Amendment 1 QAs Final.docx

Amendment #1

RFB # AD180727

Workers’ Compensation Center for Medicare Reporting Compliance Services (CMS Reporting) Department of Administration, Bureau of State Risk Management (10/11/2017)

The following is the response to questions submitted according to Section 6.2 CORRESPONDENCE, CLARIFICATIONS AND QUESTIONS, of the RFB document.

Q1: Whether companies from Outside USA can apply for this? (like, from India or Canada) A1: No, per Section 4.1 U.S. Services Pursuant to 2009 Wisconsin Act 136 [§16.705(1r), Wis. Stats.], these services shall only be performed within the boundaries of the United States.

Q2: Whether we need to come over there for meetings?

A2: No, Contractors will not need to come to Madison.

Q3: Can we perform the tasks (related to RFP) outside USA? (like, from India or Canada) A3: No, per Section 4.1 U.S. Services Pursuant to 2009 Wisconsin Act 136 [§16.705(1r), Wis. Stats.], these services shall only be performed within the boundaries of the United States.

Q4: Can we submit the proposals via email?

A4: No, emailed Bids are not accepted.

Q5: Is it preferred that all exceptions be provided to the State of Wisconsin by October 2nd, or by the due date of October 18th?

A5: Per Section 6.2 Correspondence, Clarifications and Questions, all questions, exceptions, or additions Bidders have concerning the RFB document were due Monday, October 2, 2017, 2:00 p.m. CT. Per Section 6.7 Format of Bid Response Tab 5, point-by-point exceptions of the Terms and Conditions shall be submitted with the Bid Wednesday, October 18, 2017, 2:00 p.m. CT.

Q6: Which claims system does the Bureau of State Risk Management currently use?

A6: Marsh Clearsight.

Q7: Is this bid concerning only Worker’s Compensation claims?

A7: Yes.

Q8: 1.3 of the RFB indicates criteria to identify claims to query. This includes “Hazardous Duty”. Can you please tell me how the claim type “Hazardous Duty” is defined?

A8: Wisconsin code 230.36, or Hazardous Duty = 230.36 Hazardous Duty Pay is in lieu of Temporary Total Disability (TTD.) If a state employee who is in protective status suffers injury while in the performance of duties, the employee shall continue to be fully paid by the employing agency upon the same basis as paid prior to the injury, with no reduction in sick leave credits, compensatory time for overtime accumulations or vacation and no reduction in the rate of earning sick leave credit or vacation: Here is an example of some state employees who would be entitled to Hazardous Duty Pay: Wardens, Troopers, Correctional Officers, Fire Fighters, etc.

Q9: 1.3 of the RFB mentions a report with specific criteria to pull out all claims to query with CMS which the BSRM will send to the contractor daily. In what format(s) would that report be submitted to the contractor?

A9: Microsoft Excel.

Q10: 1.3 of the RFB states that the contractor will need to submit a monthly report to CMS. 3.5 states reports to CMS on a quarterly basis. Why are there both monthly and quarterly reporting requirements?

A10: New claims are sent once a month, as stated in 1.3, with general info to see if there is a match. Quarterly file submissions are sent with new claims that were matched and updated Ongoing Medical Responsibility claims.

Q11: 3.11 of the RFB requires contractor assist BSRM in identifying diagnostic codes and ICD 10/11 codes. The current law requires use of ICD 10 after the 10/1/2015 date. Why are ICD 11 codes required?

A11: ICD 9 and ICD 10 are the correct codes; the language has been amended in Amendment 2

Q12: Will BSRM provide access to the medical bills?

A12: No, BSRM does not provide access to the medical bills.

Q13: 1.3 of the RFB notes that BSRM logs into contractor’s site directly. How many BSRM users will require such access to log into the site?

A13: Three to five.

Q14: Which contractor currently provides the services outlined in this RFB to BSRM?

A14: Corvel.

Q15: Can you kindly provide an estimated number of new claims queried and claims reported each quarter or annually?

A15: Claims queried quarterly estimate 150, Claims Reported quarterly estimated twenty (20).

Q16: Does the Wisconsin BSRM use CMS Model Language to confirm Medicare Status with beneficiaries?

A16: No, a letter of confirmation is sent to CMS.

Q17: The RFB identifies a particular set of data elements used to identify claims that are potentially associated with Medicare beneficiaries: Date of Loss, Claim type is in the list of Lost Time, Hazardous Duty, Medical only, Total paid is over $750.00; State of Wisconsin will also use Contractors web portal to update termination dates and other claim information as requested by CMS. How does BSRM currently use each of these criteria to identify claims?

A17: BSRM uses the criteria to identify claims as it is the criteria used by CMS to determine if the claims are reportable.

Q18: What other data elements, aside from those listed in the previous question will be available to the vendor in order to identify claims potentially appropriate for Medicare beneficiaries?

A18: BSRM is capable of providing many data points, therefore if there is a specific data point a vendor is in need of, this will need to be identified to BSRM in order to determine if the data can be extracted from the claim system.

Q19: Is the Wisconsin BSRM currently using X12 messages to confirm Medicare eligibility before submitting claims? If so, what volume of Medicare-eligibility queries come back as eligible, ineligible, or have another status?

A19: No, BSRM is not using X12 messages to confirm Medicare eligibility.

Q20: On average, what monthly volume of claims are identified at each stage of compliance and reporting? How much variation in volume typically occurs from month-to-month at each of the below stages?

0. Preliminary identification of claim beneficiary as potentially eligible for Medicare.

0. Query to CMS to identify Medicare Status of beneficiary.

0. Compilation and sending of information on eligible beneficiaries’ claims to CMS

0. CMS requests for additional information on a particular claim.

0. Do CMS requests for additional information on a claim generally fall into certain categories?

A20:

a. 200

b. 200

c. No changes in the format or way the compilation is sending

d. Update vendor system Monthly with any claims needing additional information

e. Either Add/ Update

Q21: Who will be responsible for writing and running the report that generates the claim data for submission?

A21: BSRM writes and runs reports from claim system and submits this report to contracted vendor who in turn submits to CMS.

Q22: How does Wisconsin currently resolve claims where payments need to be repaid or redistributed? In particular, how are the claim payments resolved in each of the following scenarios:

a. If a beneficiary wins a lawsuit, how does Wisconsin BSRM adjust payments or notify Medicare?

b. When a claimant’s injury was already paid for by Medicare, but it was later determined that it should have been covered by Wisconsin BSRM, how does BSRM notify or repay Medicare?

c. How does Wisconsin BSRM determine the date of injury for instances where the date of cause was indeterminate?

A22:

a. BSRM Update contractor’s website so update is sent to CMS in their next file submission.

b. BSRM will update contractor’s system with the information for next submission.

c. Date 1st Reported or Date of 1st Treatment.

Q23: Will answers be posted on the site or come to me directly?

A23: Per Section 6.2 Correspondence, Clarifications and Questions, “In the event that it becomes necessary to provide additional clarifying data or information, or to revise any part of this RFB, supplements or revisions shall be posted on VendorNet (https://vendornet.wi.gov/).”

Q24: My colleague has noted discrepancies between the 2 documents below regarding payment terms. We are seeking clarification regarding this discrepancy:

CMS_Reporting_RFB

4.2 PAYMENT TERMS

Payment shall not be made until the quarterly reports are determined to meet all Specifications, requirements and deliverables and have been accepted by BSRM.

Doa-3054 - Standard Terms and Conditions

11.0 PAYMENT TERMS AND INVOICING: The State of Wisconsin normally will pay properly submitted vendor invoices within thirty (30) days of receipt providing goods and/or services have been delivered, installed (if required), and accepted as specified.

A24: There is no discrepancy as both sections state payment shall not be made until the service is accepted by BSRM.

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