40DHHS-S3757

MEDICAL STAFF CREDENTIALING

QUESTIONS AND ANSWERS

1. Is it possible that you would consider using one company for enrollments and one for primary source verification? We only manage the insurance enrollments, but I see you are looking for two services within the RFP.

I prefer to have one company provide both services, however if one aspect of service cannot be provided by the vendor it would be the responsibility of awarded vendor to contract with the other vendor to provide services.

2. Is it acceptable to tranfer the RFP questions to an excel file or Google sheet and respond in that format?

No, questions must be entered in NevadaePro by March 24 @ 1:00.

3. Is it acceptable to tranfer the RFP questions to an excel file or Google sheet and respond in that format?

Refer to Question 2 as this is a duplicate.

4. What is the annual spend for this scope of work?

$200,000 in each fiscal year (FY26 & FY27); will request additional funding in FY28 & FY29, if applicable.

5. Who is the incumbent providing this service?

There is not a current contract. This is a new contract.

6. What specific healthcare provider and allied health professional job types required credentialing services last fiscal year?

To Name a Few:

Aetna Anthem Cigna Health Plan of Nevada Hometown Health Humana Silver Summit TriCare TriWest

UMR

7. At contract start, will the awarded vendor be required to perform full initial credentialing (including file build and primary source verification) for the existing 120 providers or will data be provided by the incumbent vendor and credentialing files considered current and only require recredentialing per their current cycle?

At start the awarded vendor would be required to perform full initial credentialing.

8. At the time of onboarding what percentage of credentialing files are expected to require additional follow-up due to incomplete or missing documentation?

Estimated 30%. Both hospitals are currently verifying/obtaining provider information to updated CAQH profiles.

9. What is the current re-credentialing cycle? (2 or 3 years)

It depends on the healthcare providers since some are annually and others only require one time enrollment.

10. Does the target credentialing turnaround time begin upon receipt of initial application or receipt of complete documentation from the applicant?

Receipt of completed documentation.

11. Is the vendor expected to participate in credentialing committee reviews or is the vendor’s role limited to preparing and submitting completed credentialing files for Division review?

The vendor’s primary responsibility is to prepare and submit complete credentialing files for review. At this time, the vendor is not required to participate in credentialing committee meetings. However, the vendor must be available to:

· Respond to committee questions,

· Provide clarifications or missing documentation, and

· Support the Division in resolving any discrepancies identified during review.

If future workflow or governance changes require vendor participation in committee meetings, expectations would be defined collaboratively and formalized through a change control process.

12. Can you provide a list of required commercial and government payors?

Commercial Refer to Question 6. Government payors will remain with agency until additional funding is obtained in FY28 & FY29.

13. What is the historical denial rate for payor enrollments?

Estimated around 30% due to credentialing.

14. Are vendors responsible for appeals and re-submissions? If so, should this cost be included in the enrollment fee or reflected as an administrative cost?

Yes, enrollment fee.

15. Is the vendor expected to submit and manage insurance plan payments (or just complete provider enrollment with commercial and government plans)?

Just complete provider enrollment.

16. What training elements for initial credentialing and fellowship are needed?

Training should include the operation of the website, which should include reporting capability.

17. Is any monitoring of criminal activity or sex offenders needed?

Yes, if website/application provides availability.

18. How would updating CME records be performed with Nevada licensing boards and be accessed by the third party?

Via self-attestation at renewal

19. Are there any population numbers for monitoring and cred/recred events?

Each hospital/clinic maintain its own population counts.

20. Please confirm how many distinct facility locations and legal entities (with separate Tax Identification Numbers) are in scope across South Nevada Adult Mental Health Services (SNAMHS), Northern Nevada Adult Mental Health Services (NNAMHS), and Rural Clinics. Specifically, for credentialing, privileging, and payer enrollment purposes, how many unique billing entities/Tax IDs and how many physical service locations should the vendor plan to support under this contract?

There is only one TIN for all locations.

21. Please describe the current status of credentialing and provider enrollment operations. Approximately how many providers are currently active, how many files or enrollments are in process, and is there an existing backlog of credentialing or enrollment work (and if so, what is the approximate size of that backlog)?

The hospitals are currently enrolled in Medicaid and Medicare and Rural Clinics is enrolled in Medicaid, Medicare and Commercial healthcare providers. To my understanding there is no existing backlog.

22. The Cost Schedule template allows for different ways to structure pricing (e.g., implementation/onboarding, administrative, credentialing, re: credentialing, monitoring, enrollment). How would you prefer vendors structure and present pricing in the Cost Schedule? Specifically, should fees be presented per provider, per event (e.g., per credentialing/credentialing or per enrollment), annual (e.g., annual platform or monitoring fees), per contract term, or a combination of these? Please also confirm whether you expect pricing to be based on current volumes, projected average annual volumes, or maximum volumes over the contract term.

Vendors should structure pricing using a combination of fixed fees, per‑event fees, and per‑provider fees to ensure clarity and comparability.

· Implementation/Onboarding: Fixed one‑time fees, itemized by major workstreams.

· Administrative Services: Either a fixed annual fee or a per‑provider‑per‑month rate with defined minimums and caps.

· Credentialing & Re‑credentialing: Per provider, per event, with tiers based on provider type and complexity.

· Payer Enrollment: Per provider, per payer, per event (initial, revalidation, updates).

· Monitoring: Per provider per month or annual per‑provider fee, with included monitoring scope clearly defined.

· Platform/Software: Annual organization-level fee, with itemized add‑on rates (e.g., admin seats, APIs).

Pricing should be based on projected average annual volumes.

23. For sizing and staffing purposes, how many new healthcare providers and allied health professionals do you typically hire per year today, and what is your expected annual growth in provider headcount over the anticipated four-year contract term?

On Average 5-10 new medical staff are hired at the hospitals.

24. The RFP defines an expected minimum of 120 providers to be included in the scope of work. Can you please describe if this is the size of the current roster and also provide an indication of any expected growth over the next 3 years?

The 120 was an estimate with the anticipation of growth in FY28 & FY29.

25. In our read of the RFP instructions, it appears the intended scope is to include full services for both credentialing and enrollment tasks. Is it acceptable to DPBH if a proposal covers services for credentialing and only software tools for enrollment, or will that be considered an incomplete or unresponsive bid?

Vendor will need to provide credentialing services, not just software.

26. The requirements stipulate adherence to the state's contracting terms and the opportunity to offer redlines for consideration. Understanding the burden of redlines is often impractical at this stage of an RFP, is DPBH willing to review a vendor-proposed master services agreement or will that be considered an incomplete or unresponsive bid?

DPBH will consider reviewing vendor-proposed master services agreement.

27. The RFP indicates adherence to NCQA, Joint Commission, and CMS credentialing requirements. Can you please specify the nature of the affiliations included in the scope of this work to include a count of total affiliations by entity and accreditation type? For example, is there a group appointment just subject to NCQA requirements and then separate appointments for entities requiring an appointment and privileges in accordance with JC/CMS requirements? Or are these possibly a single entity appointment with an expectation for delegated compliance with NCQA?

This RFP is focused strictly on medical staff credentialing and privileging, NCQA would not be necessary.

28. 120 providers, 20 payors each - will all 120 be credentialed from the beginning of the project or phased in over time?

We anticipate the 120 provider will be credentialed over a period of time.

29. Is the objective Verification of credentials or credentialing provider with payors. If it is credentialing the provider with the payor can the initial credentialing period be extended to 120 days?

Yes, the credentialing period can be extended to 120 days.

30. Is there a requirement for a compliance officer & what are the credentials?

There is no requirement for a dedicated Compliance Officer as part of the vendor’s staffing model. However, the vendor should have an individual responsible for oversight of regulatory and accreditation compliance related to credentialling and payor enrollment activities.

31. If we are credentialing with payors in Nevada, which payors would they be?

Refer to Question 6 for short list of providers.