |||||||||
| PSHBS-GR-23 | PSHBS General Requirements | The system shall have the capability to integrate (i.e. HI databases) with existing OPM enterprise databases to interface with both existing OPM systems and other vendor solutions that complement CEP functionality. | Yes | |||||||||
| PSHBS-GR-24 | PSHBS General Requirements | The system shall have the capability to grant access and remove access for users by Admin users. | Yes | |||||||||
| PSHBS-GR-25 | PSHBS General Requirements | The system shall provide role-based permissions for each user group. | Yes | |||||||||
| PSHBS-R-1 | Reporting | The Contractor shall provide reporting functionalities to address non-compliant resubmission of data when transactions are denied or flagged for additional information and/or corrections. | Yes | |||||||||
| PSHBS-R-2 | Reporting | The Contractor shall generate rejection reports. | Yes | |||||||||
| PSHBS-R-3 | Reporting | The Contractor shall generate reports identifying applications that are started but incomplete. | Yes | |||||||||
| PSHBS-R-4 | Reporting | The Contractor shall generate acceptance reports. | Yes | |||||||||
| PSHBS-R-5 | Reporting | The system shall generate a report that includes enrollment validation data and a mechanism for Carrier to access this data and/or exporting into OPM's Carrer Connect system | Yes | |||||||||
| PSHBS-R-6 | Reporting | The system shall automatically generate a report on reconciliation items and data incongruencies. | No | |||||||||
| PSHBS-R-7 | Reporting | The system shall provide Enrollment processing reporting and analysis capabilities including, but not limited to: |
Total number of tasks developed by the Solution on a frequency; volume of tasks waiting for action to be taken;
| time to perform tasks; task status/priority/type; and historical performance metrics. | Yes | |||
| PSHBS-R-8 | Reporting | The system shall produce ad hoc reporting capability. | Yes | |
| PSHBS-R-9 | Reporting | The system shall allow Authorized Users to create, update, and delete report templates (including parameters). | No | |
| PSHBS-R-10 | Reporting | The system shall include online dashboards displaying real-time aggregate data on program operations. | No | |
| PSHBS-R-11 | Reporting | The system shall include dashboard design capabilities and access controls for various roles - program managers, senior management, OCIO staff, etc. to display pertinent data based on each roles' needs. | No | |
| PSHBS-R-12 | Reporting | The system shall maintain a history of report templates that can be restored and viewed by Authorized Users. | No | |
| PSHBS-R-13 | Reporting | The system shall provide the flexibility to set date parameters for reporting purposes and to produce reports on daily, monthly, quarterly, or other frequencies. | Yes | |
| PSHBS-R-14 | Reporting | The system shall provide, implement, and maintain tools and methods to support data extract outputs in online, hardcopy, and Industry Standard data extract outputs including ASCII, CSV, or the appropriate flat file as determined by OPM. | Yes | |
| PSHBS-R-15 | Reporting | The system shall provide, implement, and maintain tools and methods to support data extract outputs in online, hardcopy, and Industry Standard data extract outputs including, but not limited to, ASCII, CSV, Microsoft Excel, Microsoft Word, ODBC, SPSS, Adobe PDF, JSON, and XML. | No | |
| PSHBS-R-16 | Reporting | The system shall have the capability to generate a printer-friendly version of all system-generated reports. | Yes | |
| PSHBS-R-17 | Reporting | The system shall provide tools and methods capable of supporting and enabling intuitive querying and reporting capabilities for various user types and user skill levels. | Yes | |
| PSHBS-R-18 | Reporting | The system shall have the capability to roll up/drill down data by data elements to generate enrollment analytics from data. | Yes | |
| PSHBS-UI-1 | User Interface | The system shall display all Enrollment-related Correspondences (e.g., notices) for a Member. | Yes | |
| PSHBS-UI-2 | User Interface | The system shall provide the functionality for Authorized Users to enter and maintain free form text (e.g. Assignment note, record on hold note) on an Enrollment record for auditing or reference purposes at any point in time, based on user roles. | Yes | |
| PSHBS-UI-3 | User Interface | The system shall include configurable drop-down lists to identify options available, valid values, and code descriptions. | Yes | |
| PSHBS-UI-4 | User Interface | The system shall display Member information (e.g. Eligibility data, Medicare coverage data). | Yes | |
| PSHBS-UI-5 | User Interface | The system shall track, record, and report on all manual changes, by Authorized Users, to a Member’s Enrollment data via a Dashboard. | Yes | |
| PSHBS-UI-6 | User Interface | The system shall allow Authorized Users to update Health Plan information. | Yes | |
| PSHBS-UI-7 | User Interface | The system shall allow Authorized Users to update Benefit information. | Yes | |
| PSHBS-UI-8 | User Interface | The system shall allow Authorized Users to view the Member population distribution of Enrollments through a Dashboard. | Yes | |
| PSHBS-UI-9 | User Interface | The system shall display all Enrollment-related Correspondences (e.g., notices) for a Member. | Yes | |
| PSHBS-UI-10 | User Interface | The system shall link to the relevant sections of the benefit and policy information to identify the criteria directing the Member's Enrollment status outcome. | Yes | |
| PSHBS-UI-11 | User Interface | The system shall provide Authorized Users with the access to view Member's historical information including, but not limited to, Member status, Health Plan Assignments, Health Plan renewals, dates of coverage, Health Plan information, and Health Benefit information. | Yes | |
| PSHBS-UI-12 | User Interface | The system shall have the ability to display the Enrollment status determination rules applied during Health Plan Assignment. | Yes | |
| PSHBS-UI-13 | User Interface | The system shall allow Authorized Users to manually modify Member Enrollment data utilizing a data verification process to ensure enterprise standard values are entered by the Authorized Users. | Yes | |
| PSHBS-WTM-1 | Workflow and Task Management | The system shall close tasks and alert the task owner based on the change in circumstances of a user's status. | Yes | |
| PSHBS-WTM-2 | Workflow and Task Management | The system shall generate tasks for Authorized Users when unable to automatically complete Enrollments or Disenrollments. | Yes | |
| PSHBS-WTM-3 | Workflow and Task Management | The system shall provide a Business Process Management (BPM) capability to automate and support Business Processes and Workflows. The BPM shall support, at a minimum, system-generated tasks based on -defined events, visual Workflows, role-based access, and manage Processes with no code development. | Yes | |
| PSHBS-WTM-4 | Workflow and Task Management | The system shall allow Authorized Users to manually create, assign, reassign, update, and close tasks based on business needs. | Yes | |
| PSHBS-WTM-5 | Workflow and Task Management | The system shall alert Authorized Users, via a Dashboard view, when pending or incomplete tasks have exceeded specified time limits. | Yes | |
| PSHBS-WTM-6 | Workflow and Task Management | The system shall allow Authorized Users to save an incomplete task and return to the task at a later time period for further action. | Yes | |
| PSHBS-WTM-7 | Workflow and Task Management | The system shall maintain a repository that includes a history of all task related assignments and re-assignments. | Yes | |
| PSHBS-WTM-8 | Workflow and Task Management | The system shall allow Authorized Users to modify the status of tasks (e.g. view, create, open, re-open, close). | Yes | |
| PSHBS-WTM-9 | Workflow and Task Management | The system shall allow Authorized Users to sort, search, filter, edit, and display tasks via a Dashboard view. | Yes | |
| PSHBS-WTM-10 | Workflow and Task Management | The system shall provide an approval and/or escalation process for tasks and alerts based on Workflow parameters, user roles, and program rules to meet -defined business needs. | Yes | |
| PSHBS-WTM-11 | Workflow and Task Management | The system shall provide access to system functionality and settings defined by user type/role/permissions. | Yes | |
| PSHBS-WTM-12 | Workflow and Task Management | The system shall close tasks and alert the task owner based on the change in circumstances of a user's status. | Yes | |
| PSHBS-WTM-13 | Workflow and Task Management | The system shall integrate into all testing environments to allow Authorized Users to perform “What-If Testing” and compare the before and after outcomes. | Yes |
&G
Non Functional Reqs
| RESPONDENT TO COMPLETE | AGENCY USE ONLY | |||||||||||||
| REQ ID | Component | Sub-Component (if applicable) | Rule / Requirement | MVP (Y/N) | Comments | Solution Support | Section / Reference | Respondent Notes | Requirement Met? | Reviewer Comments | Working Session Comments | HI Comments | CIO Comments | RS Comments |
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