6300 RFP for TPA Attachment K Technology Requirements.docx

ATTACHMENT K

TECHNOLOGY REQUIREMENTS AND PROPOSER CAPABILITIES

(Please do not modify the format of this Attachment)

The Contractor must have an electronic claims payment (ECP) system which will track and retain the claim payments to medical providers, facilities and pharmacies.

E F G H I J K K.1 Background and system requirements

The DOC will transmit a weekly AIC Enrollment File to the contractor using Simple File Transfer Protocol (SFTP). It is DOC’s intent to have a SFTP client installed on a DOC computer that will transmit the file. If the SFTP client is not installed it will be transmitted via email, password protected with a strong rotating password.

The Enrollment File will be in a comma separated value (CSV) format to allow for an easy conversion to the Contractors ECP system. The CSV file description and format is as follows:

State Id.

Number Facility Location

Last Name

First Name Middle Name Date of Birth Gen-der Incarcera-tion Date Release Date Classi-fication change flag

* Column headings are not present in actual file. This is an abbreviated sample

*Classification - Custody level *Change Flag: 0 = Unchanged; 1 = Changed; 2 = New Record; 3 = Removed or Deleted.

The Enrollment File transmitted weekly could have modified information with each record. The State Identification Number (SID) is the only field that will not change as this is the identification number of each AIC. For example, the Facility Location could change weekly as an AIC is moved from one facility to another. Approximated 40% of the AICs are incarcerated multiple times; therefore there could be a gap in service. The DOC needs the ability to identify this gap when reviewing AICs for case review purposes. As an option to identify this gap, the Enrollment File can be used to identify the service gap as outlined in the Prisoner Enrollment Format. Alternative solutions from Contractor will be taken into consideration to handle this gap.

The Contractor’s ECP system will not be required to retain historical copies of the weekly Enrollment Files, but will be required to update each new Enrollment File with potential new AICs or changes to the existing AICs. All AIC information such as historical claim payment and case management information will need to be retained based on the SID number.

Please review Section IX of the Sample Contract for additional management information system information and requirements.

K.2 Contractor System Requirements

K.2.1 Access and Technology Abilities

RFP S-29100-00011086 - Third Party Administrator and Provider Network Services for Off-Site Healthcare Att. K

The DOC shall have access to the ECP system through an internet connection. The ECP system is an integral part of this service contract therefore the ECP system must be simple to use and train employees of the DOC. All DOC AIC’s information within the ECP system must be made available to authorized DOC employees. The security and authorization of the ECP system to DOC employees will be cleared by the DOC. The work stations that will have access to the ECP system will be in the DOC offices, Correctional Facilities or Infirmaries, so the access must be very secure. A static connection which forces a timed logout is preferable.

The access to the DOC AICs information by DOC employees will be used to verify claim payments, conduct claim reviews and provide claims management. We anticipate that the only authorized personnel that will require access to the ECP system will be employees of the DOC.

The deployment of the system will be through the internet. The deployment will consist of a Uniform Resource Locator (URL), a username and a password. For example, https://www.ecpsystem.com, docemployee1, xxxxxx. The ECP system must be web based without the requirement of additional software enhancements on DOC automated systems and work stations. The following assumptions may be made of the DOC work stations:

· Microsoft Windows

· Internet Explorer 6.0 or 7.0, 128-bit SSL JavaScript enabled (pop-ups will be allowed only on the site)

· Broadband Internet Access (128k and up)

K.2.2 DOC use of the ECP system

The DOC will use the ECP system for various purposes including as stated above to verify claim payments, conduct claim reviews and provide claims management.

DOC is in need of an “Outside Appointment Predictor” (OAP). The two primary functions of the OAP are as an authorization system for Medical Services of AICs and to audit claim payments to Medical Providers. The OAP is a data entry system where future Medical Service is provided to an AIC. The information is logged and scheduled by DOC personnel. Reports are then generated to verify that the service was performed and/or authorized. Therefore, the ECP system should have the capabilities of scheduling appointments and treatments of AICs. The goal, but not a requirement, is that the Contractors’ ECP system will accommodate an Outside Appointment Predictor system.

The DOC will also use the ECP system for Claims Management. The ECP system should have the capability of retrieving claim notes on AICs. There will be no conversion requirements at start-up; this will be on a go forward basis.

The DOC must have the ability to change the AIC information on the ECP system. The updates could include manual Facility Location changes, Scheduling changes, Claim Note Updates, add New AICs, etc. These changes may be required to keep the AIC information updated until the next weekly upload. The DOC will not make any claim payments to Providers.

K.2.3 Security and Integrity of Data

The Contractor must make complete and thorough background checks of all employees and subcontractors that have access to the DOC information through the Contractor’s ECP system. The Contractor will supply names of all personnel that will be access to the ECP system to the DOC for review. The data and information including the AIC information, claim payment, claims notes, and any other data provided to the Contractor is the explicit ownership of the DOC. At the conclusion or cancellation of the service contract or upon demand from the DOC the data and information must be returned to the DOC in a recognizable and useable format.

K.2.4 Compatibility

Contractor’s ECP system must maintain compatibility with both existing and future DOC Information Technology systems.

K.3 Proposal requirements (100 points maximum):

Provide a description of Proposer’s proposed ECP system, including safeguards which will ensure that data is secure from unauthorized use and mismanagement. Describe how Proposer can meet or exceed each of the requirements set forth in Sections K.2.1 through K.2.4, above, and Proposer’s process for transition and implementation to Proposer’s ECP system.

Name of Firm:

Signature of Proposer’s Authorized Representative Date