attachment-3-rfp-490-27.xlsx
XLSX spreadsheet 89 KB Posted
- Attached to
- DENTAL BENEFITS ADMINISTRATION
- Solicitation number
- RFP DAS 490-27
- Issued by
- New Hampshire
About this file
This is a Request for Proposal (RFP) exhibit from the State of New Hampshire soliciting dental network services. The document requires bidders to submit comprehensive pricing information for dental services across multiple geographic areas within New Hampshire, specifically covering zip code areas 030, 031, 032, 033, and 038. Bidders must provide current discounted contractual fees for network providers and reasonable and customary maximum allowable charges for non-network providers across 47 dental procedure codes. The RFP also requires bidders to reprice actual dental claims incurred by the State between February 1, 2025, and January 31, 2026, based on contracted provider discounts effective as of May 1, 2026. Bidders proposing multiple networks must complete separate exhibits for each network.
The pricing submission must be based on actual provider contractual arrangements and historical claims data, with no projections or assumptions regarding future discounts or billed charge increases. Bidders must provide detailed explanations of repricing methodologies, identify all adjustments and supplemental provider payments, and reconcile repriced amounts to total billed charges. The Network Access exhibit requires bidders to demonstrate network adequacy by documenting the number of primary dentists, specialty dentists, and orthodontists within proposed networks across all New Hampshire counties, along with average travel distances and percentage of active members with access to at least two providers of each type within 25 miles. Additional submissions include network disruption analysis identifying whether dental providers from historical claims are in-network, and a Network Profile section documenting network composition and provider availability information current as of May 1, 2026.
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Other files
| File | Type | Posted |
|---|---|---|
| addendum-2-rfp-490-27.pdf | ||
| rfp-490-27-scoring.pdf | ||
| rfp-490-27pdf--1-.pdf | ||
| attachment-1-rfp-490-27.pdf | ||
| attachment-2-rfp-490-27.pdf | ||
| addendum-1-rfp-490-27--1-.pdf |
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Text version
Network Discount State of New Hampshire
| Proposer: | |
| No |
The exhibit lists CDT procedure codes highly utilized by the State. Bidders are required to provide current discounted contractual fees for these services for network providers in the indicated 3-digit zip code areas. Bidders are also required to provide reasonable and customary (R&C) maximum allowable charges for non-network providers.
In addition, if you are proposing multiple networks, please complete the Network Discount exhibit separate for each network.
Network Name
Zip Code Area 030 Zip Code Area 031 Zip Code Area 032 Zip Code Area 033 Zip Code Area 038
| Procedure | ||||||||||
| Code | Avg Discounted Contractual Network Fee | R&C Max. Allowance | Avg Discounted Contractual Network Fee | R&C Max. Allowance | Avg Discounted Contractual Network Fee | R&C Max. Allowance | Avg Discounted Contractual Network Fee | R&C Max. Allowance | Avg Discounted Contractual Network Fee | R&C Max. Allowance |
| D0120 |
| D0140 |
| D0150 |
| D0210 |
| D0220 |
| D0230 |
| D0272 |
| D0274 |
| D0277 |
| D0330 |
| D0364 |
| D0367 |
| D0431 |
| D1110 |
| D1120 |
| D1206 |
| D1208 |
| D1351 |
| D1354 |
| D2330 |
| D2331 |
| D2332 |
| D2335 |
| D2391 |
| D2392 |
| D2393 |
| D2394 |
| D2740 |
| D2750 |
| D2950 |
| D3310 |
| D3320 |
| D3330 |
| D4273 |
| D4341 |
| D4342 |
| D4346 |
| D4910 |
| D6010 |
| D6057 |
| D6058 |
| D6245 |
| D6740 |
| D7140 |
| D7210 |
| D7230 |
| D7240 |
| D7953 |
| D9222 |
| D9223 |
Claims Repricing State of New Hampshire Yes
| Proposer: | |
| No | |
| Reprice the State's dental claims using your proposed network(s) |
In addition, if you are proposing multiple networks, please separate “in-network” claims by network.
Please also respond to the questions below chart.
The repricing should be based on the contracted provider discounts as of May 1, 2026. Please provide an explanation detailing how you re-priced the claims, noting any and all adjustments and methodologies. You should not include any assumptions regarding projected discounts or projected increases in billed charges. The repricing should be based on actual data.
Dental claims incurred by the State from February 1, 2025 through January 31, 2026, and paid through April 16, 2026.
| DENTAL CLAIMS REPRICING | ||||||||
| Repricing of Claims Data - Non-Orthodontia | Repricing of Claims Data - Orthodontia | Repricing of Claims Data - Total | ||||||
| BILLED AMOUNT* | REPRICED AMOUNT** | BILLED AMOUNT* | REPRICED AMOUNT** | BILLED AMOUNT* | REPRICED AMOUNT** | |||
| Network Name | ||||||||
| IN-NETWORK | Network 1 | $0 | $0 | $0 | $0 | $0 | $0 | |
| Network 2 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| Network 3 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| Subtotal In-Network | $0 | $0 | $0 | $0 | $0 | $0 |
OUT-OF-NETWORK $0 $0 $0 $0 $0 $0
CLAIMS NOT ABLE TO BE REPRICED $0 $0 $0 $0 $0 $0
| Grand Total All Claims | $0 | $0 | $0 | $0 | $0 | $0 |
| FALSE | *** | |||||
| Grand Total From Data File | $26,380,662.31 |
| * Billed Amount reflects field "Billed Amount" as provided in the Detailed Dental Claims file. |
| **Repriced Amount reflects eligible charges based on application of your current provider specific discounts. This should reflect the full value of your provider discounts and should also include ANY and ALL risk-sharing and incentive payments to providers for which the State would be liable. Claims should be repriced assuming you are the sole payor and should not assume any savings or average savings from COB or liability of other parties. |
If applicable, separately identify and account for any supplemental provider payments (e.g., pay for performance fees).
*** All Billed Amounts should be accounted for and this cell should indicate "TRUE" when re-pricing is completed.
It is not acceptable to combine in-network and out-of-network claims in the same bucket regardless of how your out-of-network pricing schedules are determined.
| Provide an explanation detailing how the claims were repriced, noting any and all adjustments and methodologies. |
| Confirm you have provided a reconciliation that ties your claims re-pricing back to the total billed charges provided. |
| Confirm your re-pricing is based on your current network provider contractual fee arrangements. “Current” is defined as the discounts the State would achieve through your network as of May 1, 2026. The re-repriced amounts should reflect what you would have paid a provider if the claim was incurred on May 1, 2026. The repriced amounts should also include any and all fees paid to providers for any risk-sharing arrangements with providers. |
| Confirm your re-pricing is based on actual data and does not include any assumptions regarding projected discounts or assumed increases in billed charges. |
| Confirm you have not omitted any adjustments or methodologies from your explanation on how you re-priced the claims. |
| Confirm you have separately identified and accounted for any supplemental provider payments (e.g., pay for performance fees). |
| Are there any additional fees based on or due to any shared savings (e.g., shared savings of discounts). Respond Yes or No. |
If Yes, please indicate (1) the amount(s) and (2) whether or not the Repriced Amounts above reflect shared savings amounts.
&"Times New Roman,Regular"I 15 & 424 &"Times New Roman,Regular"&A
Network Access State of New Hampshire Yes
| Proposer: | |
| No |
Please complete for your proposed dental network. In addition, if you are proposing multiple networks, please complete the Network Access exhibit separate for each network.
Network Name
Please complete the following chart based on all lives in the census (i.e., members and dependents) :
| Number of Dentists Within YOUR Network in the Following Areas | |||
| Provider Type | Merrimack | ||
| County | Hillsborough | ||
| County | Belknap | ||
| County | Rockingham | ||
| County | Strafford | ||
| County | Cheshire | ||
| County | Sullivan, Grafton, Carroll, and Coos Counties | Outside NH | All |
| Primary Dentists | |||
| Specialty Dentists (excluding orthodontia) | |||
| Orthodontists |
| Average Travel Distance to Two Network Dentists (in miles) for State of NH active members living in the following areas | |||
| Provider Type | Merrimack | ||
| County | Hillsborough | ||
| County | Belknap | ||
| County | Rockingham | ||
| County | Strafford | ||
| County | Cheshire | ||
| County | Sullivan, Grafton, Carroll, and Coos Counties | Outside NH | All |
| Primary Dentists | |||
| Specialty Dentists (excluding orthodontia) | |||
| Orthodontists |
Percentage of State of NH active members with access, globally and for all local areas noted below.
Please use the Standard Definition of Access to Network Providers listed below.
| Provider Type | Merrimack | |||||||||
| County | Hillsborough | |||||||||
| County | Belknap | |||||||||
| County | Rockingham | |||||||||
| County | Strafford | |||||||||
| County | Cheshire | |||||||||
| County | Sullivan, Grafton, Carroll, and Coos Counties | Outside NH | All | |||||||
| Please provide your count of members from Census Information Provided | ||||||||||
| Primary Dentists | % | % | % | % | % | % | % | % | % | |
| Specialty Dentists (excluding orthodontia) | % | % | % | % | % | % | % | % | % | |
| Orthodontists | % | % | % | % | % | % | % | % | % |
| Standard for Definition of Access to Network Provider | |
| Primary Dentists | 2 dentists within 25 miles |
| Specialty Dentists (excluding orthodontia) | 2 dentists within 25 miles |
| Orthodontists | 2 dentists within 25 miles |
Do not limit your analysis of all members to only those located in the network service area.
Network Disruption State of New Hampshire Yes
| Proposer: | |
| No |
NOTE: You MUST Enter a "Yes" or an "No" starting in column L next to EACH record (Add additional columns if necessary)
| If you are proposing multiple networks, please complete for each network. |
| Dental claims incurred by the State from February 1, 2025 through January 31, 2026, and paid through April 16, 2026. |
| Name of Network: | ||||||||||
| Key | Provider Tax ID | Provider Name | Provider Address 1 | Provider City | Provider State | Provider Zip | Billed Charges | Billed Count | In-Network | |
| Y or N? | In-Network | |||||||||
| Y or N? | In-Network |
Y or N?
DATA WILL BE PROVIDED WITH COMPLETION OF APPENDIX G
&"Times New Roman,Regular"IW 15 and 424 &"Times New Roman,Regular"&A
Network Profile State of New Hampshire Yes
| Proposer: | |
| No |
Please complete for your proposed dental network. In addition, if you are proposing multiple networks, please complete for each network.
| Network name: | ||||||
| List the service area counties: | ||||||
| Network dentists as a percent of all practicing dentists in New Hampshire: | ||||||
| Information on Primary Dentists in the United States (as of 05/01/2026) | ||||||
| Unique Dentists | Unique Locations | Unique Dentists | Unique Locations | Unique Dentists | Unique Locations | |
| Number of Primary Dentists | ||||||
| Percent with open practices (i.e., accepting new patients): | ||||||
| Information on Specialty Dentists in the United States (as of 05/01/2026) | ||||||
| Number by Specialty | Unique Dentists | Unique Locations | Unique Dentists | Unique Locations | Unique Dentists | Unique Locations |
| Orthodontics | ||||||
| Endodontics | ||||||
| Periodontics | ||||||
| Oral Surgery | ||||||
| Pedodontics | ||||||
| Prosthodontics | ||||||
| Other (describe) | ||||||
| Percent with open practices (i.e., accepting new patients): |
File details come from the government source that posted it. Updated .