260125_Chapter_1E_-_Attachment_-_Dental_Questionnaires_(MOA_and_QE)-RETURN_WITH_BID.xlsx
XLSX spreadsheet 40 KB Posted
- Solicitation number
- 260125
- Issued by
- Pima County, Tucson City, Arizona
About this file
This document is a dental questionnaire and qualification document for a Request for Proposal (RFP #260125) issued by the City of Tucson for dental plan services. The RFP seeks a dental provider to offer Dental Preferred Provider Organization (DPPO) plans with Tier 1 and Tier 2 networks, covering services for the city's employees, retirees, and dependents. The contract term is proposed for three years, from July 1, 2026 through June 30, 2026, with potential for renewal. The document requires detailed responses from potential dental plan providers on numerous aspects including network composition, provider access, claims administration, customer service, implementation capabilities, and compliance with various regulatory requirements.
The pricing and financial aspects of the proposal require providers to submit guaranteed rates for the three-year period, with specific guidelines around rate adjustments based on enrollment variations. Providers must detail their network discounts, reimbursement methodologies, and financial stability, including current ratings from agencies like Standard & Poor's, A.M. Best, and Moody's. The City of Tucson seeks a dental plan provider with a minimum of five years of experience, at least 5,000 full-service covered members, three Arizona clients with a minimum of 2,000 members each, and no recent bankruptcy filings. The RFP emphasizes comprehensive service capabilities, including robust network coverage in Pima County, advanced claims processing, HIPAA compliance, and strong customer service infrastructure.
View the file
Other files
Show 40 more
Latest 50 of 58 listed here. See the rest on GovTribe.
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Questionnaire Instructions
| Questionnaire Instructions to Offerors: |
| ***DO NOT ALTER THE QUESTIONS OR QUESTION NUMBERING***. |
| Ø Provide answers to the questionnaires in MS Excel format (per instructions on the Excel files--Questionnaires. |
| Ø Provide an answer to each question even if the answer is “not applicable” or “unknown.” |
| Ø Answer the question as directly as possible. |
| Ø If the questions ask “How many…” provide a number. |
| Ø If the question asks “Do you…” indicate Yes or No first, followed by your additional narrative explanation. |
| Ø Lengthy responses may be truncated when displayed. Be concise in your response. Use bullet points as appropriate. Reconsider how to word any response that exceeds 200 words in length so that the response contains the most important points you want displayed. |
| Ø Where you desire to provide additional information to assist the reader in more fully understanding a response, refer the reader of your RFP response to your appendix/attachments. |
| Ø RFP responses will become part of the contract between the winning Contractor and the City of Tucson. |
| Ø Any references to “Client” in the questionnaire refer to the City of Tucson. |
Answers to the questions must be provided in MS Excel format. Failure to complete the questionnaire and submit in MS Excel format without alterations will make it difficult to thoroughly understand your proposal.
&"-,Bold"&14RFP #260125 Attachment 1E - Dental
&"-,Bold"&10&F&"-,Regular" Page &P
MOA Questionnaire
| MINIMUM REQUIREMENTS | OFFEROR RESPONSE | |
| 1 | Please confirm you have been in business, performing the services being proposed herein, for a minimum of five (5) years. | |
| 2 | Confirm you have five thousand (5,000) full-service Contractor covered members | |
| 3 | Confirm you have at least three (3) Arizona clients under contract with a minimum of two thousand (2,000) total members per client | |
| 4 | Confirm you have had no bankruptcy filings within the last five (5) years | |
| 5 | Acknowledge you are compliant with all City of Tucson and federal applicable regulations and currently not restricted or prohibited from conducting business in all states where City of Tucson’s members reside or access related goods and services | |
| 6 | Confirm you have no current senior officer, board member, or director with a felony conviction on record. |
For each question below, provide your response for each product (DPPO Tier 1/Tier II or DHMO). Responses will be assumed to be for both products, where applicable, unless you indicate otherwise. Indicate any additional differences to your response for DPPO based on insured funding or self-funding. Offerors proposing a traditional DPPO may skip Tier II entries.
Address how you will meet each of the requirements listed under Scope of Work. If you intend to provide services that differ from what is outlined in the Scope of Work, you must provide a detailed explanation of how your services will differ and why that method is an appropriate method for meeting the City’s needs in the Deviations and Exceptions section.
| NETWORK/PROVIDER ACCESS | DPPO-Tier 1 | DPPO-Tier 2 | |
| 1 | Composition: | ||
| 1a | For your Pima County book of business, indicate the number of dentists (by General Dentist, Periodontist, Endodontist, Oral Surgeon, and Orthodontist) per 1,000 covered participants. | ||
| 1b | What is your firm’s current network utilization percentage in Pima County? | ||
| 1c | Is your network(s) wholly owned and operated? If not, describe the leasing and/or operating arrangements. | ||
| 2 | Network/Provider Stability: | ||
| 2a | What was your dentist turnover rate for 2024 in Pima County? Please explain why the dentists left your network (i.e., voluntary, involuntary, etc.) | ||
| 2b | What is your dentist turnover rate for 2025 YTD in Pima County? Please explain why the dentists left your network (i.e., voluntary, involuntary, etc.) | ||
| 2c | How quickly do you inform employers/clients when providers are added to or leave a network? | ||
| 2d | How does your plan evaluate the clinical performance of its contracted providers and consequences for providers who fail to meet standards? | ||
| 2e | How are your dentists reimbursed? Describe your reimbursement methodology in detail and how they may differ for general dentists, specialty care dentists and orthodontists. | ||
| 2f | Does the plan hold dentists accountable for the appropriateness of care delivered to members, patient outcomes and member satisfaction? Describe. | ||
| 2g | Do you agree to update your online provider directory not less than every 96 hours for any provider changes? | ||
| 2h | Does your organization hold a financial interest in any of the providers included in your network? Please describe in detail. | ||
| 2i | Describe the toll-free telephone support and field service support you offer to providers to resolve issues that relate to the City’s members. Include standard response and resolution time. | ||
| 3 | Network Size & Expansion: | ||
| 3a | Do you agree to maintain the size of your Pima County network for the duration of the contract to be no less than the size provided in your response to this RFP? | ||
| 3b | Are you willing to expand your network(s) to meet the City’s needs in areas where you have insufficient provider access based on Geo Access criteria? Describe efforts you would take to do so. | ||
| 3c | Provide details about how plan members may notify you of vendors they would like to have added to the network and steps you would take to act upon such nominations. | ||
| 3d | Do you have a Mexico network or can you partner with a Mexico network? Describe. | ||
| 4 | Geo Access: | ||
| 4a | Have you provided Geo Access reports for each networks proposed using as criteria 1 provider in 10 miles? Break out results by General Dentists, Pediatric Dentists, Specialists, and Orthodontists. Results must be based on the census provided. Do not exclude any locations or employee/retiree groups. Geo results should also include a report showing locations where the access criteria was not met, including the number of people impacted, name of the City, County and zip code. |
| METHOD OF APPROACH - GENERAL INFORMATION | OFFEROR RESPONSE | ||
| 1 | Organization: Please complete the following background information about your organization: | ||
| 1a | Organization’s name | ||
| 1b | Address of your corporate headquarters | ||
| 1c | Address of the location that will service the City of Tucson’s account | ||
| 1d | Date your firm became operational | ||
| 1e | Ownership of your firm | ||
| 1f | If your firm is not a corporation, please advise who each of the partners, proprietors or other owners are and whether they have interest in any other service provider firms related to any services requested under this RFP. | ||
| 1g | Is your organization "affiliated" with another company? If so, describe the affiliate relationship. "Affiliated" means owned by another company, owned by a common controlling shareholder or interest, or inter-tied by contract so as to be under the dominion or influence of another. | ||
| 1h | Has your organization acquired, been acquired by, or merged with another organization in the past 24 months? | ||
| 1i | Is your organization anticipating restructuring or reorganizing in the next two years? (Include any major staff relocations or office closings.) | ||
| 1j | In order to meet ALL of the services in this Attachment are you including any subcontractors or partners in the delivery of ANY services to the City? If so, please list ALL subcontractors and partners including a list of services they will provide, their location and any fees that will be associated with their services. | ||
| 1k | Offshore: Identify any services under any subsequent contract that may be awarded as part of this RFP that are currently or planned to be performed outside the borders of the United States. | ||
| 2 | Commissions: Does your proposal include any direct, indirect compensation, fees, commissions, incentive awards, rebates, payments, fees or remuneration of any sort, however characterized, as a result of or arising from the City account? Confirm you agree that if they cannot be netted out of the rates or fees they will be paid to the City’s Consultant. Also, confirm no commissions are submitted through a third party broker. | ||
| 3 | Litigation: | ||
| 3a | Is your organization involved in any current litigation against or from the City? If yes, please describe. | ||
| 3b | Have you been involved in litigation within the last five years arising out of your performance in the administration of a program similar to what your organization is proposing for the City of Tucson? Exclude routine matters involving participants that do not reflect on your organization’s performance under the contract with your client. If the answer is yes, explain fully. | ||
| 4 | Laws: | ||
| 4a | Are you fully licensed to operate in Arizona and are you currently in compliance with all Arizona Department of Insurance Regulations pertaining to this coverage? | ||
| 4b | Explain how you stay current with changes in federal and state laws pertaining to the services you are proposing. | ||
| 4c | Confirm you agree to supply, upon request by the City, verification of compliance with any regulation stipulated herein or pursuant to any state or federal law. | ||
| 5 | Administration: | ||
| 5a | Confirm the online system accessible to the City allows them to assign different levels of access internally. | ||
| 5b | Do you agree to provide resources to respond within one-two business days to all inquiries related to quality assurance, corrective actions, deficiencies and/or inefficiencies in operations? | ||
| 5c | Do you agree to provide a team of individuals designated to implementing the provisions of this contract upon award including but not be limited to programmers; data analysts; project manager; account manager; enrollment specialists; and claims and member service staff? | ||
| 5d | Do you agree to perform, at no additional cost to the City, comprehensive system testing and quality assurance checks prior to the effective date and to report the results back to the City by no later than May 1, 2026? | ||
| 6 | Claims Administration: | ||
| 6a | Do you agree to provide the City with a minimum 12 months advance notice of any claim system conversion or change that may disrupt the current processes? | ||
| 6b | Do you have any system changes planned in the next two years? | ||
| 6c | Do you agree that if you receive claims that are missing information that prevents payment that you will pend claims for a period of not more than 60 days allowing time for additional information for processing? | ||
| 6d | Where is the dental claim payment function located? | ||
| 6e | Briefly discuss your claim payment operations and procedures including organization, staffing and workflow. | ||
| 6f | Please complete the following chart regarding your dental claims administration: | ||
| Actual Results | 2024 | 2025 YTD | |
| 6fiii | Turnaround Time | ||
| 6fiii | Claim Payment Accuracy | ||
| 6fiii | Procedural Accuracy | ||
| 6fiv | Financial Accuracy | ||
| Internal Benchmarks | 2024 | 2025 YTD | |
| 6fv | Turnaround Time | ||
| 6fvi | Claim Payment Accuracy | ||
| 6fvii | Procedural Accuracy | ||
| 6fviii | Financial Accuracy | ||
| 6g | What percent of claims are auto-adjudicated? | ||
| 6h | What is your organization’s coverage for treatment in progress when a new member joins? Specifically, please include information on banded orthodontics. Do you have the capability to adjust your processes to accommodate the City’s rules if different from your standard? | ||
| 6i | Does your claims system have the capability to show the negotiated and actual charges on the EOB messages? | ||
| 6j | For what period of time are claims records maintained after records are purged from the system? | ||
| 6k | Does your claim system have the ability to show the status of annual accumulators (deductible, calendar year maximum, lifetime maximums) on the EOB? | ||
| 6l | Outline your procedures and costs for loading orthodontia accumulators from the current administrator. | ||
| 6m | What guidelines, processes or procedures do you use in determining whether services are “necessary” or “appropriate”? | ||
| 6n | What procedures do you use to administer the coordination of benefits (COB) provision? Is COB history stored online? | ||
| 6o | What steps do you take to prevent balance billing by network providers? | ||
| 6p | Describe your internal procedures to identify, deter, eliminate, and recover fraudulent provider billing practices. | ||
| 6q | How does your claims system administer claims in excess of U&C? | ||
| 7 | HIPAA: | ||
| 7a | Confirm that if you receive individually identifiable health information (IIHI) from the City in order to perform underwriting, pricing, or other activities relating to the renewal or replacement of a contract, that you will protect such IIHI as required by HIPAA Privacy regulations. | ||
| 7b | Are all your systems and staff HIPAA compliant? | ||
| 7c | Briefly describe the steps your organization has taken to comply with the privacy standards imposed by the Health Insurance Portability and Accountability Act (HIPAA) and HITECH. | ||
| 7d | Have you had a HIPAA violation in the past? If yes, please describe. | ||
| 7e | Are you aware of any complaints that have been filed against your organization regarding HIPAA EDI, Privacy or Security with a government oversight agency? | ||
| 7f | Do you plan to sell, lease or transfer the City’s protected health information (PHI) to a third party in the course of administering this contract or after the contract has terminated? | ||
| 7g | How do you address privacy and security? Describe security measures in detail. | ||
| 7h | From what company has your firm purchased additional liability insurance in anticipation of HIPAA compliance responsibilities? | ||
| 7i | Confirm you agree to provide City insurance staff with access to secure email for resolving any eligibility or other related issues. | ||
| 8 | Implementation: | ||
| 8a | Confirm you agree to begin implementation immediately upon award or at the direction of the City. | ||
| 8b | Provide an implementation plan outlining tasks necessary to install the program, the timetable and the parties responsible. | ||
| 8c | Will you provide the City with communications and data support within a specified time-frame designated by the City during implementation for a successful transition to the new contractor? Describe. | ||
| 8d | Describe your capacity to produce communication materials and ID cards. Do you produce these materials or are these services subcontracted? | ||
| 8e | What is the minimum amount of implementation lead-time you need in order to initiate the proposed services for the City of Tucson? | ||
| 8f | List any transition issues the City of Tucson should consider with respect to moving services from an existing Contractor to your organization. | ||
| 8g | Are there any specific administrative procedures or information that your firm will need from the City of Tucson in order to implement your services? If yes, please describe. | ||
| 9 | Scope of Work: | ||
| 9a | Do you agree to provide each and every item listed in the Scope of Work? | ||
| 9b | Confirm you agree to provide City insurance staff with access to secure email for resolving any eligibility or other related issues. | ||
| 10 | Future: | ||
| 10a | What features or enhancements to the program or services you are proposing are on your roadmap for the next 12 months? | ||
| 11 | Appeals and Disputes: | ||
| 11a | Please detail your procedures for responding to appeals and disputes as well as reporting the responses and results to the City. | ||
| 11b | Please confirm you will manage all levels of claims appeals and disputes and act in the capacity of a fiduciary to the plan. | ||
| 11c | How do you monitor and track appeals and complaints, payment issues (i.e., employee, provider)? | ||
| 12 | Fiduciary: Would you be willing to be a named claims fiduciary under the City’s plans? Would you be willing to meet fiduciary standards as found in ERISA, even though the City’s programs are not governed by ERISA? | ||
| 13 | Performance Guarantees: | ||
| 13a | Do you agree to maintain performance standards and performance guarantees relating to all services provided as requested in the Performance Guarantees? | ||
| 13b | Performance Tracking – Confirm you will provide a detailed report on each performance measure by appropriate time period including the status narrative for each of the requirements in the Proposed Performance Standards section of this Attachment: | ||
| 13bi | Quarterly | ||
| 13bii | Annual | ||
| 13c | Do you agree to remit to the City any performance penalties assessed within 30 days after identification and substantiation of results? | ||
| 14 | Eligibility and Billing: | ||
| 14a | Confirm you agree that the City determines eligibility for coverage. | ||
| 14b | Confirm you agree to continue surviving spouse (indefinitely) and/or child(ren) coverage (until age 26) of retirees who age out or pass away, with appropriate premium payment. | ||
| 14c | Confirm you agree to determine and maintain eligibility for all dependents age 26+ who are disabled. | ||
| 14d | Are you able to administer an end-date for dependents to age 26 (end of the month) and ensure it remains in place even when new eligibility files are received that may continue to show the dependent? If not, could you generate a monthly report for the City showing dependents that are ageing off the plan? | ||
| 14e | Confirm you agree that the City may change enrollment system providers at any time and that there shall be no charge from you to the City if the City changes enrollment system providers, even if it requires your team to build new reporting interfaces. | ||
| 14f | Do you agree to receive enrollment information via weekly electronic feed from the City’s current online enrollment system, at no additional cost to the City? | ||
| 14g | Confirm you agree to load eligibility within 2 working days of receipt. | ||
| 14h | Confirm you agree to notify the City of discrepancies and errors within the eligibility file within 2 working days of receipt of each eligibility file. | ||
| 14i | Confirm you agree to accept the City's self-bill (no true up of any eligibility discrepancies other than those based on eligibility file transfer). | ||
| 14j | Grace Period: Confirm you agree to accept payment of fees and premiums 60 days in arrears. For example, July’s premium would be due August 29. | ||
| 14k | Do you have any minimum participation requirements? | ||
| 14l | Do you agree to establish appropriate FTP site(s) to exchange eligibility data at no additional cost and at the frequency established by the City? | ||
| 14m | Can the City and their designated Consultant access eligibility and reporting through a secure website? Describe. | ||
| 15 | Account Management: | ||
| 15a | Do you agree to provide to the City an electronic tracking and resolution log of all open and closed City issues? | ||
| 15b | Do you agree to notify the City within 1 business day of receipt of any public information written request regarding any information that relates to the City’s benefit plans and to review all responses with the City and obtain approval prior to the release or response of any inquiry? | ||
| 15c | Do you agree to respond to the City’s HR team’s questions within 1-2 business days of request (even if the answer is “I am working on it”)? | ||
| 16 | Onsite Visits: | ||
| 16a | Do you agree to provide knowledgeable personnel to attend all scheduled in person meetings. | ||
| 16b | What capabilities do you have to support the City’s employee and retiree enrollment and orientation meeting needs using video conference or other electronic means? | ||
| 16c | Do you agree to attend in person (or via video conference) monthly, quarterly and annual on-site program reviews, with periodic telephone calls, upon request from the City’s insurance benefits office? | ||
| 16d | Do you agree to be available for onsite meetings with City of Tucson staff at a minimum of one meeting per month? | ||
| 17 | Customer/Member Service: | ||
| 17a | Describe your company’s expectations for quality of customer service. | ||
| 17b | Confirm you will provide at a minimum a designated customer service team of representatives for the City and describe that team. | ||
| 17c | Describe how members will have access to claims/customer service representatives. How are after hours calls handled? | ||
| 17d | Does customer service have a toll free number? | ||
| 17e | Where is the customer service staff located that will service the City of Tucson account? | ||
| 17f | Describe your phone management system's ability to track, monitor and manage incoming calls. How are calls distributed to staff? | ||
| 17g | Do you provide members with limited English proficiency, Spanish-speaking, and those who are deaf or hearing impaired with access to communication services that enable them to utilize the phone lines? | ||
| 17h | Please detail your escalation process to assist in matters that cannot be resolved at the customer service unit level. | ||
| 18 | Quality: | ||
| 18a | Discuss your organization's dental utilization review program and quality control protocols. | ||
| 18b | Are you able to capture patient satisfaction information? Describe. | ||
| 18c | What quality assurance procedures are in place to ensure efficiency in the claim processing and member service functions? | ||
| 19 | Data: (Respond with no more than 500 words in total) | ||
| 19a | Describe your organization’s approach to authorizing systems access and City information access both for your employees and for participants of the program. | ||
| 19b | Who owns the critical data (i.e., client information, network data, etc.) within your organization and how is it secured? | ||
| 19c | What quality control measures do you have in place to ensure it remains secured? | ||
| 19d | Are these processes audited? If yes, how often? | ||
| 20 | Reporting: | ||
| 20a | Are you able to provide the reports identified in the scope of work section titled “Data and Reporting” and at the frequency rate requested? | ||
| 20b | What types of additional cost and utilization reports are available? Please provide sample copies of these reports. | ||
| 20c | What reports are accessible by the City through the Internet? | ||
| 21 | Communications: | ||
| 21a | What type of communication support do you provide to your clients (scheduling, posters, kits, etc.)? Provide samples. | ||
| 21b | Are customized communications available at no additional cost to the City? | ||
| 21c | If your organization is awarded the City’s business, how soon after notification of the award would you be able to have a draft of the plan booklet ready for the City to review? | ||
| 21d | Does your organization have the capability to provide communication pieces in Spanish and other languages? Please specify which languages you can accommodate. | ||
| 21e | Identify the services and any communication allowances you will provide to help the City introduce the new program to its employees. | ||
| 21f | Describe all services currently available to members on your website. What on-line services do you expect to make available to members in the coming year? | ||
| 21g | Confirm you will supply both written and electronic member communication materials (flyers, plan summaries, etc.) at no additional cost to the City. | ||
| 22 | Website and/or Mobile Applications: | ||
| 22a | Indicate if you have a mobile application or mobile optimized website. | ||
| 22b | What features does the mobile application include or is it limited compared to the regular member website? | ||
| 22c | What information (if any) can be customized by the City at no additional charge? | ||
| 22d | Indicate whether and how you maintain consistency between your mobile application and website. | ||
| 22e | Please provide a demo of your website and/or mobile application(s) that would be used by the City and their participants. |
| METHOD OF APPROACH - DENTAL | OFFEROR RESPONSE | |
| 1 | Plan Design: | |
| 1a | Deviations to requested plan designs must be detailed in the Deviations exhibit included in this RFP, stating the current language and the proposed deviation. Do not merely refer the reader to your schedule of benefits to figure out your proposed benefit differences. | |
| 1b | Does your proposed plan include any exclusions or limitations that are less generous than the current plan? Include specific details in the Deviations exhibit. | |
| 1c | Describe how your plan would handle a late entrant. | |
| 1d | How does your plan handle a resin composite filling on teeth that traditionally would be treated with an amalgam? | |
| 1e | What types of sedatives do you cover and what are the coverage limitations? | |
| 1f | Do you cover temporary fillings? | |
| 1g | Does your plan cover appliances for the treatment of bruxism? | |
| 1h | Do you cover Guided Tissue Regeneration (GTR)? | |
| 1i | Up to what age do you cover fluoride treatments and how often? | |
| 1j | What limitations (if any) do you have on sealants? | |
| 1k | Does your plan cover dental implants? Are there any inside limits (e.g. lifetime maximums)? | |
| 1l | Does your plan allow nitrous oxide analgesia? If so, please indicate any additional costs. | |
| 1m | If benefits under the City’s plan are exhausted or not covered, can members take advantage of your negotiated pricing? If not, please explain. | |
| 1n | How will your plan pay benefits for dependents and retirees who reside outside of the state of Arizona? | |
| 2 | Pre-Existing Condition Limitation | |
| 2a | Do you agree that any employee, retiree or dependents switching from one City of Tucson sponsored dental plan to another shall not be subject to any pre-existing condition limitations? | |
| 2b | Do you agree to no pre-existing condition limitations for currently covered participants other than those currently applicable under the City of Tucson dental programs? | |
| 2c | Describe any missing tooth limits your plan may have for new participants. | |
| 3 | Dental PPO | |
| 3a | Can your company duplicate the three tier DPPO plan of benefits? | |
| 3b | What is the turnaround time for a pretreatment review? | |
| 3c | How are “usual and customary” charges determined by your company for non-network claims? | |
| 3d | Does your plan use maximum allowable cost for limiting non-network allowances? If yes, explain how the allowable is derived. | |
| 3e | Attach a complete copy of the benefit summary for the DPPO plans that you are quoting. If you are unable to match all benefits, please include these in your Deviations exhibit. | |
| 3f | Confirm you have completed the DPPO Benefit Design grids in the Excel workbook. | |
| 3g | Do you have a program similar to CIGNA’s Oral Health Integration Program (see OHIP document for details). Please outline the details of your program. |
| COST (RATES/ASO FEES/FINANCIALS) | OFFEROR RESPONSE | |||||
| 1 | Multi-Year Rates/Fees/Renewals | |||||
| 1a | Is your pricing guaranteed for three (3) years (July 1, 2026 through June 30, 2026)? Do any underwriting conditions and/or caveats apply? | |||||
| 1b | Do you agree to guidelines relating to re-evaluation of proposed fees due to variation in enrollment in the plan must not be less than 20% of the enrollment at the beginning of each plan year? | |||||
| 1c | Do you agree to provide final renewal notification at least 180 days prior to the contract anniversary date? | |||||
| 1d | Does your DPPO claim figures include any non-claim expenses (i.e. % of discounts retained by the network or other non-patient expenses)? Describe. | |||||
| 2 | Network Discounts: In the following table, place an “x” to describe the methods of reimbursement which apply to the following DPPO providers in your Pima County network. In the last column, indicate the average discount the City could expect. | |||||
| 2a | Tier 1: | Discount Off Billed Charges | Fixed Fee Schedule | Capitation | Other | Avg. Discount Off Billed Charged |
| 2ai | General Dentistry | |||||
| 2aii | Endodontics | |||||
| 2aiii | Orthodontics | |||||
| 2aiv | Pedodontics | |||||
| 2av | Periodontics | |||||
| 2avi | Prosthodontic | |||||
| 2avii | Surgery, Oral & Maxillofacial | |||||
| 2b | Tier 2: | |||||
| 2bi | General Dentistry | |||||
| 2bii | Endodontics | |||||
| 2biii | Orthodontics | |||||
| 2biv | Pedodontics | |||||
| 2bv | Periodontics | |||||
| 2bvi | Prosthodontic | |||||
| 2bvii | Surgery, Oral & Maxillofacial |
&"-,Bold"&14RFP #260125 Attachment 1E - Dental
Q&E Questionnaire
| QUALIFICATIONS AND EXPERIENCE | OFFEROR RESPONSE | ||
| 1 | Organization: Please complete the following information about your organization: | ||
| 1a | Provide a Brief History | ||
| 1b | Date your firm became operational for the services requested in this Attachment | ||
| 1c | How many employees does your organization have? | ||
| 1d | In Arizona, what is the size of the staff that will service the City of Tucson? | ||
| 1e | How long have you been providing services requested in this Attachment to employers in Arizona? | ||
| 1f | Describe your experience providing services to other public sector employers in Arizona. | ||
| 1g | What is the average group size (covered employees/retirees)? | ||
| 1h | What proportion of your business is providing the coverage you are proposing? | ||
| 1i | What are your long-term corporate objectives regarding your business with respect to the coverage you are proposing? | ||
| 1j | In what states are you NOT licensed to do business? | ||
| 1k | What certifications, accreditations, awards or recognition has your organization received? | ||
| 1l | What is your organization’s customer service philosophy? How do you ensure consistent implementation of the philosophy? | ||
| 1m | What key attributes distinguish your organization from your competitors? | ||
| 1n | How do you propose to alert the City’s key management and human resource staff regarding problem areas or trends identified? | ||
| 2 | Financials: | ||
| 2a | Provide your current rating and one prior rating for each entity holding any part of the insurance risk by the following agencies. | Current | |
| Rating | Prior Rating | Date |
Changed
| 2ai | Standard and Poor’s (S&P) | ||||
| 2aii | Duff and Phelps | ||||
| 2aiii | A.M. Best | ||||
| 2aiv | Moody’s | ||||
| 2b | Within the last 24 months, has your organization been served or involved in a significant and/or class action lawsuit that might impact your rating? | ||||
| 2c | Describe any changes in the organizational structure (including, but not limited to, demutualization, addition/deletion of claim offices, addition/removal of product lines, and staff reductions) that have occurred in your organization over the last 12 months or are anticipated to occur in the next 24 months. | ||||
| 2d | Do you agree to promptly notify the City (Benefits Office and Procurement Office) of any change in your ownership or control affecting 10% or greater interest, any acquisition by you of 10% or greater interest in any subsidiary, and any new agreement with, by or between any affiliates that is relevant to this contract? | ||||
| 3 | Account Management: | ||||
| 3a | Designated Account Team: Provide the names, titles, resumes, locations, email addresses and phone numbers of all proposed key personnel including the Account Manager and day-to-day contact who will service the City’s account. Provide their respective qualifications and credentials and the capacity in which they will serve. | ||||
| 3b | Describe your account management team’s experience in providing services for similar entities including how they will be trained in the City’s plan issues, their accessibility to the City and their capacity and authority to respond to the City’s issues in a timely manner. | ||||
| 3c | Confirm you agree to provide the necessary staff for planning, transition, implementation, annual open enrollment(s), and/or any special open enrollments and ongoing administration of the plan at no additional cost to the City? | ||||
| 4 | References: | ||||
| Current Client References (Similar Sized Arizona Clients Preferred) | |||||
| Client Name | Contact Name | Phone Number and Client Location | Number of Members | Contract Start Date | |
| 4a | |||||
| 4b | |||||
| 4c | |||||
| Recently Terminated Clients (Similar Sized Arizona Clients Preferred) | |||||
| Client Name | Contact Name | Phone Number and Client Location | Number of Members | Contract Start Date | |
| 4d | |||||
| 4e | |||||
| 4f |
&"-,Bold"&14RFP #260125 Attachment 1E - Dental
File details come from the government source that posted it. Updated .