6300 RFP for TPA Attachment L General Information Questionnaire.docx
DOCX document 36 KB Posted
- Solicitation number
- S-29100-00011086
- Issued by
- Marion County, Oregon
About this file
This document is an Attachment L General Information Questionnaire for a Request for Proposal (RFP) issued by the State of Oregon for Third Party Administrator and Provider Network Services for Off-Site Healthcare. The RFP seeks proposals from contractors and subcontractors to provide claims administration, provider network, and case management services for the Department of Corrections (DOC). Key requirements include average claims turnaround, claims accuracy, auto adjudication percentage, provider network discounts, and implementation of a case management program. Proposers must provide information on their company background, key personnel, claims administration capabilities, provider network, and implementation plan. The contract term is not specified.
The RFP requires proposers to provide documentation of financial assets, financial stability, and proposed performance guarantees. Proposers must also describe their ability to detect and recover overpayments, as well as their process for fraudulent claim detection. The RFP includes specific reporting requirements, and proposers must address how they would process Medicaid claims and meet Medicaid-specific reporting requirements.
View the file
Other files
Show all 15
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
ATTACHMENT L
GENERAL INFORMATION QUESTIONNAIRE
(Please do not modify the format of this Attachment.)
Proposers must provide the following information
D E F G H I J K L L.1 Company Background, Key Personnel, and Experience to be completed by all contractors and sub-contractors (100 points maximum)
L.1.1 Year established (include former firm names and year established, if applicable).
L.1.2 Type of ownership and parent company (if any) and how long has your company been in business under present ownership?
L.1.3 Explain your current and future technology goals regarding transparency and integration with healthcare partners and certification of proper operational checks and balances.
L.1.4 Number of years Proposer, as a company, has been in the business of supplying services of the nature described in the Scope of Work, RFP Section 3, and the Sample Contract - Statement of Work, including how many State of Oregon contracts and employees you serve?
L.1.5 The rate of turnover in your claims department, case management and top management positions and the rate of turnover in your established PPO network in the last 24 months.
L.1.6 Documentation of financial assets sufficient to support/ensure the viability of the Proposer for the duration of the proposed contract.
L.1.7 Provide information to support your financial stability, such as bureau rating classifications.
L.1.8 If you are an insurance carrier, list the advantages you can offer DOC compared to a standalone TPA, and if you are a TPA, list your advantages over an insurance carrier.
L.1.9 How can your experience provide innovative solutions to help DOC save money and manage risk?
L.1.10 Describe the organizational structure and hierarchy you would put in place in order to facilitate a positive working relationship with DOC, including:
a) The name and title of the individual who would serve as the liaison to DOC. Provide an organizational chart and identify the individual or level at which the liaison operates in the organization. What staff/ancillary support will be available to the liaison to provide management information and other transaction and quality assurance and utilization review information to DOC?
b) A brief description of responsibilities and qualifications for all Key Personnel, including liaison, network Account Manager and other proposed contractor staffing in Oregon (reference Attachment 2, Section V.C of the Sample Contract). Provide information that clearly demonstrates professional competence to perform the Work.
RFP S-29100-00011086 - Third Party Administrator and Provider Network Services for Off-Site Healthcare Att. L
L.1.11 Within the past five years, has Proposer been a party to an administrative or civil judicial proceeding relative to the scope of this RFP? If yes, please provide a brief explanation below:
L.2 (Reserved)
L.3 Claims Administration (5 points each, 90 points maximum) Contractor must provide a consistent level of claims service, disclose outsourced services, define on-line capabilities, explain the process used for recovery of overpayment, explain fraudulent claim detection and provide the location of administrative claim services. Please include the following specific information:
L.3.1 What is your average claims turnaround, claims accuracy percentage and auto adjudicated percentage?
L.3.2 Percent of processed claims that are audited and the number of filed grievances per 1,000 enrollees.
L.3.3 What tools do you provide to ensure good stewardship of plan funds and negotiation of non-PPO claims?
L.3.4 List all outsourced services and subcontractor relationships.
L.3.5 How would you ensure quality performances by all subcontractors involved in providing services to DOC?
L.3.6 Please list the location of all claims offices; if more than one claims office, specify which office is primary.
L.3.7 Are you involved with accreditation audits such as SAS70 certified and if so, what programs are they?
L.3.8 Describe any on-line access that will be available to the DOC including your ability to provide clinical data care patterns.
L.3.9 What steps would you take to verify AIC eligibility?
L.3.10 Reserved
L.3.11 Have you ever had to pay on a performance guarantee? If yes, provide details. Please identify proposed Performance Guarantees in Section D.7.
L.3.12 What are the total medical members you insure fully and/or self-fund?
L.3.13 How will Proposer attempt to provide discounts on PPO and non-PPO claims? And of all claims processed, what percentage do you predict will include some type of discount?
L.3.14 Describe how Proposer will ensure that data and information retained on the Electronic Claims Payment (ECP) system is secure from unauthorized use and mismanagement. Reference Technology Requirements Attachment F, Section F.1.
L.3.15 Describe how provider files of overpayment will be flagged/offset and the process used for recovery of overpayment.
L.3.16 Describe Proposers prepayment editing process to detect and correct erroneous or fraudulent billing practices.
L.3.17 Describe Proposers capability to generate “frequent standard” and “on-demand” reports, including but not limited to: monthly claims activity, medical distribution of charges, claims turnaround time, medical savings, large claims (over $20,000 per AIC per year), utilization by diagnosis, average length of hospital stay, utilization by provider and utilization by AIC.
L.3.18 Medicaid Claims. Describe how Proposer would process Medical claims and how Proposer would meet Medicaid claim requirements described in Section II.A, “Medicaid Benefits”, of the Sample Contract. Include how Proposer would meet all State and Federal required Medicaid-specific reporting requirements.
L.4 Provider Network (150 points maximum)
L.4.1 Provide your average hospital and specialist PPO savings for each city where an institution is located.
L.4.2 Provide a detailed list of network hospitals within 60-mile radius where an institution is located and list any city where AICs would not have access to a provider network.
L.4.3 How will your organization set the Reimbursement Schedule for new healthcare providers added to your network in order to meet the needs of DOC? Specify and give details if your provider contracts include outlier reductions on large claim amounts.
L.4.4 Will the Reimbursement Schedule be affected by geographic location? If so, how?
L.4.5 Provide Proposer’s PPO Network growth goal projections for adding future providers. Describe how Proposer intends to meet the Performance Guarantees contained in Section X.B of the Sample Contract.
L.4.6 How many networks will be involved to provide statewide coverage and what discounts are available for non-network claims?
L.4.7 How often do you negotiate statewide provider contracts and what percentage of negotiations is done in person?
L.4.8 What percentage of growth and savings will you target for physician and/or hospital new PPO contracts if awarded the DOC contract?
L.4.9 Will the provider network re-price claims or will the quoting carrier/TPA have the discounts loaded in their claim system? Please explain.
L.4.10 List all outsourced services or sub contracted relationships.
L.4.11 Provide Geo Access report as follows: Practice SpecialtyProviders Miles from each Institution Number of In-Network
PCP
Specialist
Acute Care Hospitals
L.4.12 The complaint resolution process must respond timely and appropriately to questions and concerns of network providers and DOC. Describe your proposed complaint resolution process. Include a description of the development of recommendations and methods used to implement solutions, as well as timeframes for corrective action.
L.4.13 Describe Proposer’s credentialing process for network and non-network providers and how it will meet requirements described in Section VII of the Sample Contract.
L.5 Case Management (100 points maximum)
Describe how your proposed case management program will meet requirements as described in Section 2.4.5 of this RFP and Section VI of the Sample Contract.
L.6 Implementation and Transition Plan (50 maximum points)
If you are awarded the contract, provide an overview of how Proposer can meet or exceed all of the requirements identified in RFP Section 3 and the Sample Contract (Exhibit 1) Statement of Work. Identify specific activities you will accomplish, and data/information needed from DOC prior to beginning claims administration services. Provide a description of how transition from current TPA contractor would be accomplished, including but not limited to meeting requirements described in Sections VIII.B.21 and X.C.3 of the Sample Contract.
L.7 Performance Measures and Guarantees (50 maximum points)
Section X.B of the Sample Contract identifies performance measures and guarantees currently in effect. Please describe performance guarantees and measures Proposer offers to provide.
File details come from the government source that posted it. Updated .