Amended BSS Average Monthly Volume.docx

DOCX document 28 KB Posted

Attached to
26EHSPMMHPROBSS MassHealth Provider Operations Business Support Services RFR
Solicitation number
BD-26-1039-EHS01-ASHWA-128591
Issued by
Suffolk County, Boston City, Massachusetts

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This document is a Business Support Services (BSS) amended scope detailing average monthly volume metrics for Calendar Year 2025. The file outlines service requirements across five primary functional areas: Provider Enrollment and Credentialing, Electronic Data Interchange and Claims, Provider Education and Training, Audits, and Authorizations. Under Provider Enrollment and Credentialing, the contractor must process an average of 751 monthly enrollment applications resulting in 1,095 enrolled providers (comprising 479 Ordering/Referring/Prescribing Individuals, 527 Fee-for-Service Individuals, and 89 Fee-for-Service Entities), handle 3,024 monthly provider file update requests, review approximately 15 Provider Review Committee cases monthly, and process 756 monthly provider revalidations. Electronic Data Interchange and Claims services include conducting 11-12 monthly EDI provider tests, processing 40 monthly DDE paper claims, managing 8-10 monthly EDI 90-day waivers, adjudicating 2,500 monthly suspended waiver claims, and conducting outreach to approximately 40 providers experiencing 100% claims denials. Provider Education and Training activities encompass contacting 65 providers monthly via email and 175 via phone, sending 8 monthly listserv emails to approximately 1,500 providers, delivering 10 monthly office hours sessions and five 1-on-1 trainings, conducting one large-scale monthly training (50+ attendees), hosting four annual Provider Association Forum meetings with 47 provider associations, and facilitating eight annual Massachusetts Healthcare Training Forum meetings with average attendance of 56 participants.

The Audits component requires the contractor to process an annual average of 80 Payment Error Rate Measurement requests and 46 Single-State Audit requests. The Non-Emergency Transportation Authorization (NETA) function involves managing 50,000 monthly transportation requests with 90% automatically adjudicated and 10% requiring manual adjudication. The document provides specific volume metrics for workforce planning and service delivery capacity but contains no information regarding pricing, contract term, renewal options, funding sources, set-asides, or incumbent contractor information.

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Other files

File Type Posted
Attachment A - BSS Model Contract.docx DOCX document
BSS RFR - Bidders Conference Presentation.pdf PDF
Provider Application - Independent Clinic.pdf PDF
Contractor Authorized Signatory Listing Form CASL for Corporations~6.pdf PDF
BSS RFR Amendment 1.docx DOCX document
Appendix A - Service Level Agreements.xlsx XLSX spreadsheet
Appendix D - Secretariat Application Reference Manual.pdf PDF
Provider Application and Contract Ordering Referring and Prescribing ORP.pdf PDF
Commonwealth Terms and Conditions~32.pdf PDF
Amended Appendix E - MES Outcomes - CMS-Required Provider Management.xlsx XLSX spreadsheet
Provider Application Cover Letter and Check List - Medical Practitioner.pdf PDF
Appendix C - Data Management and Confidentiality Agreement~1.docx DOCX document
Virtual Bidders Conference Attendance Report.xlsx XLSX spreadsheet
Appendix F - Regulatory References.docx DOCX document
Amended Attachment B - Cost Response Instructions and Workbook.xlsx XLSX spreadsheet
Provider Application - Medical Practitioner.pdf PDF
Appendix B - Payment Schedule.docx DOCX document
Prompt Pay Discount Form~17.pdf PDF
Massachusetts Substitute Form W-9~14.pdf PDF
Contractor Authorized Signatory Listing Form CASL for Sole Proprietors~7.pdf PDF
Appendix G - Medicaid Enterprise Technical Requirements.docx DOCX document
MassHealth Provider Operations Business Support Services RFR - Q and A.docx DOCX document
Standard Contract From Instructions and Contractor Certifications~1.pdf PDF
Provider Types PTs.xlsx XLSX spreadsheet
SDP_Plan_Form~6.xlsx XLSX spreadsheet
Business Support Services RFR.docx DOCX document
Standard Contract Form~14.pdf PDF
Business Reference Form~11.docx DOCX document
Provider Application Cover Letter and Check List - Independent Clinic.pdf PDF
Appendix H - Business Support Services - Concept of Operations ConOps Diagram.pdf PDF
Evaluation Criteria~18.docx DOCX document
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Business Support Services - Average Monthly Volume (Calander Year 2025)

1. Provider Enrollment and Credentialing

a. Provider Enrollment

i. Monthly Average of applications distributed: 751 requests

ii. Monthly Average of applicants enrolled: 1,095 providers Enrollments of Ordering, Referring, and Prescribing Individuals: 479 Enrollments of Fee-for-Service Individuals: 527 Enrollments of Fee-for-Service Entities: 89

b. Provider File Update Monthly Average of update requests processed: 3,024 requests Average requests by entities: 2,778 providers

1. Average requests by individuals: 245 providers

c. Provider Review Committee

i. Monthly Average of cases reviewed: 15 cases

d. Provider Revalidations

1. Monthly Average of revalidations processed: 756 revalidations Revalidations of Ordering, Referring, and Prescribing Individuals: 235 Revalidations of Fee-for-Service Individuals: 431 Revalidations of Fee-for-Service Entities: 90

2. Electronic Data Interchange and Claims

a. EDI Testing

i. Monthly Average: 11-12 providers

b. DDE Paper Claims

i. Monthly Average: 40 Claims

c. EDI 90-day Waivers

i. Monthly Average: 8-10 waivers

d. 90-day Suspended Waiver Claims

1. Monthly Average: 2,500 claims

e. Outreach for 100% Denial of Claims

i. Monthly Average of providers contacted: 40 providers

3. Provider Education and Training

a. Provider Communications

i. Monthly Average of Providers contacted via Email: 65

ii. Monthly Average of Providers Contacted via Phone: 175

iii. Monthly Average of Emails sent to Listservs: 8 Average amount of providers included on Listserv emails: 1,500

iv. Monthly Average of Emails sent to specific Provider types: 3

b. Provider Training Sessions

i. Monthly Average of Office Hours: 10

ii. Monthly Average of 1-1 Trainings: 5

iii. Monthly Average of Large-Scale Trainings: 1 Large-scale refers to trainings with 50+ attendees

c. Provider Association Forum (PAF)

1. PAF meetings per year: 4 meetings Number of Provider Association Contacts: 47 associations

d. Massachusetts Healthcare Training Forum (MTF)

1. MTF Meetings per year: 8 meetings Average attendance volume: 56 attendees

4. Audits

a. Payment Error Rate Measurement (PERM)

i. Annual Average: 80 requests

b. Single-State Audit (SSA)

i. Annual Average: 46 requests

5. Authorizations

a. Non-Emergency Transportation Authorization Unit (NETA)

i. Monthly Average of Transportation Requests: 50,000 requests Amount automatically adjudicated: 90% Amount manually adjudicated: 10%

File details come from the government source that posted it. Updated .