5.Att.E-Technical Questions-FINAL 4.25.22.pdf

RFP No.: DMS-21/22-027 Attachment E: Technical Questions Page 1 of 3

ATTACHMENT E: TECHNICAL QUESTIONS

Instructions: Respondent should provide a response to each of the following questions and requests for information and should restate the item and follow the restatement with the Respondent’s response in at least 11-pt. Calibri, Arial, or Times New Roman blue font.

Failure to provide a response to any of the questions and requests for information below may result in a lower score, including a possible score of zero (0). Each question will be scored zero (0) to five (5) points. The responses to the questions and requests for information will be scored in accordance with section 4.3.1, of this RFP.

I. Implementation

Describe and/or provide the following implementation information:

1. Provide a detailed Implementation Plan that clearly demonstrates the Respondent’s ability to meet the State's requirements to have a fully functioning program in place and operable on January 1, 2023. The Implementation Plan should include a list of specific implementation tasks/transition protocols and a timetable for initiation and completion of such tasks, including the milestones provided for in AR-1. Submit as Tab 7 Attachment TQ-1: Implementation Plan.

a. Indicate the critical dates that must be met to meet the Implementation Date of January 1, 2023. Include the processes that shall be reviewed, steps to be taken including but not limited to, system testing, required transition data from incumbent, and timelines for development of Plan documents.

b. Describe what is anticipated in terms of the Respondent's role and the Department's role in the implementation process.

Notice to Respondent: The Respondent(s) awarded a contract will be required to submit their final Implementation Plan to the Department no later than ten (10) Business Days following execution of the Contract.

2. Provide an organizational chart identifying the names, titles, area(s) of expertise, functions, and reporting relationships of key individuals responsible for implementing and providing ongoing servicing of the State’s account. Submit as Tab 7 Attachment TQ-2: Organizational Chart.

3. Describe any major transition issues Respondent reasonably anticipates during implementation and how it proposes to mitigate the impact of those potential issues.

4. Describe the duties and percentage of time the Implementation Manager will dedicate to implement this Contract for the State as compared to duties and time for other Clients.

5. Describe the flexibility of Respondent’s technology team to program, test, and load into production Plan eligibility files.

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II. Account Management

6. Identify the Account Manager(s) who will have primary responsibility of planning, supervising, and performing account management services for the State if the Respondent is awarded a Contract under this RFP.

a. What other duties, if any, does the Account Manager(s) have? Include the number and size of other accounts for which this person will be responsible.

b. What percentage of this person's time will be devoted to the contract resulting from this RFP?

c. Describe the role and support of the Respondent’s Account Manager in the following areas:

External and internal meetings;

Communications and marketing;

Implementation of Plan Design changes;

Customer service;

Modification and update of enrollment files;

Reporting capabilities;

Development and dissemination of Member materials; and Plan and benefits education.

III. Support Services

Describe and/or provide the following support services information:

7. Describe Respondent’s experience with claims processing. Include the following information: average clean claim processing turnaround time; average claim processing accuracy; top five (5) reasons for a delay in claims processing; and top five (5) causes of inaccurate claims processing.

8. Describe Respondent’s actions taken when providers bill incorrectly, including balance billing and other Member overbilling.

9. Describe Respondent’s experience in providing customized Plans for employer groups of at least 50,000 participants.

10. Describe the challenges or difficulties Respondent reasonably anticipates may impact the State’s dental program and how Respondent would overcome or mitigate the effect of these difficulties, given Respondent’s experience with similar groups.

IV. Customer Service

Describe and/or provide the following customer services information:

11. Describe the Respondent’s customer service call center. Include the following information: location of call center that will serve Members; hours of operation; number of representatives, or ratio of representative to Members that will be assigned to the State’s account; and security protocols for the customer service call center and representatives.

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12. Describe Respondent’s training, experience, and turnover of the customer service call center representatives; quality control and improvement processes in place; and commonly measured statistics, including but not limited to, average speed to answer, abandonment rate, average length of call, average hold time, Interactive Voice Response (IVR) self-service interactions, reason for call.

13. Describe the Respondent’s customer service call center communication abilities other than telephone calls (i.e., online chat, email, etc.); and languages, other than English, the customer service call center can support and how that support is provided (i.e., language line or call center representatives).

V. Network

Describe and/or provide the following information on the Respondent’s provider network:

14. Describe Respondent’s process for providing pre-service estimates. Include the following information: average turnaround time; whether network providers are encouraged to submit pre-service estimates on behalf of the Member; the recommended cost threshold for submitting a pre-service estimate; and how Respondent provides education to Members on submitting pre-service estimates.

15. Describe Respondent’s provider network model or strategy in Florida. Include the following information: impact of the geographic location of the State’s population;

impact of geographic location on claim costs; and stability of the network (relying on gross data, not net provider data).

16. Describe Respondent’s steps taken to ensure provider information (i.e., contact information, participation in network, acceptance of new patients, etc.) is accurate and available to Members online; include the timeframe for updating and posting provider information online.

17. Describe Respondent’s provider credentialing and termination processes, including quality control measurements and protocols; Respondent’s process for measuring provider satisfaction, including steps taken to correct or improve provider dissatisfaction; and any actions Respondent takes to attract high-quality providers.

18. Describe the Respondent’s process of identifying and filling coverage gaps (particularly gaps made by lack of specialists); the types of specialties Respondent pays particular attention to in relation to access and the reason such attention is paid;

and any age limitations for pediatric dentists or other limitations for access to specialists.

19. Describe Respondent’s top five (5) reasons for Member dissatisfaction with its network or network providers and Respondent’s steps taken to improve or correct such reasons; include statistics, such as average wait time for an appointment, book of business customer satisfaction survey results for the last three (3) years, written grievances / appeals, etc.

20. Describe any key competitive advantages of Respondent that set Respondent apart from other industry competitors.