95PEBP-S1579 Bid QA.xlsx
XLSX spreadsheet 972 KB Posted
- Attached to
- Third Party Administrator (TPA) for the Public Employees' Benefits Program (PEBP) State and local contract opportunity
- Solicitation number
- 95PEBP-S1579
- Issued by
- Churchill County, Nevada
About this file
This document contains a bid Q&A for a Request for Proposals (RFP) issued by the State of Nevada's Public Employees' Benefits Program (PEBP) for a Third Party Administrator (TPA) contract. The RFP is seeking proposals for medical and dental claims administration, network access, and related services for PEBP's consumer-driven health plans, EPO plan, and Medicare retiree plans. The contract term is 6 years beginning July 1, 2022. PEBP is currently in open enrollment and has introduced a new low deductible plan for the upcoming plan year, so enrollment counts are expected to change. The current TPA is HealthSCOPE Benefits, and the current medical network is provided by Aetna, which will become the in-state network effective July 1, 2021.
Pricing terms allow for escalators, but PEBP prefers flat fees. The winning bidder will be expected to absorb any claims run-out costs from the incumbent. PEBP will maintain its current banking structure, with the TPA paying claims from state-owned, controlled disbursement accounts. PEBP will invoice the TPA monthly based on participant headcount. The RFP also requires the TPA to integrate with various other vendors such as the pharmacy benefit manager, utilization management provider, and potential future vendors for services like transparency solutions and reference-based pricing.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| 1.5 - Paid Claims Summary 201901-202012.xlsx | XLSX spreadsheet | |
| 2.1 - Intent to bid.pdf | ||
| 1.3 - Insurance Schedule.docx | DOCX document | |
| 95PEBP-S1579 Presentation Notification~2.pdf | ||
| 1.1 - RFP Information.docx | DOCX document | |
| 1.2 - Standard Form Contract.docx | DOCX document | |
| 1.4 - Sample Business Associate Agreement.docx | DOCX document | |
| 1.7 - Discount Instructions.pdf | ||
| 95PEBP-S1579 Letter of Intent.pdf | ||
| Quote Instructions.pdf | ||
| 2.2 - TPA RFP Revised 2021-05-07.xlsx | XLSX spreadsheet | |
| 2.3 - References - CONFIDENTIAL.xlsx | XLSX spreadsheet | |
| 1.6 - Enrollment Summary 202104.xlsx | XLSX spreadsheet |
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Text version
Bid Q&A for Export Report
| Bid Q&A | ||||
| Number | Vendor | Subject | Question | Answer |
| 1 | G | Employee Census | Can you please provide a census that includes all eligible employees, waivers, tier enrollment, plan enrollment, date of birth, employee zip code and gender? |
Please see current report attached. We are not providing date of birth to protect EE identities. It is important to note that PEBP is currently in Open Enrollment and has introduced a new low deductible plan for the upcoming plan year. Enrollment counts in each plan are expected to be different due to this new offering.
| 2 | A | PBM Contract | Will the PEBP PBM contract be bid separately from the TPA contract? | Yes. |
| 3 | G | Network | The State of Nevada has indicated that a new contract to access the Aetna provider network becomes effective 7/1/21. Please confirm whether the State intends for the Aetna network to remain in place under the administrator awarded from this RFP. Additionally, please confirm whether the State?s contract with this network includes any language guaranteeing access to the network regardless of the medical administrator. | PEBP's in-state network contract with Aetna will remain in place unless the winning vendor has included an alternative in-state network as part of the proposal and PEBP chooses to include it as part of the TPA contract. |
| 4 | F | Credit Request | Please confirm the amount requested for the pre-implementation credit. | We are requesting you provide the amount you would charge for implementation as a credit - hence a "no cost to PEBP" implementation. |
| 5 | F | Questionnaire clarification fraud, waste and abuse | What vendor is the State using to audit claims for fraud, waste and abuse? | Claim Technologies |
| 6 | F | Subcontractors | Please provide the names of the subcontractors in place or in consideration for the services outlined in the Critical Items Tab, 1.2 a-h. Can bidders propose their own solutions as an alternative? | As mentioned elsewhere in the RFP - A is Diversified Dental. B, C, D, and E are all out to bid this year. F is currently handled by HealthScope Benefits. G is American Health Holdings. H is not currently contracted. |
| 7 | F | Medical Management | Who is the contracted medical management vendor? What services do they provide to the State? Do they perform utilization management, case management, disease management and wellness? | American Health Holdings is the contracted medical management vendor. They perform case management and utilization management. AHH does not administer disease management or wellness programs on behalf of PEBP. |
| 8 | F | Questionnaire format issue | Question 8.3 on the Technical tab only provides the ability to include a Yes/No answer, yet it is asking us to describe our business continuity and disaster recovery. How would you like us to provide our response? Can it be provided as an attachment? | A corrected version of this document has been released which resolves this issue. |
| 9 | F | Questionnaire format | Can the Subcontractor info tab be duplicated to accommodate more than two subcontractors? | An updated version of this document has been released with a second subcontractor tab. Should you need more than 4, save that tab as a pdf and submit as an additional attachment. |
| 10 | B | Vendor Contracting | Can you explain more about PEBP?s expectations surrounding contracting with ancillary medical vendors? Is the expectation that PEBP will negotiate the contract but the TPA will sign-off on the contract and PEBP will not be a signing party? Can you provide a sample/example of what is in place today? |
Who is administering the HSA/HRA today?
| Who is the partner for direct contracting / reference-based pricing today? | PEBP will RFP for these services and negotiate the terms of the contract. The expectation is that the TPA will contract directly with the vendor under the negotiated terms and pricing. PEBP will remit payment through the TPA contract. Currently, the HSA/HRA administration is performed by HealthScope. HealthScope also performs all direct contracting with providers on behalf of PEBP. | ||||
| 11 | B | Fees | Is PEBP looking for 6 year flat fees or are escalators acceptable? Is PEBP expecting the TPA to cover any termination fees that may be charged from incumbent vendors/partners? | Escalators are acceptable, however flat fees are preferred. There are no associated termination fees however claims run out is expected to be absorbed by the winning bidder. | |
| 12 | B | Dental | Is the expectation that the TPA will need to adjudicate all dental claims on Diversified Dental?s behalf? Or will Diversified be adjudicating claims and the TPA will simply need to integrate with Diversified in order to share claims data with members and PEBP? | The TPA processes dental claims based on the dental network's fee schedule. | |
| 13 | B | Network Discounts | Can you provide a separate attachment for Discount Submission Requirements pdf? We were unable to open the attachment in the TPA RFP spreadsheet. | This attachment was posted on May 7th. | |
| 14 | B | Financial Management | RFP States: "Offeror shall pay claims from PEBP owned controlled disbursement bank accounts. PEBP will fund the accounts daily for the checks/EFT that has been presented for the previous business day.....Confirm your understanding that claims will be paid through a required Wells Fargo, State Owned Controlled Disbursement Account. The account will be funded daily (M-F) for claims paid the following business day." |
| Question: Would PEBP allow for the TPA to open a separate bank account (owned by the TPA but solely used for PEBP payments) that pulls funds from the PEBP | Pursuant to NRS 356.011 and 356.020, state agency bank accounts upon approval by the State Board of Finance must be in the name and employee identification number (EIN) of the State of Nevada and collateralized in accordance with statute. PEBP will maintain the current banking structure which complies with statute and provides for efficient flow of state funds with the use of controlled disbursement bank accounts which fund payments (via check, ACH or debit card) as presented by participants and/or medical providers. | |||
| 15 | B | Financial Management | RFP states: ?Offeror shall accept a payment in a manner determined by PEBP. All payments are made a minimum of one month in arrears without interest or late payment penalty. Premiums due the first of the month will be paid by PEBP no later than the 15th of the following month (e.g. July premium paid by August 15). PEBP will create a monthly invoice using the monthly headcount report generated by the PEBP eligibility system each month." |
| Question: Can you clarify exactly what this will look like and what the current set-up is today? Would you accept the TPA self-billing monthly admin fees based on the headcount received on the eligibility files? | The PEBP created invoice using the monthly headcount is generated from the same system that the eligibility files are generated from so they should not have major variances. The montly headcount will be used for billing/invoicing because that is the PEBP official record. | ||||
| 16 | H | Network Strategy | If we are quoting the incumbent network, do we need to provide disruption/access and UDS data? | If Aon already has the UDS data, all we need is permission to use that data. |
In regards to Provider Disruption/Access - we always solicit the incumbent to complete the disruption request as well, due to possible network changes. Some of the providers that were in-network when the claim was adjudicated, may no longer be part of the network and some of the providers that were out-of-network when the claim was adjudicated, may now be in-network. This allows the incumbent, an opportunity to provide the most current network information for the client's evaluation. This becomes even more important as PEBP is changing their network on July 1, 2021.
| 17 | C | Network | 1. | Will PEBP be exclusively using Aetna for in-state provider network services beginning 7/1/2021? | yes. | ||
| 18 | C | Network | 2. | If Aetna Signature Administrators remains the In-State Network as of 7/1/2022, does your contract with Aetna enable you to utilize services from alternative TPAs if so requested by the State of Nevada? | Aetna has confirmed that it is willing to work with the TPA selected by PEBP. If not already partnered with Aetna, the winning vendor will need to adhere to certain requirements. Examples of those requirements are provided below: • | Have strong financial performance | |
| • | Administer self-funded medical claims for at least 50,000 employee members | ||||||
| • | Can process claims in an “Aetna-like” way | ||||||
| o | Use up-to-date industry standard editing software | ||||||
| o | Adhere to Aetna participating provider contracts (i.e. no cuts to contracted rates, apply any relevant contract deviations, adhere to utilization management nuances) | ||||||
| o | Use Aetna’s Clinical Policy Bulletins for determining medical necessity (including experimental and investigational determinations) | ||||||
| o | Pay electronic clean claims within 15 business days and paper claims within 30 business days | ||||||
| o | Meet claim payment accuracy target | ||||||
| • | Can answer provider calls in an “Aetna-like” way | ||||||
| o | Answer calls within 30 seconds (on average) | ||||||
| o | Appropriately resolve issues to completion | ||||||
| o | Have a call monitoring program to assess and meet quality standards | ||||||
| 19 | C | Network | 3. | How will alternative in-state provider networks be considered as part of this bid? Meaning, is the PEBP seeking a full replacement in-state provider network, an in-state regional carve-out provider network with Aetna serving outside of the carve-out, a full side by side in-state provider network offering choice to PEBP members, or another preferred solution? | When determining whether PEBP wishes to replace the in-state provider nework with a proposed network, PEBP will take into consideration cost (claims repricing) and provider availability. PEBP is in favor of streamlining their networks, but is open to various proposed solutions to find one that best meets members needs as well as being fiscally responsbile. | ||
| 20 | C | Network | 4. | Which out-of-state provider network(s) is/are being used by PEBP currently? And effective 7/1/2021? | Aetna is currently PEBP's out of state provider and will also become in-state network effective 7/1/21 | ||
| 21 | C | Medical Management | 5. | Which vendor does the PEBP use for Medical Management? | American Health Holdings. | ||
| 22 | C | Claims | 6. | Based upon Document 1.5 of the RFP materials (Paid Claim Summary), about 30% of the overall number of medical claims volume and about 26% of the overall medical paid claim volume is ?Out of State?. This Document 1.5 states ?In State is based on HometownHealth and Sierra Health Options; Out of State is everything else.? |
| For the purposes of this Document 1.5, does ?Out of State? include claims that were incurred in the State, but were outside of the HometownHealth and Sierra Health Options networks? If so, can the PEBP provide a further breakdown of the ?Out of State? (Number of Claims and Total Paid) for those claims that were actually incurred in the State vs. outside of the State? We are trying to best understand the volume of Out of State claim utilization, and if it is truly Out of State. | We are including a new report here, where the Out of State claims that were in Aetna's Out of State network are labeled and the remaining claims are labeled Out of Network. | |||||
| 23 | C | Enrollment | 7. | Related to and as shown in the enrollment summary, can the employee counts be provided for each plan and how many employees in each medical plan also have coverage in a dental plan? | All participants enrolled in a medical plan also recieve dental plan coverage. It is important to note that PEBP is currently in Open Enrollment and has introduced a new low deductible plan for the upcoming plan year. Enrollment counts in each plan are expected to be different due to this new offering. As noted in column M of the Headcount tab of the Enrollment Summary provided as Attachment 1.6, members on the Medicare Exchange are able to elect and pay for Dental Coverage. | |
| 24 | C | Enrollment | 8. | Please identify which medical and dental plans and covered enrollees are specifically included for services within this RFP? | Medical/dental administration for all eligible partipicants (active employees and retirees) on the CDHP, EPO and LD plans. Additionally, some Medicare retirees who access their Medical plans through a Medicare Exchange and do not participate on the PEBP plans have the ability to enroll in dental only. The HMO is not included in these services. Please refer to PEBP's Master Plan Document Section of the PEBP website for more information. https://pebp.state.nv.us/homepage/open-enrollment-plan-year-2022/ | |
| 25 | C | Claims | 9. | Related to the Paid Claims summary, can the count of calls received by month be provided for the medical and then dental claims? | HSB receives anywhere from 11k to 14k calls per month. Since HSB also administers HSA/HRA, the call volume includes this category. PEBP does not currently have the call volume broken out by category. Call volume appears to be lowest in December and highest in January, July and August. | |
| 26 | J | 1. | Is the TPA expected to administer the fully-insured HMO product? If so, what network does that product utilize? Is the TPA responsible for administering the election of primary care physicians? Is the TPA responsible for applying referrals? If so, who is administering the referral process and how are the referrals provided to the TPA? | No. The TPA will not be administering the fully insured HMO. | ||
| 27 | J | 2. | Is the TPA performing utilization management? If not, who would be providing prior-authorizations to the TPA and how would they be provided? | American Health Holdings performs this function and will work closely with the TPA. | ||
| 28 | J | 3. | Would it be necessary for the TPA to enter a contractual relationship with Aetna to administer the claims Aetna is re-pricing for their network? Is Aetna committed to integrating their re-pricing process with the TPA? Would the TPA be expected to compensate Aetna in any way for the work that Aetna performs? | The TPA will need to be able to administer both in-state and out-of-state claims. All self-funded medical claims are expected to be administered through the TPA. If you are unable to work with Aetna, there are many questions in the RFP where you can provide that information as well as propose an alternative in-state network other than Aetna. | ||
| 29 | J | 4. | Is the dental network provider re-pricing claims or is the TPA re-pricing dental claims based on network/pricing information provided by the dental network provider? If the dental network provider is pricing claims, would it be necessary for the TPA to enter a contractual relationship with dental network provider to administer the claims dental network provider is re-pricing for their network? Is the dental network provider committed to integrating their re-pricing process with the TPA? Would the TPA be expected to compensate the dental network provider in any way for the work that the dental network provider performs? | The TPA processes dental claims based on the dental network's fee schedule. | ||
| 30 | J | 5. | The following table is a list of potential vendor integrations that were gleaned from the RFP. Which of the following would the TPA have to integrate with? | |||
| a. | HRA/HSA administration vendor | |||||
| b. | Transparency solution vendor | |||||
| c. | Telemedicine vendor | |||||
| d. | PBM | |||||
| e. | Utilization management/care management vendor | |||||
| f. | Expert Second opinion vendor | |||||
| g. | Surgical center of excellence vendor | |||||
| h. | Direct contracting/Reference based pricing vendor | |||||
| i. | Behavioral health vendor | |||||
| j. | COBRA vendor | |||||
| k. | Data Warehouse vendor | |||||
| l. | Wellness vendor | The most signficant integration will be with the Enollment and eligibility system vendor (k) and the PBM (d). The remainder are more minor integrations requiring basic claims and/or eligibility data. The following integrations in the list provided are not under contract at this time but might be added during the duration of this 6-year contract: (g), (h), (i), (j), (l) | ||||
| 31 | J | 6. | What is the nature of the service that the reference-based pricing vendor is providing? Are they holding contracts with providers or are they truly determining a referenced based price such as percent of medicare? What services are subject to RPB? What is the nature of the integration with the reference-based pricing vendor? Is the TPA sending claims for re-pricing or is the TPA expected to apply a contractual price? | Referenced based pricing is managed through plan design and steerage; RBP applies to hip and knee replacement in Nevada. There is a predetermined limit that the plan pays for hip/knee joint replacement; the medical management vendor is responsible for steering members to exclusive providers as determined by the TPA; exclusive providers are selected by the TPA based on quality, cost, and outcomes. | ||
| 32 | C | Plan Design | 10. | Related to the Critical Items Tab, can you provide context and any other direction on the question related to 1.7.A which is ?what efforts are underway at your organization to reduce unwarranted price variation such as reference-based pricing?? | This question refers to potential cost controls or solutions your organization may be able to implement or use. | |
| 33 | C | Plan Design | 11. | Is Reference Based Pricing used? If so, for which situations? | Referenced based pricing applies to hip and knee replacement surgeries performed in Nevada. There is a predetermined limit that the plan pays for hip/knee joint replacement; the medical management vendor is responsible for steering members to exclusive providers as determined by the TPA; exclusive providers are selected by the TPA based on quality, cost, and outcomes. | |
| 34 | C | Run Out | 12. | Please confirm if run-out administration is included in your current pricing with the incumbent administrator? Or is the price for run-out offered separately? | Run out administration is NOT included in current pricing with the incumbent. | |
| 35 | C | Credits | 13. | Does your current administrator provide you with any credits? If yes, what credits are included, what is the amount, and what is the frequency? | The current administrator does not provide any formal credits, however they have historically provided ample services to PEBP at no cost. Reporting requests, implementation of HSA requirements, and requirements unique to PEBP have been accomodated without associated fees. | |
| 36 | C | Stop Loss | 14. | We understand stop loss is not part of this RFP, however may we ask how it is handled for the State of Nevada? Does the state have Stop Loss? When is this usually secured and who is the incumbent stop loss market? | Stop loss applies to out-of-state health care. The stop loss policy is included in the out-of-state network fees. Stop-loss applies to members residing in Nevada who travel outside of Nevada for their health care and members residing outside of Nevada. It was a requirement of our network, the State previously did not have Stop Loss prior to having this particular network. | |
| 37 | C | Client Services | 15. | Related to Minimum Quals, what training would be required for PEBP staff? | PEBP staff would need to receive training on any systems or processes unique to the TPA that would need to be utitlized by PEBP staff. | |
| 38 | J | 7. | What is meant by ?coordinating claims paid? for potential carve-outs to other vendors? Typically in carve-out situations, the only ?coordination? is accumulation sharing if necessary. Is this what is expected? Are there currently vendor carveouts other than PBM? | The carve-out applies to the sharing of accumulators with the PBM vendor. | ||
| 39 | J | 8. | What business purposes do you have in mind for our predictive modeling capabilities? | Although PEBP uses actuarial consultants to provide predictive modeling analytics, PEBP would like to have hands on access and coordination with its TPA to be able to better identify patterns in data and recognize the chance of particular outcomes. | ||
| 40 | J | 9. | What is the nature of the referrals we would be receiving or be required to send to other vendors? Please provide an examples if you would. | The TPA works closely with the utilization management company when directing or redirecting members to health care care providers when there are no in-network providers capable of providing the service. For example, referrals may be necessary for specialists and air transport services. | ||
| 41 | J | 10. | What is the nature of the ?EFT Transfer? function that you have inquired about in our employer portal? Is this to fund claims and pay administrative bills? | Claims can be funded through check, ACH, debit card or EFT Transfer. Pursuant to NRS 356.011 and 356.020, state agency bank accounts upon approval by the State Board of Finance must be in the name and employee identification number (EIN) of the State of Nevada and collateralized in accordance with statute. PEBP will maintain the current banking structure which complies with statute and provides for efficient flow of state funds with the use of controlled disbursement bank accounts which fund payments (via check, ACH or debit card) as presented by participants and/or medical providers. | ||
| 42 | J | 11. | You have inquired on our ability to include an activation sticker on ID cards. What do you expect that activation event to accomplish? | Activation sticker is not necessary, however any information you can include regarding ID card availability, issuance and distribution would be appreciated. | ||
| 43 | J | 12. | What is the distinction between ?Medical & Dental Claims Administrator? beginning on 12/1/21 and ?Claims Administrator and Out-of-State network provider? beginning on 7/1/22? What will be expected for 12/1/21 v. 7/1/22? | Although the contract will not officially begin until 7/1/22, the winning vendor will be expected begin implementation activities to ensure services can begin on 7/1/22. | ||
| 44 | J | 13. | Can you provide more detail on what is expected of a medical director and his or her direct work with the CEO? | Historically, PEBP has relied on the expertise of a medical director to assist in making sound policy or process changes affecting health coverage or health outcomes. | ||
| 45 | C | Marketing | 16. | Related to Technical 9.6, would vendor be required to print materials or just distribute? Can a sample of the materials be provided and what is the preferred mode of distribution? | Typically OE materials aare made available to members online by PEBP, however on occasion (infrequently) there may be situations where PEBP may require the TPA to assist in the printing and distributing, or electronic distribution of communications related to OE or specific benefit changes. | |
| 46 | C | Claims | 17. | Related to Technical 3.2, what is the volume of claims that fit this definition that were processed by month for the claims paid volumes that were provided in exhibit 1.5 Paid Claims Summary? | PEBP received a total of 29 CMS demands between August 2019 and April 2021 with a total of 1677 claims. August 2019 - 184 Claims September 2019 - 496 Claims November 2019 - 47 Claims March 2020 - 324 Claims April 2020 - 66 Claims May 2020 - 246 Claims June 2020 - 161 Claims July 2020 - 59 Claims August 2020 - 28 Claims October 2020 - 19 Claims January 2021 - 33 Claims April 2021 - 14 Claims |
tc={B90CA9FA-98B2-40AF-9C14-4B06E7B0DD55}: [Threaded comment]
Your version of Excel allows you to read this threaded comment; however, any edits to it will get removed if the file is opened in a newer version of Excel. Learn more: https://go.microsoft.com/fwlink/?linkid=870924
Comment:
@Cari Eaton this refers to the CMS demand notices. Can you provide a volume?
Reply:
I don;t know how to answer this. We don't recieve too many CMS demand notices, but I wouldn't know how to determine a volume from them. @Nancy Spinelli Would you be able to answer?
| 47 | C | Performance Guarantees | 18. | Related to performance guarantees: | |
| a. | 1.10 Is call back performance based on calls received by a live agent from a member that require a call back? | ||||
| b. | 1.18 What details are you asking for at the FTE level. How often do you want the list to be refreshed? Are you expecting a report or a data feed? | ||||
| c. | 1.19 a. Must remove PEBP member PHI within 3 business days of offeror known or should have known using commercially reasonable efforts that such PHI is stored on designated server. To what does ?Known or should have known? refer? | a. Correct. B. Specific names are not necessary. Positions/titles will suffice for this and a summary of their role. C. Should this data not be stored on a designated server (as has been requested), and you discover that it's not on a designated server, we are requesting that the PHI identified be removed from that non-designated server within 3 business days. | |||
| 48 | C | IT | 19. | Related to EDI vendor connections, can the file layouts be provided for review? |
There are several file exchanges, the exact layout for which is to be negotiated between the awardee and PEBP's other vendors. PEBP has provided an example of the elibility file specs to use as reference however, PEBP is transitioning to a new enrollment and eligibility system vendor on 1/1/22 and will also be potentially implementing a new PBM on 7/1/22 so the file specs are subject to change.
| 49 | C | ID Cards | 20. | Related to request to reprint ID cards, what is the frequency this will be need and how many ID cards would need to be reprinted? | The need to reprint ID cards arises when major vendor changes take place and the information on the card is no longer relevant (changes in PBM vendor, network). PEBP does not anticipate this to occur frequently, but vendors should anticipate reissuing ID cards on average, every 3 years. | |
| 50 | D | Effective date | Please confirm effective date is 7/1/2022. | Effective date is 7/1/22. | ||
| 51 | D | Previous Fees | Please provide the current fees for services under Aetna, current TPA, and other subcontractors. | TPA Medical Claims Administration - $13.95 PPPM TPA Dental Claims Administration - $1.35 PPPM In-State PPO Network - $4.51 PPPM National PPO In-State Access - $5.90 National EPO In-State Access - $4.00 National PPO Out-of--State Access - $13.97 | ||
| 52 | B | RFP Spreadsheet | We noticed in the RFP Spreadsheet provided by the state that some of the cells requiring response are locked for editing. Are you able to provide an updated spreadsheet? Alternatively, would you prefer that we provide our own version of the RFP response spreadsheet? | |||
| Locked cells: Vendor Info - Line 49. Subcontractor Info - Lines 13-34. | A corrected version of this document has been released which resolves this issue. | |||||
| 53 | B | Compliance | Does PEBP require the TPA to send a particular type (or multiple types) of EOBs, appeal notices, SPD, and other plan documents in order to meet state law requirements? Is it acceptable for these formal notices to be designed to meet federal requirements? | The EOBs, appeal notices, SPD, and other documents comply with both federal and state requirements. All notices must comply with federal requirments, and if the state's requirements are more stringent, the TPA must comply with the state requirements. | ||
| 54 | B | Compliance | Are there unique state required notices or forms needed for PEBP that the TPA will be required to prepare and deliver on their behalf? | The TPA files an annual state immunization survey and remittance on behalf of PEBP. | ||
| 55 | B | Compliance | Does PEBP use the state's claims adjudication, appeal, and/or external review procedures that the TPA will need to abide by? | Yes. | ||
| 56 | B | Compliance | Technical #4.11 asks, "Do you have the claims and appeals process documented for client reference and DOL requirements? Yes/No. If no, please explain." | |||
| Question: Are there any unique DOL requirements needed for PEBP that the TPA should be aware of outside of normal processes? | The claims and appeals process is documented in PEBP's policies and procedures. There are no unique DOL requirements applicable to PEBP. | |||||
| 57 | I | Services | 1. | Is/was Hometown Health providing TPA services, meaning paying the claims in addition to providing the network? | No. Hometown Health only provided the network. | |
| 58 | I | Services | Was Hometown Health providing the Out-of-State network | No. Aetna is the OOS network and will also be the in state network starting 7/1/21 | ||
| 59 | I | Network | 3. | Aetna was hired in the fall of 2020 with a Go Live date of 7/1/21. Is it the expectation that Aetna will make their national network available, thereby satisfying the request or need to also provide an Out-of-State medical network outlined in the RFP? | PEBP's in-state network is contracted directly with PEBP, however the out of state network was contracted through the TPA. The expiration of the TPA contract results in the expiration of the out of state Aetna network as well. Although the in-state network portion of this RFP is not mandatory, the out of state network is and should be included as part of the RFP submission. | |
| 60 | I | Network | 4. | Has there been any discussion or consideration by the Board of Examiners (BOE??) regarding a Joint Administration Agreement between the TPA and the network as a savings opportunity for the State? | The Board of Examiners will only see and discuss this contract after PEBP and the awarded vendor negotiate and produce a final contract. The RFP provides the opportunity for a TPA to include an in-state network (but mandates an out of state network) in order to leverage savings. | |
| 61 | I | Services | 5. | Was Hometown processing Vision claims or is this a new element for the TPA? Please provide the claims volume (# of claims not dollar amount paid). | Vision claims are processed by the TPA. | |
| 62 | I | Services | 6. | Please provide the call volume broken down by week or month for the past 12-24 months. | HSB receives anywhere from 11k to 14k calls per month. Since HSB also administers HSA/HRA, the call volume includes this category. PEBP does not currently have the call volume broken out by category. Call volume appears to be lowest in December and highest in January, July and August. | |
| 63 | I | Service Providers | Is HealthSCOPE the Third Party Administrator for the EPO Plan | yes | ||
| 64 | I | Service Providers | Does HealthSCOPE process all dental claims? | yes | ||
| 65 | I | Services | Please provide detail surrounding the administration of the Consumer Driven Health Plans, HSA and HRA. The RFP notes that HealthSCOPE Benefits is the administrator for the HSA and HRA. Is HealthSCOPE taking in the contributions and maintaining the balances; or, are they also paying all medical and dental claims under these two Consumer Driven Plans? | |||
| a. | The supporting materials indicate the CDHP administrator will go to bid at a later date. Is this independent of the TPA for the EPO and Dental claims administrator (we want to be clear on the Scope of Services)? | Currently PEBP holds a separate contract with HealthScope to administer the HSA/HRA benefit. This service will also be going out to bid shortly. The HSA/HRA administration piece is a small function of the CDHP and completely separate from the CDHP claims administration function. | ||||
| 66 | I | Vendor Clarification | Can you describe the relationship and workflow with Healthcare Bank? | Healthcare Bank (Now Wex, Inc.) is the TPA's system for Health Savings Accounts. | ||
| 67 | I | Staffing | Is there still a full-time employee of the TPA onsite at the State to support employee claims issues as well as offering general support? | Yes. | ||
| 68 | I | Services | Please provide the average number of Single Case Agreements (SCA?s) or Letter of Agreements (LOA?s) each month. | |||
| a. | Are you able to provide the breakdown between gaps in care for in and out of network, as well as the number in Nevada rural areas? | Average 3-5 per month mostly in the northern rural areas (Ely, Elko) for services such as DME, psychology, and autism services. | ||||
| 69 | I | Services | Where are the Board meetings held? | Carson City, Nevada is the main location, however some Board members attend via teleconference from a separate Las Vegas location. PEBP prefers vendors attend in Carson City, but will allow vendors to attend in Las Vegas if necessary. Additionally, PEBP has been holding virtual meetings through the pandemic. This may be an option that is considered in the future. | ||
| 70 | I | Services | Where is the annual strategy meeting held? | Typically in the Reno/Carson City/Tahoe area. | ||
| 71 | I | Technical | The RFP states that PEBP strongly prefers that the TPA provides feeds to subcontractors for things such as Transparency, Expert 2nd Medical Opinion, Telemedicine, etc. Specifically, what type of data is the PEBP requesting be fed to the subcontractors? | Typically these vendors rely on receiving claims data and/or eligibility data from the TPA in order to perform their functions. | ||
| 72 | I | Services | Please confirm that BenefitFocus is taking in employer contributions and producing eligibility. | Confirmed. | ||
| 73 | I | Technical | Is BenefitFocus producing electronic eligibility files and sending to vendors such as Aetna, Hometown Health, Express Scripts and Diversified Dental? | Yes. Today eligibility files are only produced by Morneau Shepell (and soon Benefitfocus) for the PBM, TPA and Medicare Exchange. The networks and others integrate with the TPA. The TPA also integrates with the PBM in order to properly apply accumulators. | ||
| 74 | I | Services | Will the Privacy Officer and Security Officer roles remain with the State of Nevada or is it the expectation that the TPA will take these functions on? | This will remain with PEBP | ||
| 75 | I | Services | Who administers COBRA? | PEBP is contracted with an enrollment/eligibility vendor who will be responsible for administering COBRA for PEBP participants. | ||
| 76 | D | Out-of-State Claims | Please confirm that the out-of-state claims spend is truly outside of the state of Nevada. | We are including a new report here, where the Out of State claims that were in Aetna's Out of State network are labeled and the remaining claims are labeled Out of Network. | ||
| 77 | E | Mandatory Min Quals #4 | Our company does not have 2 clients at 8,000+ in size, as stated in the requirement. Our average client size is 5,000 and our largest being 30,000+. Does that mean we do not meet the Mandatory Minimum Qualifications and our proposal would not be considered if submitted? | The MMQ #4 requests that you have two or more current clients who have 5,000 employees or more. We are not asking for 2 over 8,000. We do think it's important that you have the ability to handle a client of PEBP's size on day 1. |
Microsoft_Excel_Worksheet2.xlsx Sheet1
MEDICAL CLAIMS DENTAL CLAIMS
IN STATE ASA Aetna (Out of State) OUT OF Network
REPORTMONTH # CLAIMS TOTAL PAID # CLAIMS TOTAL PAID # CLAIMS TOTAL PAID REPORTMONTH # CLAIMS TOTAL PAID
01-2019 35,093 $11,437,992.17 2,991 $3,745,725.76 14,183 $1,622,980.55 01-2019 13,300 $2,166,281.88
02-2019 40,574 $12,211,016.20 1,774 $2,498,674.59 13,558 $2,451,853.43 02-2019 12,137 $1,944,589.16
03-2019 40,648 $12,239,940.95 2,271 $2,193,490.62 13,157 $1,493,043.26 03-2019 11,902 $1,847,727.32
04-2019 41,330 $11,924,927.32 1,735 $1,495,878.53 14,032 $1,553,280.56 04-2019 13,428 $2,131,581.06
05-2019 37,977 $13,212,619.70 2,300 $2,235,178.77 13,878 $3,953,388.16 05-2019 12,746 $2,029,052.97
06-2019 43,939 $13,498,400.63 2,395 $2,558,858.31 13,886 $1,766,239.23 06-2019 12,702 $1,969,143.46
07-2019 29,456 $11,233,516.67 2,006 $3,544,223.78 13,008 $1,287,618.93 07-2019 13,441 $2,236,616.81
08-2019 49,354 $11,564,883.17 2,887 $2,935,609.16 17,125 $1,390,336.62 08-2019 15,403 $2,582,013.29
09-2019 45,025 $9,958,130.28 2,511 $1,810,804.25 16,482 $1,293,578.66 09-2019 13,978 $2,312,826.36
10-2019 44,745 $13,652,263.70 2,470 $2,482,115.91 16,408 $1,924,053.38 10-2019 14,256 $2,363,913.11
11-2019 43,805 $10,391,044.41 2,663 $2,395,574.54 16,042 $1,670,556.06 11-2019 12,542 $2,076,715.73
12-2019 38,109 $12,075,813.09 2,189 $2,132,857.69 13,531 $1,355,662.00 12-2019 11,350 $1,777,632.50
01-2020 39,362 $11,748,487.14 2,137 $3,982,153.26 16,285 $1,473,956.50 01-2020 13,080 $2,241,939.71
02-2020 41,992 $13,318,857.91 2,234 $2,687,765.22 15,286 $1,427,472.94 02-2020 12,298 $2,028,858.42
03-2020 45,097 $14,609,288.63 2,569 $2,352,842.63 15,907 $2,190,253.19 03-2020 10,361 $1,815,401.23
04-2020 30,114 $13,572,927.00 1,825 $3,169,806.54 13,650 $2,436,358.97 04-2020 2,225 $403,162.18
05-2020 28,140 $8,515,024.48 1,677 $1,295,588.59 10,533 $1,308,119.67 05-2020 5,374 $923,993.73
06-2020 40,401 $13,225,451.13 2,069 $1,928,266.37 13,751 $1,616,310.66 06-2020 13,202 $2,298,731.06
07-2020 35,950 $9,363,997.41 2,307 $1,276,951.02 12,358 $1,276,361.88 07-2020 11,656 $2,244,880.00
08-2020 38,791 $11,614,401.39 2,226 $2,780,880.18 14,079 $2,087,643.77 08-2020 12,064 $2,198,197.33
09-2020 35,296 $8,130,425.99 1,774 $1,148,377.50 12,137 $1,774,893.78 09-2020 11,717 $2,133,348.15
10-2020 43,239 $11,635,432.71 2,613 $2,708,596.38 14,220 $1,564,989.11 10-2020 12,197 $2,151,072.77
11-2020 41,312 $11,256,685.10 2,238 $1,919,349.57 14,248 $1,885,582.84 11-2020 10,819 $2,004,554.02
12-2020 39,082 $11,031,715.44 2,510 $1,687,099.77 15,130 $1,415,897.64 12-2020 11,105 $1,983,338.27
*In State is based on Network PPO IDs for HTH and SHO; Out of State is everything else
Microsoft_Word_Document.docx
Group Benefits Administration
Implementation Workbook
Chapter 7 – Interfaces
Health Scope
1. Introduction 3
2. General Information 3
3. Assumptions and Constraints 3
4. File Name 43
5. File Transmission 4
6. File Layout 5
6.1 Employee 5
If coverage is termed on any date other than the last day of the month, the term date shall be set to the end of that month. 6
6.2 Dependent 109
7. Notes 1312
7.1 Data Types 1312
7.2 Termination Notes 1312
7.3 Division Notes 1312
7.4 Health Spending Account and Health Reimbursement Account Deposit 1312
8. Appendix – Domain Values 1413
8.1 Plan Numbers 1413
8.2 Medical, dental, and vision coverage codes: 1413
8.3 Dependent Relationship Codes 1514
8.4 Termination Reason 1514
8.5 Employee Status 1614
8.6 Division number 1614
8.7 Eligibility Codes 1615
8.8 Beneficiary Relationship Codes 1716
Introduction
The purpose of the Health Scope interface is to provide master data to the insurance company for the management of employee benefit plans.
The interface is designed to contain the type of information required to manage health plans properly, and to include the type of information required by downstream providers such as insurers. Minimum information requirements include:
· Specific member demographics used to identify the member, such as employee number, SSN, and name;
· Factors affecting coverage, such as gender, dependent status and birth date;
· Information to identify plan participation levels and other factors that may affect claims.
General Information
Following are key elements of the HRIS interface:
· The interface is a fixed-length ASCII file.
· This file shall include employees who are participating in the PPO health options, the HMO plans or those who have ‘declined’ participation in the PEBP health option, as Health ScopeTPA is responsible for enrollment into the dental plans
· The file shall also include those who have elected Exchange plan with PEBP dental
· Left justify and blank-fill the unused portion of each field.
Assumptions and Constraints
1. All employees and dependents will be included in the same feed. They will be identified based on the record type indicator in the first column of each record
2. Employee records must always precede any dependent records.
3. File format will be Full File and will contain only one record per participant/dependent
4. Medicare detail will be included in the file layout
5. Date fields shall be populated as YYYYMMDD
6. Effective dates: Effective date included in the health effective date field must be the greater of the three benefits included in the plan code determination. Therefore, the effdate shall be equal to the greater effective date of Medical and/or Wellness
· For example.
· If MED opt -01 effdate = 07/01/2006 and WELL opt 99 effdate 07/1/2007 then Plan effective date = 07/1/2007
· If MED opt 01 effdate 07/01/2007 and WELL opt 01 effdate 6/01/2007 then Plan effective date = 7/01/2007
Effective date: If coverage is effective on any date other than the 1st of the month, the effective date shall be set to the first of the following month
Example
Effective date = 9/14/2011 Program eligibility start date = 10/1/2011
Effective date = 10/1/2011 Program eligibility start date = 10/1/2011
File Name
The name of the files should be composed as follows:
File name: HealthScope_PEBP.ccyymmdd.txt
File Frequency shall be as follows:
Indicate the frequency with which the file will be sent:
Daily Monday to Friday
File Transmission
Files can be sent to Health ScopeTPA using FTP or by uploading to the benefits website using the interface module upload feature. Encrypting FTP files using PGP software before sending them is required. Please note that we must exchange public keys before sharing PGP-protected data to maintain the highest level of security.
Files will be transferred to the PEBP FTP site.
Files will be pgp encrypted with 2 keys. Key to the recipient and key for PEBP ftp://ftp.pebp.state.nv.
File Layout
Employee
Field No.
Description
Start Position
Length
Type
Required
Notes
File Version
A
Yes
Version = 1.0
File Type
A
Yes
Type = TXT
Record Type
A
Yes
Type = EE
Group Number
A
Yes
NVPEB
Division
A
Yes
See Appendix for Division Codes
Division Effective Date
D
Yes
Employee SSN
A
Yes
9 digit SSN No Dashes
Last Name
A
Yes
Hyphen and apostrophe are the only acceptable punctuation
Middle Initial
A
No
First Name
A
Yes
No punctuation allowed
Address Line 1
A
Yes
Restrict to 30 chars
Address Line 2
A
No
City
A
No
State
A
No
US Postal Service abbreviation of State
Zip
A
Yes
Left justified and space fill additional unused spaces. Use either 5 or 9 digit zip code.
Department
A
Yes
Pay Center
Department Effective Date
D
Yes
Please set equal to the member status effdate.
Area
A
No
Not required
Area Effective Date
A
No
Not required
Date of Birth
A
Yes
MMDDYYY
Phone Number
A
No
Area code and phone number. No dashes, parenthesis or 0’s. Blank fill if not available
21a
Country Code
A
No
Blank fill
21b
Entrant Status
N
No
Leave blank or populate with “1” for late entrant
21c
Filler
S
Yes
Blank fill
Marital Status
A
No
1 – single
2 – married
3 – widowed
4 – divorced
5 – separated
6 – unknown
Gender
A
Yes
M – male
F – female
Filler
S
Yes
Blank fill
Filler
S
Yes
Blank fill
Filler
S
Yes
Blank fill
Emp Bank Route Number (for EFT)
N
No
Do not use
Emp Bank Account Number (for EFT)
N
No
Do not use
Employee Status
A
Yes
See Appendix
Status Effective Date
D
Yes
- Please make sure not to change the status effective date. The status effective date needs to stay as the hire date, rehire date etc. for terminations
- For all other status changes, please use the appropriate status date
- Effective date: If coverage is effective on any date other than the 1st of the month, the effective date shall be set to the first of the following month
Example:
Effective date = 9/14/2011 Program eligibility start date = 10/1/2011
Effective date = 10/1/2011
Program eligibility start date = 10/1/2011
Filler
S
Yes
Blank fill
Status/Employment Termination Date
D
Yes
Only required for employment termination date, not all status changes
If coverage is termed on any date other than the last day of the month, the term date shall be set to the end of that month.
Employment Termination Reason or Qualifying Event Code
A
Yes
Required. See Appendix for list of codes.
Only populate this field when Field 32 is populated
Filler
S
Yes
Blank fill
Annual Salary
N
No
Do not use
Salary Effective Date
D
No
Do not use
Employee Classification
A
No
Not required
Filler
S
Yes
Blank fill
Medical Plans
A
Y if covered
See Appendix
Medical Coverage Code
N
Y if covered
See Appendix
Medical Effective Date
D
Y if covered
Minimum effdate of July 1, 2011
Medical Termination Date
D
Y if covered
Filler
S
Yes
Blank fill
Dental Plans
N
Y if covered
See Appendix
Dental Coverage Code
N
Y if covered
See Appendix
Dental Effective Date
D
Y if covered
Dental Termination Date
D
Y if covered
Filler
S
Yes
Blank fill
Vision Plan3
N
No
Vision Coverage Code
N
No
Vision Effective Date
D
No
Vision Termination Date
D
No
Filler
S
Yes
Blank fill
Drug Plan
A
No
Not required
Drug Coverage Code
N
No
Not required
Drug Effective Date
D
No
Not required
Drug Termination Date
D
No
Not required
Filler
S
Yes
Blank fill
Health Savings Account Contribution
N
No
PEBP contribution. Annual deposit for each year beginning July 1 XXXX.
See 7.3 notes in Appendix on how to send changed values
Must include volume from HSAF and OTSC (Cat S) values. Amount needs to be pulled from VOL1.
H.S.A Effective Date
D
Y if covered
If H.S.A deposit
See 7.3 notes for annual eff date change
*Effective date should be the First of the month following (if the PF stored value is midmonth) OR coincident (if the PF stored value is already the first of a month) to the effective date of coverage or the effective date of change
H.S.A Termination Date
D
Y if covered
Health Reimbursement Account Contribution
N
No
PEBP contribution. Annual deposit for each year beginning July 1 XXXX.
See 7.3 notes in Appendix on how to send changed values
Must include volume from HLRA and OTSC (Cat R) values. Amount needs to be pulled from VOL1.
H.R.A Effective Date
D
Y if covered
If H.R.A deposit
See 7.3 notes for annual eff date change
*Effective date should be the First of the month following (if the PF stored value is midmonth) OR coincident (if the PF stored value is already the first of a month) to the effective date of coverage or the effective date of change
H.R.A Termination Date
D
Y if covered
H.S.A. terms and conditions acknowledgement
A
Yes
Y if accepted by Partic, blank if not accepted or if HRA/HMO partic
H.S.A. custodial agreement and disclosure acknowledgement
A
Yes
Y if accepted by Partic, blank if not accepted or if HRA/HMO partic
H.S.A participant annual voluntary contribution
N
Yes
Amount entered by participant from OE. If a participant did not enrol during OE and had a contribution from the prior plan year, then the contribution rolls forward again as a new contribution for the new plan year in the PowerFlex system and in the Health Scope system. However blanks will be sent on the file for participants in this scenario. See section 7.4 for details.
1st H.S.A Primary Beneficiary Name
A
Yes
First name Last name
1st H.S.A Relationship
See Appendix
1st H.S.A Primary Beneficiary %
A
Yes
000.00
2nd H.S.A Primary Beneficiary Last Name
A
No
First name Last name
2nd H.S.A Relationship
See Appendix
2nd H.S.A Primary Beneficiary %
No
000.00
3rd H.S.A Primary Beneficiary Name
A
No
First name Last name
3rd H.S.A Relationship
See Appendix
3rd H.S.A Primary Beneficiary %
No
000.00
1st H.S.A Contingent Beneficiary Name
A
Yes
First name Last name
1st H.S.A Relationship
See Appendix
1st H.S.A Contingent Beneficiary %
A
Yes
000.00
2nd H.S.A Contingent Beneficiary Name
A
No
First name Last name
2nd H.S.A. Relationship
See Appendix
2nd H.S.A Contingent Beneficiary %
No
000.00
3rd H.S.A Contingent Beneficiary Name
A
No
First name Last name
3rd H.S.A Relationship
See Appendix
3rd H.S.A Contingent Beneficiary %
No
000.00
Email address
N
No
COB Carrier/HIC Number
A
No
* Note COB Carrier fields can also be used for the Medicare
Policy number (HIC) if enrolling in the Medicare Direct program.
COB Effective date
D
No
Must be populated if value passed in field 95
COB Termination date
D
No
Required for termination
COB Type:
N
No
“01” = Other Coverage Prim.
“02” = Other Coverage Sec.
Medical Primary Care Physician
A
No
Not required
Medical PCP Effective Date
D
No
Not required
Medicare PCP Termination Date
D
No
Not required
Medical Network ID
A
No
Not required
Dental Primary Care Physician
A
No
Not required
Dental PCP Effective Date
D
No
Not required
Dental PCP Term Date
D
No
Not required
Dental Network ID
A
No
Not required
Employee ID Number
N yes
Employee ID number. Only include Empno and cap at 8 digits. Right justify no leading zeros. Currently all accounts max at 6.
ID Sequence
N yes
00 = Employee
Medicare number
N
No
Medicare Number
Left justified
Medicare A effective date
N
No
Medicare A termination date
N
No
Medicare B effective date
N
No
Medicare B termination date
N
No
Medicare D effective date
N
No
Medicare D termination date
N
No
Eligibility Code
N
Yes
See Appendix
Record Date
D
Yes
YYYYMMDD
Care Management Program – Diabetes enrolment flag
A
Yes
IF enrolled in CMP-Diabetes(ECMD) the following will apply:
H = USPM program opt code 01 or 02
C = Carson Tahoe program – opt code 03
Other codes TBD
N = not in program – opt code 99
CMP – Diabetes eff_date
D
No
Required if 110 is not “N”
CMP – Diabetes term_date
D
No
Care Management Program – Obesity enrolment flag
A
Yes
Y - enrolled in CMP-Obesity (EDMO)
N – not in program
CMP – Obesity eff_date
D
No
Required if 113 is “Y”
CMP – Obesity term_date
D
No
Dependent
Field No.
Description
Position
Length
Type
Required
Notes
File Version Number
A
Yes
Version = 1.0
File Type
A
Yes
Type = TXT
Record Type
N
Yes
Type = ‘DP’
Filler
S
No
Blank fill
Employee SSN
A
Yes
No dashes
Last Name
A
Yes
Middle Initial
A
No
First Name
A
Yes
Relationship Code
N
Yes
See Appendix
Filler
S
No
Blank fill
Date of Last School Verification
D
No
Date of Birth
D
Yes
Filler
S
Yes
Blank fill
Gender
A
Yes
M – male
F – female
Filler
S
Yes
Blank fill
Dependent SSN
N
No
Filler
A
No
Blank fill
Dependent Medical Plan
N
No
Do not fill in this field unless the dependent’s medical plan is different from the employee’s medical plan.
Filler
S
Yes
Blank fill
Medical Effective Date
D
Y if covered
Required if dependent is covered for medical
Medical Termination Date
D
No
Required if dependent terminates
Filler
S
Yes
Blank fill
Dependent Dental Plan
N
No
Do not fill in this field unless the dependent’s dental plan is different from the employee’s dental plan.
Filler
S
Yes
Blank fill
Dental Effective Date
D
Y if covered
Required if dependent is covered for dental
Dental Termination Date
D
No
Required if dependent terminates
Filler
S
Yes
Blank fill
Dependent Vision Plan
N
No
Do not fill in this field unless the dependent’s vision plan is different from the employee’s vision plan.
Filler
S
Yes
Blank fill
Vision Effective Date
D
No
Vision Termination Date
D
No
Filler
A
Yes
Blank fill
Dependent Drug Plan
A
No
Not required
Filler
S
Yes
Blank fill
Drug Effective Date
D
No
Not required
Drug Termination Date
D
No
Not required
Filler
Filler
Filler
Filler
Filler
Filler
Filler
Filler
Medicare HIC Number
A
No
* Note COB Carrier fields can also be used for the Medicare Policy number (HIC) if enrolling in the Medicare Direct program.
COB Eff date
D
No
COB Term date
D
No
COB Type:
N
No
“01” = Other Coverage Prim.
“02” = Other Coverage Sec.
Medical Primary Care Physician
A
No
Not required
Medical PCP Effective Date
D
No
Not required
Medicare PCP Termination Date
D
No
Not…
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