41NHA-S3818-Reference-Questionnaire.docx
DOCX document 41 KB Posted
- Attached to
- Medicaid Third Party Liability (TPL), Recovery Audit Contracting (RAC), and Medicaid Estate Recovery
- Solicitation number
- 41NHA-S3818
- Issued by
- Nevada
About this file
This is a Reference Questionnaire document issued by the Nevada State Purchasing Division, Department of Administration, in support of a formal solicitation (41NHA-S3818) for Medicaid Third Party Liability (TPL), Recovery Audit Contracting (RAC), and Medicaid Estate Recovery (MER) Services on behalf of the Nevada Health Authority. The questionnaire is designed to collect client feedback on proposing vendors or subcontractors for projects of similar size and scope. Vendors must submit completed reference questionnaires from current or former clients by the due date of August 9, 2026, to Heather Moon (hmoon@admin.nv.gov), with the solicitation number included in the subject line. The State requests that all questions be answered, with responses marked as "U/K" (unknown) or "N/A" (not applicable) where appropriate.
The reference questionnaire evaluates vendor performance across twelve rated criteria using a 0-10 scale, including knowledge and expertise, flexibility relative to scope and timeline changes, quality of delivered materials and products, staff dynamics, schedule adherence, customer service, billing accuracy, problem resolution, business requirement flexibility, local office responsiveness, and likelihood of future recommendation. Additional unrated evaluation items request information on the vendor's service aspects that were most satisfactory and whether the client would recommend the vendor for future engagement. Completed reference questionnaires are designated as confidential business information pursuant to Nevada Revised Statutes and are not subject to public disclosure. The State reserves the right to contact references directly for further clarification during the evaluation process.
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Other files
| File | Type | Posted |
|---|---|---|
| RFP Attachment - SLA TPL Vendor Checklist.xlsx | XLSX spreadsheet | |
| RFP Attachment - TPL Comparision Report Sample.xlsx | XLSX spreadsheet | |
| 41NHA-S3818 SOWs Final 06.08.26.docx | DOCX document | |
| RFP Attachment - 213 MCO Subrogation Sample.xlsx | XLSX spreadsheet | |
| Standard-form-contract~3.docx | DOCX document | |
| RFP Attachment - Vendor Recovery Recoup Checklist.xlsx | XLSX spreadsheet | |
| 41NHA-S3818-Request-for-Proposals.docx | DOCX document | |
| 41NHA-S3818 - Insurance Schedule - RFP.docx | DOCX document | |
| Terms-and-conditions-for-services~5.pdf | ||
| 41NHA-S3818 - Cost Schedule Final 06.09.26.xlsx | XLSX spreadsheet | |
| 41NHA-S3818 - Business Associate Addendum.docx | DOCX document | |
| Certification-regarding-lobbying~5.pdf | ||
| RFP Attachment - 210 MCO TPL Report Sample.xlsx | XLSX spreadsheet |
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Text version
Nevada State Purchasing Division Department of Administration 515 E Musser St Ste 300 Carson City, NV 89701 purchasing.nv.gov nevadaepro.com
Reference Questionnaire
Due Date 08/09/2026
Solicitation number 41NHA-S3818
Single point of contact name Heather Moon
Single point of contact email hmoon@admin.nv.gov
Proposing vendor or subcontractor
Client providing the reference
Client contact name and title
Client telephone and email
Period of performance
1. Client reference instructions
1.1. As part of a formal solicitation the State of Nevada has requested vendors provide references from current and/or former clients for projects of similar size and scope. This reference questionnaire is to provide a client reference for the proposing vendor or subcontractor above. Once you have completed the reference questionnaire, please submit to the single point of contact via email, with the solicitation number in the subject line, no later than the due date above.
1.2. The State requests all questions be answered. If an answer is not known, please answer as ‘U/K’. If the question is not applicable, please answer as ‘N/A’. If additional space is needed to answer a question or provide a comment, please attach additional pages. If attaching additional pages, please place your company/organization name on each page and reference the appropriate RFP number.
1.3. Do not return the completed reference questionnaire to the proposing vendor. To allow for candid responses, completed reference questionnaires are designated as confidential business information by the Administrator pursuant to NRS 333.020(5(b) and not public information pursuant to NRS 333.333. In addition to the reference questionnaire, the State may contact references for further clarification.
Where a rating is requested, please provide a rating between 1-10. For all items, please provide any comments you feel would be helpful to the State in evaluation below each item. Poor or inadequate performance: 0; Below average performance: 1-3; Average performance: 4-6; Above average performance: 7-9; Exceptional performance: 10.
Evaluation items
In what capacity have you worked with this vendor in the past? (no rating)
Vendor’s knowledge and expertise, rating:
Vendor’s flexibility relative to changes in scope and timelines, rating:
Your satisfaction with delivered materials, rating:
Dynamics and interaction between the vendor and your staff, rating:
Your satisfaction with products developed by the vendor, rating:
Was the schedule met and deliverables timely? Rating:
Overall customer service and timeliness in response and issue resolution, rating:
Accuracy and timeliness of billing, rating:
Vendor’s ability to quickly and thoroughly resolve a service-related problem, rating:
Vendor’s flexibility in meeting business requirements, rating:
Response time and customer service of local office, if applicable, rating:
Likelihood of recommending this vendor to others in the future, rating:
Which aspects of this vendor’s services are you most satisfied with? (no rating)
Would you recommend this vendor to your organization again? (no rating)
Revised 2024-10 Page 2 of 2
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