ATT015_TPA_ProcessFlow_Transfer.pdf
PDF 175 KB Posted
- Solicitation number
- 75D301-24-RFI-WTCHP-TPA
About this file
This document is a Request for Information (RFI) and draft Performance Work Statement (PWS) for a planned solicitation for a Third-Party Administrator (TPA) contract for the World Trade Center (WTC) Health Program, which is administered by the National Institute for Occupational Safety and Health (NIOSH), part of the Centers for Disease Control and Prevention (CDC) within the U.S. Department of Health and Human Services (HHS).
The draft PWS outlines the requirements for the TPA, which include receiving and processing enrollment applications and certification requests, maintaining member demographic information, managing a call center, managing provider networks, administering WTC Health Program benefits, and processing medical claims. The government is seeking industry feedback on the draft PWS, as well as information on additional data requirements, potential contract structure and incentives, and recommended evaluation factors. Responses to the RFI are requested by October 25, 2024, and the government plans to release the solicitation in mid-January 2025, with a contract award expected in September 2025. The government will not pay for any costs associated with responding to this RFI.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| ATT101_TPA_SummaryVolumeData_Shell.xlsx | XLSX spreadsheet | |
| ATT012_TPA_ProcessFlow_Enrollment.pdf | ||
| Questions and answers template.xlsx | XLSX spreadsheet | |
| WTC Health Program TPA draft PWS.docx | DOCX document | |
| ATT013_TPA_ProcessFlow_Certification.pdf | ||
| ATT001_TPA_Glossary.xlsx | XLSX spreadsheet |
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Text version
World Trade Center Health Program – End‐to‐End Transfer Process
N
IO
SH
Th ird
‐P ar ty A dm in is tr at or (T
PA
Da ta C en te r
O rig in at in g Cl in ic C
CE
/N
PA
M em be r
De st in at io n Cl in ic C
CE
/N
PA
A U T O
Receive Member Transfer Exception Request
Start Submit Signed HIPAA Authorization
Receive Signed Form from Member
Upload/Input Transfer Request into Local System
Schedule Exit Interview with
Member
Conduct Exit Interview with
Member
Collect Member Records
Upload/Input Member Records
Review Member Medical Records Transfer
Approved?
No
Contact Member with Transfer Decision
Receive Transfer Decision from
Originating Clinic
End Member Communication
Authorize and Begin Case Management
Contact Member to Set Up First
Appointment with Clinic
Schedule Appointment with Destination Clinic
Approve Transfer
Exception?
No
C
C
A U T O
Send Transfer Request and Records to
Destination Clinic
A U T O
Send Member Transfer Exception
Request to NIOSH
A U T O
Send Approval Notification to
HPS
A U T O
Receive Member Transfer Request
A U T O
Notify Originating Clinic of Transfer Exception Denial
CARE
AYes
B
B
A
A U T O
Notify Destination Clinic of Transfer Exception Approval
A U T O
Notify Originating Clinic of Denial
Decision
A U T O
Receive Notification of Transfer Denial
Update Local Records System
A U T O
Create and Send Weekly
Demographic Report
A U T O
Receive Demographic
Report
A U T O
Receive Approval Notification
CARE
A U T O
Update Person Directory after Demographic Data Exchange
CARE
Evaluate Transfer Exceptions
Transfer Exception?
Generate Daily Transfer Report
Send Transfer Report to Each Clinic
Review Details and Place a Decision on Transfer Exception
Update Member Clinic Assignment and Demographic
Details
End Transfer Records
No
D
D
D
Yes
CARE
CARE
CARE
CARE
CARE
CARE
Legend
Start/End
Activity Step
Decision Step
Predefined Process/ Subprocess
Annotation
On‐page ConnectorSystem[Name]
A U T O Automated Activity
Five local systems of record exist:
TrialDB: NYC Responder Clinics WTC Portal: FDNY WTCEHC Database: NYC H+H MedNet: WSC CareConduit: NPN
CARE
CARE
CARE
Transfer Exceptions include:
Less than one year since member’s last transfer Exception to care request Mid‐monitoring exam request (NPN members only)
NIOSH will be contacted if a transfer denial is considered. A denial must be approved by
NIOSH.
A tailored transfer report is sent to each clinic that is involved in 1 or more transfer requests submitted the previous day. The report summarizes member information (demographics, enrollment, certification) for all transfer requests involving that clinic, and are used to create member profiles in the CCE/NPA’s local system.
Demographic details updated through daily data import into CARE from TPA system
Plexis/
DW
Transfer Reports are generated and sent daily from the TPA to the CCEs/NPA. Currently, this occurs via SFTP.
This Weekly Demographic Report is used to provide the Data Centers with updates to the member’s record obtained by the TPA. The Data
Centers also send a weekly demographic report to the TPA with updates to the member’s record obtained by the CCEs/NPA.
Text
E2E Transfer Process�
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