ATT111_TPA_CorporateExperienceQuestionnaire (v4 revised 04.29.25) (1).pdf

RFP No. 75D301-25-R-73216 World Trade Center Health Program Third-Party Administrator

Volume 10: Corporate Experience Corporate Experience Questionnaire

Offeror name:

Offeror unique entity identifier (UEI):

This questionnaire addresses various aspects of an offeror’s corporate experience performing third-party administrator (TPA) services for a health benefit plan, including the corporate experience of any entities the offeror intends to use as a subcontractor under this contemplated contract, and the corporate experience of any predecessor company, parent company, or affiliated company of the offeror. Hereafter, any planned subcontractor, predecessor company, parent company, and affiliated company of the offeror is collectively referred to as “another entity” or “other entities.”

The corporate experience of another entity may be used in the offeror’s response to this questionnaire to the extent that the corporate experience of the other entity can be properly attributed to the offeror and considered predictive of the offeror’s success in performing this contemplated contract. A predecessor company is one that precedes and is replaced by a successor company/the offeror. For a planned subcontractor, parent company, or affiliated company, corporate experience may be properly attributed to the offeror only if the resources of the planned subcontractor, parent company, or affiliated company would be substantially involved in contract performance.

All experience used to respond to this questionnaire must have been performed by the offeror company or another entity (as defined above) whose experience can be properly attributed to the offeror and considered predictive of the offeror’s success in performing this contemplated contract. The experience of specific employees of the offeror company or other entities will not be considered. CDC’s evaluation is focused on corporate experience of the offeror and other entities, rather than the experience of individuals, because the scale and importance of this requirement demands a contractor who has the requisite experience at the corporate level to successfully serve as the World Trade Center Health Program TPA.

Corporate Experience Questionnaire

Corporate Experience Questionnaire

Instructions: Please answer each of the questions below by checking the appropriate radio button. For “yes” responses, provide a narrative justification for your response, highlighting your corporate experience (and/or the corporate experience of other entities whose experience you are using to respond to this questionnaire) in the relevant area. If you use the corporate experience of another entity to respond to a question, you must clearly indicate in your response which entity performed the work described (e.g., your company as the offeror itself, one of your planned subcontractors, an affiliated company). You are encouraged to include concrete details from past contracts to clearly illustrate how your company and/or other entities have the corporate experience in the relevant area. Include past client names, contract titles, tasks performed, and, where relevant, metrics that describe the scale and complexity of the contract and the work performed under it (e.g., dollar values, members served, number of providers, etc.). The narrative justification for each question is limited to 2,500 characters, including spaces. Offerors may apply bold, italic, underline, superscript, or subscript formatting to their narrative responses. Offerors shall not modify the text size or font face, or any other aspect of the text formatting. Text in superscript or subscript will count towards the total character limit. A narrative justification is not required if you answer “no” to the question.

Offerors may attach (in this same PDF file or in a separate file) the following:

(1) An acronym list with the following information:

(a) Acronym.

(b) Complete words or phrase that constitute the acronym.

(2) A contract list index with the following information (as applicable) for each past contract:

(a) Index number (please assign a reference number to each contract).

(b) Contract number.

(c) Contractor name.

(d) Proposed role of contractor for the TPA contract (e.g., offeror, planned subcontractor, affiliated company of the offeror).

(e) Client name.

(f) Contract title.

(g) Contract dollar value.

(h) Period of performance dates.

The intent of these additional documents is to enable the offeror to reference index numbers and acronyms in questionnaire responses without having to use response space to describe contracts or define acronyms. The acronym list and contract list index shall only include the elements enumerated above.

Question 1: Do you have experience providing TPA services at a similar or greater scale than the World Trade Center Health Program (hereafter, “the Program”)? The Program currently serves approximately 132,000 members in all 50 U.S. states, the District of Columbia, Guam, the Commonwealth of Puerto Rico, the Northern Mariana Islands, the Virgin Islands, American Samoa, and the Trust Territory of the Pacific Islands. Treatment is provided through several Clinical Centers of Excellence in the New York metropolitan area and a nationwide network of thousands of medical of providers, in addition to a pharmacy benefits manager. The Program currently process approximately 500,000 to 600,000 medical (to include dental) claims per year.

Yes No

Question 2: As a federal health benefit program, the Program operates according to not only its enabling legislation, but also other federal requirements. Do you have experience providing TPA services for a U.S. federal government health benefit program?

Question 3: The Program’s enabling legislation requires the Program to perform coordination of benefits for 9/11 Survivors with the Survivor’s primary health insurance. Do you have experience facilitating coordination of benefits (e.g., collecting other health insurance information) or performing coordination of benefits?

Question 4: Do you have experience using industry-leading software and technology related to TPA services, including but not limited to role-based member management systems, call center systems, self-service portals, prior authorization systems, or claims processing and adjudication systems?

Question 5: Do you have experience using industry-leading analytics platforms that can be used for dashboarding, ad hoc reporting, or data manipulation?

Question 6: Do you have experience transitioning the performance of TPA services (either as the incoming contractor or the outgoing contractor, or both) for health plans at a similar or greater scale than the Program?

Question 7: Do you have experience supplying, developing, or renting a regional or nationwide provider network?

Question 8: Do you have experience managing a provider network, performing such tasks as maintaining provider adequacy, managing provider relations, enrolling and credentialing providers, or educating providers on health plan requirements?

Question 9: Do you have experience maintaining and improving the experience of health plan members or providers? If so, what results have you achieved with regard to member or provider satisfaction?

Question 10: Do you have experience with prospective utilization management/prior authorization, concurrent utilization management, and/or retrospective utilization management?

Question 11: Do you have experience processing and adjudicating medical claims at a similar or greater scale than the Program, including the use of auto-adjudication? The Program currently process approximately 500,000 to 600,000 medical (to include dental) claims per year.

Question 12: Do you have experience with the management and integration of data repositories?

Question 13: The Program currently handles a significant amount of information through physical mail. Do you have experience with document processing and mail center operations, specifically the handling of personally identifiable information (PII) and protected health information (PHI)?

Question 14: The Program TPA will be required to establish bidirectional data exchanges with a number of other Program contractors. Do you have experience with data migration, data conversion, or data exchanges, and ensuring data integrity across multiple systems?

Question 15: Do you have experience working with PII/PHI data subject to the Health Insurance Portability and Accountability Act (HIPAA), and have you worked with those data types within a federal government program?