26-0137-RFP_WorkersCompensationThirdPartyAdministratorFAQs.pdf

FREQUENTLY ASKED QUESTIONS

The following are questions, information, clarifications, and responses related to 26-0137-RFP Workers' Compensation Third-Party Administrator Services.

QUESTION(S)/RESPONSE(S):

1. Question: What is the current RMIS utilized by the County? Can you provide a sample date field layout for data conversion?

RESPONSE: Riskonnect Clearsight – I do not have a sample data field layout; the selected company will have to work with our vendor.

2. Question: Per Excel Loss Run: Total of 152 Open Indemnity and 80 Open Medical Only claims for Sheriff and Non-Sheriff departments. Is this correct?

RESPONSE: We have approximately 200-300 files open. We have approximately 70 files that are closed in our system, but we treat them once per year so that the statute does not run.

3. Question: How many claims are in Litigation?

RESPONSE: Approximately 30 claims

4. Question: Are there any “paper files”? If so, how many?

RESPONSE: We have been paperless since 2006; however, we have some paper files for approximately 25 claims. We also have approximately 6 digital files that are housed in a separate system.

5. Question: I reviewed the current RFP for Pinellas County and found that the proposer must provide services to include fraud investigation and SIU services (among other things).

My question is, does the TPA, which generally does not have these units in-house, specify who they will be using these services in their proposal?

RESPONSE: If the TPA does not have in-house SIU services, it is expected to have a contract in place to handle the reporting requirements.

6. Question: When does the county expect to make a final decision?

RESPONSE: Proposals will be evaluated by an evaluation committee. A decision will be made to move forward with negotiation and award once the evaluation committee determines the most qualified proposer per the evaluation criteria.

7. Question: Follow up/presentation dates after responses have been reviewed?

RESPONSE: The evaluation committee will determine if presentations will be needed.

8. Question: What is the expected go-live date?

RESPONSE: 2-3 months after the contract is awarded.

9. Question: OSHA handling? Please clarify

RESPONSE: Pinellas County Government is not bound by OSHA, but we follow OSHA as a best practice, and our safety team uses some claims data to evaluate losses. There is no annual reporting for OSHA.

10. Question: What is the current claims system?

RESPONSE: Riskonnect Clearsight

11. Question: Is there an opportunity/desire to re-badge current staff?

RESPONSE: Yes

12. Question: How many adjusters/supervisors are currently over the WC program?

RESPONSE: 2 workers' compensation claims adjusters and 1 Manager. The manager oversees the liability and WC program.

13. Question: Room for staff of 2 or more on-site?

RESPONSE: Yes, that is a possibility,

14. Question: Is Lexington still the excess carrier? If not, who is the excess carrier?

RESPONSE: ARCH Insurance Group – annual renewal 3/1.

15. Question: In Section E – Scope of Work, Section 5) No Exceptions to RFP (50 Points): If there are minor exceptions, are all 50 points at risk? Can you please elaborate?

RESPONSE: Yes. Exceptions to any terms and conditions contained in the RFP or the Services Agreement will result in a 50-point deduction.

16. Question: Can Pinellas County provide a managed care/medical cost containment summary report for the preceding three years that includes the following:

• Total number of medical bills processed against the state fee schedule

• Total gross billed charges for all medical bills processed

• Total reductions in dollars from gross billed to the state fee schedule

• PPO penetration rate

• Total PPO reductions in dollars below the state fee schedule

• Total other savings below the state fee schedule, including Out-of-Network/Hospital specialty review savings

• Total pharmacy scripts filled

• Total pharmacy savings in dollars below the state fee schedule

RESPONSE: Please see the attached report

17. Question: Who is Pinellas County’s current PBM vendor?

RESPONSE: Mitchell International – Mitchell Script Advisor

18. Question: Is there a triage program in place today? Intake process (web, phone, other?)

RESPONSE: Company Nurse – 24/7 telephonic reporting of claims with a registered nurse, and they also provide initial authorization to our authorized clinics. The telephonic claims are imported into our system.

19. Question: Is there a formal RTW program in place today?

RESPONSE: There is no written program, but departments are expected to return their employees to work in a light-duty capacity. We have an approximately 95% compliance rate.

20. Question: Are there dedicated clinical resources supporting Pinellas County today?

RESPONSE: Pinellas County Government does not have an on-site clinic.

21. Question: Is there a formal medical UR plan in place for treatment review?

RESPONSE: No - UR is performed on a case-by-case basis and sent to a vendor.

22. Question: Is there any specified medical provider/clinic preferred by Pinellas County today?

RESPONSE: We are not managed care; we do have a set of initial treatment sites that we use, and we have providers that we work with for specialists’ referrals, not unlike any other employer.

23. Question: Are there any union affiliations in place with Pinellas County?

RESPONSE: Pinellas County Government does not have any union affiliations. Pinellas County Sheriff’s Office has PBA for law enforcement sworn only.

24. Question: Does Pinellas County currently use field or telephonic case management? If so, please provide the name of the vendor who is currently providing the services and the number of hours per year for the last three years broken down by field or telephonic?

RESPONSE: We had a full-time registered nurse as an employee who handled telephonic and field case management. After this person left mid-2020, the County is using Paragon Case Management for FCN services. County does not have a break down.

25. Question: Regarding Page 19, item #10 “The Proposer must provide an adequate number of experienced licensed lost time adjusters dedicated to the County’s WC claims to handle all matters in a timely manner.

Additionally, one adjuster may be located on-site in the County’s WC office Monday through Friday for 8 hours a day, the time to be established by the County and the Proposer. This adjuster will also act as the liaison for the County’s WC administration office and be available to handle WC claim situations needing immediate attention.”

a. Does Pinellas County want all adjusters exclusively dedicated to their program or could just the on-site adjuster be exclusively dedicated? Could other adjusters be designated to the program if claim counts did not mandate a second full time adjuster?

RESPONSE: If we have an adjuster on-site, they would be dedicated to the account. Yes, the 2nd adjuster can be assigned to other accounts to make their caseload a full caseload.

26. Question: Insurance Limits – Will you accept or negotiate lower limits of any of the listed coverages?

RESPONSE: No, the County will not reduce the limit of insurance requirements.

27. Question: Can you please elaborate on the adjuster needed during the transition. Will County staff no longer be handling the files? Would this adjuster utilize the County’s claim system?

RESPONSE: Until the transition is complete, it is anticipated that the adjusters will remain on site helping through the transition. There will be a date when the selected TPA will start intaking claims and processing claims while the transition of legacy claims has been completed.

28. Question: What is the County’s desired method for claims reporting? reporting electronically in real time to a claims system? or to a 1-800 line for reporting the injury that includes Nurse triage/hotline ? Does the County currently use a telephonic 24-hour nurse hotline for every claim? Is that an allocated expense?

RESPONSE: We have a hybrid system right now. We have a 24/hr. nurse hotline currently (see question

20) and the Sheriff’s Office enters clams directly into our RMIS system. The expense for Company Nurse is paid on the file and allocated to the Department who had the loss.

29. Question: Is it mandatory to participate in the E Payable program? Is this only for TPA monthly invoices and replenishment of the WC checking account?

RESPONSE: Pinellas County offers a credit card payment process (ePayables) through Bank of America. It is not mandatory. Yes, this is for monthly invoices.

30. Question: How many paper boxes do they currently have?

Reference: Section E – Scope of work #8 The Proposer must consult prior paper files, if any, as part of its claims process and maintain all legacy paper files on pending WC claims received from the County in a secure and organized manner. Paper files shall be returned to the County in a secure manner when no longer needed.

RESPONSE: I cannot estimate the number of boxes we would have as files are both in our office (2 standard 4-drawer filing cabinets) and other legacy files are in storage.

31. Question: What’s their average number of Medical bills and pharmacy bills per year for the last 5 years?

RESPONSE: Please see the report attached.

32. Question: Who is the incumbent TPA?

RESPONSE: Self-Insured/Self-Administered – claims are currently handled by Pinellas County Risk Management, and there is no TPA.

33. Question: Please provide number of TCM cases/hours for the last 5 years.

RESPONSE: I don’t have that as I had a full-time RN working for the County.

34. Question: Please provide the current expiring fee or contract.

RESPONSE: We do not currently use a third-party administrator (TPA).

35. Question: Which vendors are currently providing bill review, utilization review, and case management services, if any?

RESPONSE: Corvel for bill review, Mitchell ScriptAdviser for pharmacy, utilization review is case by case and depending on services being UR ’ed, case management is currently with Paragon Case Management.

36. Question: What is the current staffing assigned by the incumbent TPA to handle the inventory identified RFP.

Based on the wording below, would the County require one “on location” adjuster?

The Proposer must provide an adequate number of experienced licensed lost time adjusters dedicated to the County’s WC claims to handle all matters in a timely manner. Additionally, one adjuster may be located on-site in the County’s WC office Monday through Friday for 8 hours a day, the time to be established by the County and the Proposer. This adjuster will also act as the liaison for the County’s WC administration office and be available to handle WC claim situations needing immediate attention.

RESPONSE: We currently have no in-house adjusters assigned to handle claims, and the TPA has an assigned legal adjuster, a lost time & medical only adjuster, as well as a claims supervisor on both the County and PCSO.

37. Question: Is it the County’s preference that the claims adjusters secure their own recorded statements?

RESPONSE: Yes

38. Question: How are claims referred to case management?

RESPONSE: Our internal nurse reviewed all incoming claims for both TCM and FCM. Currently, we are using a vendor, so we refer to files based on criteria such as surgeries, complexity, and heart/lung bill claims.

39. Question: How many files are currently with a case manager?

RESPONSE: Approximately 45

40. Question: Can we have a five-year medical bill history? Number of bills, reductions and allowed.

RESPONSE: Please see the attached report.

41. Question: Is there a current PPO in place?

RESPONSE: Currently, Corvel does our medical bill review, check writing, and EDI reporting, so we benefit from their PPO.

All other specifications, terms, and conditions remain the same.