Attachment D - Questionaire.xlsx

XLSX spreadsheet 425 KB Posted Nov 14, 2025

Attached to: Medical Network and Pharmacy Administration Services
Solicitation number: 25RFP17863
Issued by: Pennington County, South Dakota

About this file

Written by GovTribe AI · Nov 17, 2025

This is a questionnaire attachment (Attachment D) for a Request for Proposal (RFP) issued by the State of South Dakota for Medical Network and Pharmacy Administration Services. The RFP seeks an Administrative Services Organization (ASO) to provide comprehensive claims administration, enrollment services, provider network management, medical management, and Pharmacy Benefit Manager (PBM) services for the State Employee Health Plan. The current program covers approximately 12,435 active employees across four medical plans and one pharmacy plan. The questionnaire is designed to gather detailed information from potential vendors regarding their organizational structure, plan design capabilities, compliance with regulatory requirements, network adequacy, medical management programs, administrative operations, implementation capabilities, and performance guarantees. A letter of intent and Offeror Privacy and Security Agreement are due by November 7, 2025, with complete proposals due by December 15, 2025, at 5:00 p.m. CDT. The contract will be effective July 1, 2026, through June 30, 2031, with potential for two five-year renewals.

The State is self-insured for all medical plans and currently operates without stop-loss coverage. CVS Caremark currently administers pharmacy services; however, the RFP does not definitively designate them as the incumbent for the comprehensive services being procured. The evaluation will be conducted on a 100-point technical scoring basis considering specialized expertise, resources and availability, past performance, project management, cost, account management services, reporting capabilities, and network management adequacy. No specific set-aside designations for disadvantaged enterprises are mentioned. The successful vendor must integrate with the State's existing technology infrastructure, including compliance with BIT Technology Standards and Single Sign-On integration with the State's OAuth 2.0 standard. Implementation must be completed 60 days prior to the FY27 Annual Enrollment period beginning April 15, 2026, with final vendor selection anticipated by January 16, 2026. Vendors must provide detailed implementation timelines, performance guarantees across five key areas, and demonstrate network adequacy through geoaccess reports showing provider access within specified distances.

View the file

Other files

File	Type	Posted
Attachment G Roosevelt Plan SPD FY26.pdf	PDF	Nov 25, 2025
Attachment O - BHRA Business Associates Agreement.docx	DOCX document	Nov 25, 2025
Attachment K. - BIT Technology Standards.docx	DOCX document	Nov 25, 2025
Attachment G Washington Plan SPD FY26.pdf	PDF	Nov 25, 2025
Response to Offeror Questions document.docx	DOCX document	Nov 25, 2025
Attachment G Lincoln Plan SPD FY26.pdf	PDF	Nov 25, 2025
Attachment H - Network Access.xlsx	XLSX spreadsheet	Nov 25, 2025
Attachment D - Questionaire.xlsx	XLSX spreadsheet	Nov 25, 2025
Attachment C Benefit Guide.pdf	PDF	Nov 25, 2025
Attachment I - Cost Proposal.xlsx	XLSX spreadsheet	Nov 25, 2025
Attachment J Security and Vendor Questions.docx	DOCX document	Nov 25, 2025
Attachment B - Offeror Privacy and Security Agreement.docx	DOCX document	Nov 25, 2025
Attachment G Jefferson Plan SPD FY26.pdf	PDF	Nov 25, 2025
Addendum 1-RFP Document.pdf	PDF	Nov 25, 2025
Attachment N - Deviations Exceptions -- 10.06.25.docx	DOCX document	Nov 25, 2025
Attachment B - Offeror Privacy and Security Agreement.docx	DOCX document	Nov 14, 2025
Attachment G Jefferson Plan SPD FY26.pdf	PDF	Nov 14, 2025
Attachment G Roosevelt Plan SPD FY26.pdf	PDF	Nov 14, 2025
Attachment J Security and Vendor Questions.docx	DOCX document	Nov 14, 2025
Attachment G Lincoln Plan SPD FY26.pdf	PDF	Nov 14, 2025
Attachment I - Cost Proposal.xlsx	XLSX spreadsheet	Nov 14, 2025
Attachment N - Deviations Exceptions -- 10.06.25.docx	DOCX document	Nov 14, 2025
Attachment C Benefit Guide.pdf	PDF	Nov 14, 2025
Attachment G Washington Plan SPD FY26.pdf	PDF	Nov 14, 2025
Addendum 1-RFP Document.pdf	PDF	Nov 14, 2025
Attachment H - Network Access.xlsx	XLSX spreadsheet	Nov 14, 2025
Attachment K. - BIT Technology Standards.docx	DOCX document	Nov 14, 2025
Attachment O - BHRA Business Associates Agreement.docx	DOCX document	Nov 14, 2025
Attachment B - Offeror Privacy and Security Agreement.docx	DOCX document	Nov 3, 2025
Attachment C Benefit Guide.pdf	PDF	Nov 3, 2025
Attachment G Lincoln Plan SPD FY26.pdf	PDF	Nov 3, 2025
Attachment G Roosevelt Plan SPD FY26.pdf	PDF	Nov 3, 2025
Attachment H - Network Access.xlsx	XLSX spreadsheet	Nov 3, 2025
Attachment K. - BIT Technology Standards.docx	DOCX document	Nov 3, 2025
Attachment I - Cost Proposal.xlsx	XLSX spreadsheet	Nov 3, 2025
Attachment N - Deviations Exceptions -- 10.06.25.docx	DOCX document	Nov 3, 2025
Attachment A - Census.xlsx	XLSX spreadsheet	Nov 3, 2025
Attachment G Jefferson Plan SPD FY26.pdf	PDF	Nov 3, 2025
Attachment G Washington Plan SPD FY26.pdf	PDF	Nov 3, 2025
Attachment O - BHRA Business Associates Agreement.docx	DOCX document	Nov 3, 2025
RFP Document.pdf	PDF	Nov 3, 2025
Attachment D - Questionaire.xlsx	XLSX spreadsheet	Nov 3, 2025
Attachment J Security and Vendor Questions.docx	DOCX document	Nov 3, 2025

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ListOffered	Offered
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ListYNNA	Yes
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ListOwnLease	Owned
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ListSubcontractServ	Changed in Last 12 Mo's
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	No
	No - See "Explanation"
	N/A

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	No
	Not Applicable - No Website

ListLeasedNetwork	Not Applicable - No Leased Networks
	< 4 Leased Networks - See Data Below
	> 4 Leased Networks - See "Explanation"

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	> 2 Service Centers - See "Explanation"

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	Practitioner-Oriented Accreditation
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	Provisional Accreditation
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ListRecommendFreq	Daily
	Weekly
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	Quarterly
	Annually
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	Weekly
	Monthly
	Quarterly
	Annually

ListPropFeeLenTime	18 months
	24 months
	36 months
	48 months
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ListMinLeadTime	1 month
	2 months
	3 months
	4 months
	6 months
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ListPropRequirement	Accept
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	Tape
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ListInOutBound	Both in-bound/out-bound
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	2
	3
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	5
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	AA (Very Strong)
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	A
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Questionnaire

Request for Proposal (RFP) 2205 for State of South Dakota

Medical Claims Administrator

To Vendor: Use Column F to provide a brief explanation. However if the length of the explanation is greater than 400 characters, you must use the "Explanation" worksheet to provide your detail explanation.

I.			General Vendor Information
			General Information	Response	Explanation
	1.		Vendor Brand Name
	2.		Parent Co. Legal Entity Name
	3.		d/b/a (Name in Marketplace)
	4.		Year Established/Incorporated
	5.		NAIC Code
	6.		Industry Classification
	7.		Stock Ticker #
	8.		FEIN (Federal Employer Identification Number)
	9.		Tax Status
	10.		Public or Privately-Held
	11.		Ownership/Controlling Interest Structure
	12.		Significant organizational changes (including changes in ownership, business operations, or partnerships) that were implemented within the past 24 months.
	13.		Significant changes in ownership, business operations, technologies, partnerships or staffing in the next 24 months that would impact services requested in this RFP or the level of service provided to the State.
	14.		Is your company owned by another company or by a common controlling shareholder of interest? If so, describe these affiliate relationships.
	15.		Length of time in business providing services described in this RFP.
	16.		Number of employees both locally and nationally.
	17.		Location(s) where employees will be assigned to provide services described in this RFP. Also list location(s) of other company offices.
	18.		Describe company background/history and why vendor is qualified to provide the services described in this RFP. (Limit response to 10-15 sentences.)
	19.		List the number and percentage of employer clients of similar size to the State that your organization currently contracts with directly for Medical TPA services.
	20.		List the number and percentage of government clients that your organization currently contracts with directly for Medical TPA Services.
	21.		Mergers, acquisitions, spin-off's, significant organizational changes in past 2 years.
	22.		Are you authorized to do business in the State of South Dakota?
	23.		Anticipated changes in ownership or business developments, including but not limited to mergers, stock issues, and the acquisition of new venture capital.
	24.		Organization's core competency(ies), including significant differentiators that the organization delivers to its customers. (Limit response to 10-15 sentences.)
	25.		Please describe your organization's accreditations.
	26.		Please describe what legal assistance and services the Vendor will provide to the State in the event of litigation related to claims processing and adjudication disputes. (Limit response to 10-15 sentences.)
	27.		How many subcontractors will provide administrative services should your organization be awarded this business?
	28.		Subcontractor #1 - Name
		a.	Year Established/Incorporated
		b.	NAIC Code
		c.	Services to be provided by this entity
	29.		Subcontractor #2 - Name
		a.	Year Established/Incorporated
		b.	NAIC Code
		c.	Services to be provided by this entity
	30.		Subcontractor #3 - Name
		a.	Year Established/Incorporated
		b.	NAIC Code
		c.	Services to be provided by this entity
	31.		Subcontractor #4 - Name
		a.	Year Established/Incorporated
		b.	NAIC Code
		c.	Services to be provided by this entity
	32.		Subcontractor #5 - Name
		a.	Year Established/Incorporated
		b.	NAIC Code
		c.	Services to be provided by this entity
	33.		Subcontractor #6 - Name
		a.	Year Established/Incorporated
		b.	NAIC Code
		c.	Services to be provided by this entity
	34.		Home Office Location
		a.	Address Line #1
		b.	Address Line #2
		c.	City
		d.	State
		e.	Zip
		f.	Web Address

II.		General Plan Information	Response	Explanation
	1.	On a separate page, please address the following:

Identify your organization’s top 2–3 short-term strategic priorities for 2021 and 2022.

Identify your 2–3 long-term strategic priorities for the next five years and explain how they align with the State’s strategic goals.

Describe where key investments will be made and how these investments will benefit the State.

Save and submit your document using the following file name format:

[Your Organization’s Name]_Priorities

2.		On a separate page, explain: Describe how your company will support and enhance the State of South Dakota's objective of improving the health and wellbeing of its members. Name the file: [Your Organization's Name]_Wellbeing.
3.		On a separate page, outline how your organization would partner with the State and other contracted vendors to advance a value-based care model. Describe strategies for improving care coordination, integrating data across programs, and aligning incentives to achieve better health outcomes and greater accountability for the State’s health care investment. Name the file: [Your Organization's Name]_Strategies.
4.		How has your organization demonstrated innovation and leadership in developing and implementing impactful health care strategies? (Limit response to 15-20 sentences.)
5.		For each function listed, indicate whether it will be performed in-house by your organization or outsourced to another entity. In addition, specify whether the function is centralized (managed and performed from a single location or under a unified leadership structure) or decentralized (performed across multiple locations or business units). Provide the location(s) where the work will occur in the Explanation column, and describe how this structure supports effective coordination, communication, and accountability within the State’s health program framework.
	a.	Claims Administration
	b.	Member Services
	c.	Network Management
	d.	Medical Management
	e.	Eligibility Services

III.			Compliance	Response	Explanation
	1.		Vendor to confirm they are able to meet all requirements set forth in the RFP narrative in the mandatory minimums Section 5.0. Please Confirm Yes or No.
	2.		Vendor is fully compliant with the Genetic Information Nondiscrimination Act (GINA).
	3.		Vendor maintains professional liability insurance that exceeds $1 million per claim.
		a.	If not, please explain amount of coverage.
	4.		Your organization will maintain adequate levels of corporate/general liability insurance.
	5.		Provide details on the levels of coverage your organization maintains.
	6.		Your plan will accept liability for claim processor negligence or fraud.
			Network Management	Response	Explanation
	7.		What is the name of the network your organization has proposed for the client?
	8.		Please describe the networks that would be available for use with this RFP.
	9.		What network management services will be delivered by a subcontractor or other outside organization? (Include any leased network arrangements.)
	10.		If you use leased networks to service this account, are the leased discounts loaded into your claims system?
	11.		How does your organization determine the appropriate number and type of providers for a given population? What are these standards and how were they developed? (Limit response to 10 sentences.)
	12.		Outline your definition of an adequate network. (Limit response to 10 sentences.)
	13.		Describe any specific measures used by your organization to monitor physician access. Provide the most recent corresponding statistics available. (Examples: physician to patient ratios).
	14.		In South Dakota overall, what has been your average network turnover rate within the last twenty-four (24) months for each of the following categories of providers:
			For purposes of question 14. a.) PCP is defined as the following: Family/General Practitioner and Internist, OB/GYN, and Pediatrics
		a.	PCPs
		b.	Specialist
		c.	Hospitals
	5.		What is your standard advance notice period before terminating a network location?
	16.		Describe how your network will provide access and accommodation for active and COBRA State of South Dakota members that reside outside of the State of South Dakota.
	17.		What system edits have been added to detect erroneous data and fraud or to support network quality?
	18.		How often are provider directories updated online?
	19.		What has been your average percent increase in provider reimbursement for 2024 and 2025? What are you projecting for 2026 and 2027?
	21.		Do you foresee any significant provider contracts coming up for negotiation in the next three years based where the State's employees are located?

IV
		Medical Management	Response	Explanation	KEEP SECTION PER Heidi
		Utilization Review
	1.	Describe in detail your utilization management program (example: nurse lines, self-help resources, etc)
	2.	Do you have NCQA or URAC accreditation? If yes, what is the rating?
	3.	What services do you recommend for pre-certification?
	4.	Pre-certification includes the analysis and determination of which of the following: Appropriate Level of Care (IP vs OP), Reasonable Length of Stay, Actual Medical Necessity and appropriateness of surgery being requested, necessity for the services of an assistant surgeon with each operative procedure analysis, necessity for a proposed preoperative hospital day, necessity for a proposed 23-hour observation stay for a hospital admissions, other
	5.	Indicate the primary method for determining the appropriate length of stay for a hospital admission.
	6.	Indicate the category of staff that can approve/disapprove a pre-service request.
	7.	Is there information regarding the option for an appeal, the timeframe and the mailing address in the body of any denial notification letter?
	8.	Does your organization perform concurrent review services?
		Disease and Care Management			Keep section per Heidi
	9.	Is the program an opt-in or opt-out model?
	10.	5. Describe your method for stratifying members into risk groups based on their severity level or other criteria.
	11.	How often are members stratified?
	12.	Is predictive modeling used to identify future high risk? If so, how is it used in the delivery of disease management programs?
	13.	How are interventions delivered to members (i.e. telephonically, mail, email)? What is the typical frequency of these interventions?
	14.	What percentage of the identified members do you attempt to contact by phone?
	15.	Describer your typical process for member education, counseling and interaction.
	16.	Describe how you ensure that all services you provide are accessible to all members, including those with limited reading skills or with disabilities. Do you have mulity-lingual capabilities?
	17.	Describe any Web-based or online services provided to members and physician. Is an online member assessment provided?
	18.	Please provide the average number of actively managed members per high risk care management RN.
	19.	Please indicate how Health Risk Assessment plans can be integrated in the disease management process to achieve higher treatment and prevention compliance. What data can your organization share in order to achieve a high level of integration?

V.			Administration Requirements
			Administration	Response	Explanation
	1.		Please confirm that you are in agreement with the ASO guarantee period of 7/1/2026 through 6/30/2031. Fees cannot change except on the contract anniversary date. Include in explanation the not to exceed increase either in a percent or dollar amount over the term of the 5 yr contract.
	2.		Please indicate if you agree with the following: The State reserves the right to audit (or designate an independent third party to audit) the selected health plan at any time during and up to two years following termination of the business relationship with prior written notification. The State will not be held responsible for time or miscellaneous costs incurred by the health plan in association with an audit including, but not limited to, the costs associated with providing audit reports, systems access, or space. Furthermore, the State expects the selected administrator to pay for the cost of any follow-up audit, should the results of the initial audit prove unsatisfactory.
	3.		Please confirm that all ASO fees will remain the same regardless of any mid-year plan design changes throughout the contract year.
	4.		Please confirm that all ASO fees will be on an incurred basis and that no additional fees will be required to pay run-out claims for up to 12 months following contract termination.
	5.		If your organization carries a fiduciary bond as any arrangements where you serve as fiduciary. Provide details of the fiduciary bond you carry.
	6.		The Vendor will be designated as the final claims appeal fiduciary for the plans of the client. If not, describe why you would be unwilling to agree to this request.
			Claims Administration	Response	Explanation
	7.		Describe process for updating claims system (e.g., real time or batch)? If batch, how often is the system updated? Please highlight both the process and timing for manual updates of all systems.
	8.		What percent of claims received electronically are automatically adjudicated?
			Customer Service	Response	Explanation
	9.		Please specify the hours of operation for each of the following.
		a.	Customer Service Center
		b.	Claims Processing Center
	10.		How are after-hour phone calls handled?
	11.		Provide the following statistics for the customer service center that will handle the client account. We are requesting actual results for the proposed customer service center; therefore, standards are not provided.
		a.	Average customer service telephone response time (seconds) : Prior Plan Year
		b.	Average customer service telephone response time (seconds) : Current Plan Year
		c.	Call abandonment rate (%) : Prior Plan Year
		d.	Call abandonment rate (%) : Current Plan Year
		g.	Length of hold time : Prior Plan Year
		h.	Length of hold time : Current Plan Year
		i.	First call resolution percentage : Prior Plan Year
		j.	First call resolution percentage : Current Plan Year
	12.		Please answer the following questions as they relate to Claims Processing:
		a.	Claim payment accuracy (number of correct payments divided by number of payments) : Prior Plan Year
		b.	Claim processing accuracy (number of claims processed with 100 percent accuracy divided by number of claims) : Prior Plan Year
		c.	Financial accuracy (dollars paid correctly divided by total dollars paid) : Prior Plan Year
		d.	Average turnaround time (x% in x business days) : Prior Plan Year
		e.	Average number of days claims are pended : Prior Plan Year
		f.	Average number of days claims are pended : Current Plan Year
	13.		How do you handle transition of care if a member is receiving care from a non-network provider on the transition date? For example, a member in the 2nd or 3rd trimester of their pregnancy.
	14.		Please confirm you will have a dedicated toll-free telephone number for the participants of the State of South Dakota health plan operational in advance of the beginning of 7/1/2021.
	15.		Please describe your process for handling access to care and continuity of care and the turn around time.
			System Integration	Response	Explanation
	16.		Are all of your internal systems integrated? (e.g., claims payment, eligibility, enrollment, customer service)
	17.		Please confirm you agree to interface with (e.g., sending to and/or receiving from) the contracted COBRA Administrators of the client.
	18.		Please confirm you agree to interface with (e.g., sending to and/or receiving from) "Full Reveal" files that include all fields used in claims and eligibility administration and/or clinical information with the States Consulting Actuary or a potential contracted Data Warehouse Vendor of the client.
	19.		Do you charge separate fees to send or receive data to other vendors of the client?
	20.		What is the time lag between the eligibility, and enrollment and claims systems? Are all systems updated in real time?
	21.		Describe how your system handles eligibility and enrollment history and retroactive coverage changes.
			Vendor Integration	Response	Explanation
	22.		On a separate page, describe your efforts at integration between medical, Rx, and medical management programs. Discuss specifically how these efforts would be applied to the Client, as well as if there is a potential cost impact. Do not discuss actual cost here. Name the file: [Your Organization's Name]_Integration.
	23.		On a separate page, describe your process for referring members to other programs such as EAP or behavioral health. Name the file: [Your Organization's Name]_Referrals.
	24.		Do you warm transfer to other vendors?
	25.		Do you accept inbound warm transfers from other vendors?
			Website Capabilities	Response	Explanation
	26.		Please identify which of the following services are currently available on your website to the enrolled members
		a.	Update eligibility or change/add dependents
		b.	Request additional or replacement ID cards
		c.	Print ID cards directly from site
		d.	Access historical health data
		e.	Provider directories (standard)
		f.	Provider cost information
		g.	Provider selection where users enter search criteria
		h.	Plan design information
	27.		Please specify the tools available to the client via the employer portal of your organization's website?
		a.	Real-time secure access to information for the client
		b.	On-line eligibility maintenance
		c.	EFT Transfers
		d.	Access to claims data
		e.	Access to member-specific coverage information
		f.	Account level delegate rights
		g.	Eligibility verification
		h.	Request ID cards
			Communications	Response	Explanation
	28.		Please provide sample written/print communication materials that will aid members in plan usage and understanding the availability and capability of your resources. Name the file: [Your Organization's Name]_Communication Sample #_. For which of these communications do you track and report effectiveness? Describe your capabilities in reporting the linkage between plan usage and communication activities.
			Reporting Capabilities	Response	Explanation
	29.		You will provide monthly paid claims and enrollment reports by group and plan type to the client as part of your standard reporting package. Costs for standard reports should be included in the base administrative fee. If you disagree, please explain
	30.		You will meet with the client on a Monthly basis (at minimum) to review claim experience, plan progress, service-related issues, etc.
	31.		Will the Client's specific results be compared to national averages, your book of business and/or government averages?
	32.		Can the reports be customized to further meet the client’s needs? If so, explain the levels of customization available and any additional charges incurred.
	33.		Can you provide ad hoc reports? If so, provide any additional charges incurred.
	34.		Please provide an electronic copy of each report within the standard reporting package (use sample data)
			Performance Guarantees	Response	Explanation
			Medical Administration - Service & Performance Guarantees
	35.		Financial Accuracy: Financial Accuracy is the absolute dollar value of all claim payment errors in an audit sample, subtracted from the total benefits paid in the same audit sample. The result is then divided by the total medical benefits paid in the audit sample.
		a.	Measurement Period: Annually
		b.	Service Objective: 99.35%
		c.	Fees at Risk: 1.5%
		d.	Any monetary penalties will be paid to the Client no later than December 31st of each year.
	36.		Overall Accuracy: Overall Accuracy is the total number of claims within an audit sample processed without any type of error, divided by the total number of claims within the audit sample.
		a.	Measurement Period: Annually
		b.	Service Objective: 95.50%
		c.	Fees at Risk: 1%
	37.		Turnaround Time: Turnaround time is measured from the date a paper claim, or an electronic claim submission is received by the administrator, or by a subcontracted vendor responsible for the initial receipt of claims, to the date the claims are resolved.
		a.	Measurement Period: Annually
		b.	Service Objective: 92.00% in 14 calendar days, or 10 business days; 98.00% in 30 calendar days, or 20 business days
		c.	Fees at Risk: 1%
	38.		Claim Adjustment Processing: Claim adjustment processing time is measured from the time a prior claim submission requiring an adjustment is identified through the date the claim adjustment is processed by service facility personnel.
		a.	Measurement Period: Annually
		b.	Service Objective: 95.00% within 7 calendar days, or 5 business days
		c.	Fees at Risk: 1%
	39.		Telephone Service Factor: Defined as the percentage of the Client telephone inquiries answered by facility Customer Service Representatives (CSRs) within 30 seconds. Measured from the time the caller completes the prompts of the automated telephone system to the time the caller reaches a CSR.
		a.	Measurement Period: Annually
		b.	Service Objective: 85% of calls answered within 30 seconds
		c.	Fees at Risk: 1%
	40.		Call Abandonment Rate: The call abandonment rate is the total number of participant and provider calls abandoned, divided by the total number of calls received by the facility's customer service telephone system.
		a.	Measurement Period: Annually
		b.	Service Objective: 2.00%
		c.	Fees at Risk: 1%
	41.		First Call Resolution Rate: First Call Resolution rate is the percentage of telephone inquiries completely resolved within a 'window period' of time. A call is considered 'resolved' when the same participant or a family member under the same subscriber ID has not contacted the administrator's customer service facility again regarding the same issue within 60 calendar days of the initial call.
		a.	Measurement Period: Annually
		b.	Service Objective: 95.00%
		c.	Fees at Risk: 1%
	42.		Open Inquiry Closure: Open Inquiry Closure addresses the time taken in hours and/or days by CSRs at the administrator's service facility to close open inquiries placed by participants of Client to the facility.
		a.	Measurement Period: Annually
		b.	Service Objective: 90.00% within 48 hours and 98.00% within five business days
		c.	Fees at Risk: 1%
	43.		CSR Audit, or Quality Scores: CSR audit or quality scores should be determined by the process used to evaluate the effectiveness and accuracy of participant telephone call handling at the administrator's customer service facility.
		a.	Measurement Period: Annually
		b.	Service Objective: 97.00%
		c.	Fees at Risk: 1%
	44.		CSR Callback Performance: CSR Callback Performance is measured from the CSR commitment data in hours and/or days to the time the actual callback was placed to the participant.
		a.	Measurement Period: Annually
		b.	Service Objective: 90.00% within 24 hours
		c.	Fees at Risk: 1%
	45.		Participant Email Response Performance: Email Response Performance is measured from the time an email is received by the administrator's response team to the time in hours or days to the time the actual email response is sent to the participant.
		a.	Measurement Period: Annually
		b.	Service Objective: 90% within 8 hours, 95% within 24 hours
		c.	Fees at Risk: 1%
	46.		Member Satisfaction: At least 95 % member satisfaction with the services. Measured as the number of satisfied to highly satisfied survey ratings divided by the total number of survey responses. Survey tool and survey methodology to be mutually agreed upon by vendor and the State.
		a.	Measurement Period: Annually
		b.	Service Objective: 95% satisfied
		c.	Fees at Risk: 1%
	47.		Account Management
			Plan will guarantee that the services provided by the health plan's team during the guarantee period will be satisfactory to Client Areas of satisfaction will include:
		a.	Knowledge/Capabilities - Account representative demonstrates competence in getting issues and problems resolved.
		b.	Responsiveness - All calls returned within 24 hours; along with an alternate person identified who can assist with service issues when account representative is unavailable.
		c.	Ability to meet deadlines - Supplying all requested materials accurately and in a timely manner, along with all necessary documentation (i.e. enrollment kits, rate confirmations, plan performance work plans, group contracts, ZIP code file, etc.).
		d.	Professionalism - Demonstrates objectivity and empathy with customer problems.
		e.	Flexibility - Ability to meet client-specific needs.
		f.	Participation in periodic meetings - Attendance at all required client meetings or conference calls.
		g.	Guarantee measured with staff responses to internal questionnaire. A scale from 1 to 5 will be used to measure performance, where 1 means 'very dissatisfied' and 5 means 'very satisfied'; and 2 through 4 are defined respectively.
		h.	Periodic program reports will be provided and presented with recommended actions. Standard program reports, within 30 days to quarter-end. Year-end activity report, within 45 days of program year end.
		i.	Open Enrollment Support: Accurate materials will be provided at least 60 days prior to the open enrollment period starting on May 1 each year. Representative will be available, if requested, for up to 5 employee benefit fairs.
		j.	Measurement Period: Annually
		k.	Service Objective: 3.5
		l.	Fees at Risk: 2%
	48.		Eligibility Processing: Confirm daily and weekly eligibility and enrollment within specified business days of the receipt of the eligibility information, given that information is complete and accurate.
		a.	Measurement Period: Annually
		b.	Service Objective: 98.00% within 2 business days
		c.	Fees at Risk: 1%
	49.		Administrative Fee Guarantee
		a.	Administrative Fee Guarantee: Indicate your guaranteed medical ASO Fee Increases for the population for the next three years (FY2022 FY2023 and FY2024). Identify trend corridors, if any.
		b.	Fees at Risk: Not less than 1%
	50.		Implementation Satisfaction: Vendor shall effectively manage program implementation and resolve any issues identified with implementation in a timeframe mutually agreed by the Client and the Account Executive.
		a.	Service Objective: The client program manager will determine if expectations are met.
		b.	Pre-Implementation Audit: Vendor will fully fund (up to $35,000) and pass a pre-implementation audit focusing on its phone and claims system, and will have any issues identified during the audit resolved prior to the July 1, 2021 effective date.
		c.	Service Objective: 90.00% of audit claims processed correctly, and all audit issues corrected prior to effective date.
	51.		ID Card Production and Distribution
		a.	Service Objective: 100% within 10 business days
		b.	Service Objective: Minimum 5% of total ASO fees at risk
	52.		Discount Guarantee: Submission of a discount guarantee within the Manage Attachments section of this RFP is required. Discount guarantees should be based on the network(s) and markets specific to this proposal and should not contain a risk-sharing corridor.
		a.	Requested Fees at Risk 25%

VI.		Implementation	Response	Explanation
	1.	How much lead time do you typically require for new implementations?
	2.	Will you be providing the State with a dedicated implementation manager?
	3.	Please confirm that you have provided an implementation timeline with your RFP submission.
	4.	Please confirm that the Vendor shall effectively manage program implementation and resolve any issues identified with implementation in a timeframe mutually agreed by the Client and the Account Executive.
	5.	Are all implementation fees included in your cost proposal? Are there additional fees for implementing? Please confirm Yes or No. Do not provide fee information here.

&"Arial,Italic"&F &D &"Arial,Italic"&8&P

Explanation

Request for Proposal (RFP) for State of South Dakota

Explanation

This worksheet should be used to provide additional explanations for any questions for which a "See Explanation" response

was given. Explanations must be numbered to correspond to the question to which they pertain and they must be brief.

State the number of questions you addressed with further explanation:

Section/ Question # Explanation

60	What tools and methods are used to prevent hospital emergency room usage and hospital readmissions
	What tools and methods are used to prevent hospital emergency room usage and hospital readmissions

&"Times New Roman,Italic"&F &D &"Arial,Italic"&8&P

OldListbox

List Box Name

Value

Census File sent on

diskette

listSentCensusOn

hard copy

Current Medical Plan

replace

to replace or supplement

supplement

listReplaceSupp

RFP list Name

ListYesNoSeeExplain

Yes

No - See "Explanation"

ListYesExplain

Yes - See "Explanation"

N/A

ListYesNo

Yes

ListYesNoNA

Yes

N/A

ListYesNoNotRequested

Yes

Not Requested

ListCompleted

Completed

Not Completed

ListAttached

Attached

Not Attached

ListABC

ListYesNotRequested

Yes

Requested

ListABC_G

ListABC_H

ListYears

< 2 years

2 to 5 Years

5 to 10 Years

> 10 Years

ListAccreditation

Excellent

Commendable

Accredited

Provisional

Denied

Appealed by Plan

In Process

Revoked

Scheduled

Suspended

Under Review by NCQA

NHP Accreditation

NHP Under Review

NHP Expired

NHP NCQA Discretionary Review

NHP Initial Decision Pending

NHP Future Review Scheduled

ListNameInsureEntity

Offered

Not Offered

ListJCAHO

Accreditation Not Requested

Accreditation With Commendation

Accreditation Without Type I Recommendations

Accreditation With Type I Recommendations

Provisional Accreditation

Conditional Accreditation

Preliminary Denial of Accreditation

Accreditation Denied

Accreditation Watch

Listtaxstatus

For-Profit

Not-For-Profit

ListModel

Group

IPA

Mixed

Network

Staff

PPO Platform

ListMetNotMet

Met

Not Met

ListUnderwriting

Individual Statement of Health

Employer Statement acting as gatekeeper)

Other; specified in "Explanation"

ListProposedRating

Community Rating

Group Specific (Adjusted) Community Rating

Community Rating by Class

Community Rating by Age

Experience Rated/Non-Div Eligible (Prospectively-rated)

Experience Rated/Div Eligible (Retrospectively-rated)

ListCommissions

Standard commissions are included in basic premium rates regardless of whether they are paid.

Standard commissions require an increase to basic premium rates.

No commissions included

ListGeo

Zip code dispersion

Center of zip code

Geo-coding (employee zip code address)

States

Contract Situs (State):

Alabama

ComboBox

Alaska

Arizona

Arkansas

California

Colorado

Connecticut

Delaware

District of Columbia

Florida

Georgia

Hawaii

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Maine

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana

Nebraska

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota

Ohio

Oklahoma

Oregon

Pennsylvania

Puerto Rico

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

Vermont

Virginia

Washington

West Virginia

Wisconsin

Wyoming

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120

180

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premium

administrative fees

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120

180

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Full

One - Year

Provisional

Denied

Under Review

NCQA Discretionary Review

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HMO

PPO

POS

HMO/PPO/POS

HMO/PPO

PPO/POS

HMO/POS

No - "See Explanation"

ListURAC

Accredited

Not Accredited

ListGuaranteeType

financial

service

NEW DROP DOWNS

Commission %: (can be used for stop loss and regular commission)	0.50%
	1%
	1.50%
	2%
	2.50%
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	8%
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	9%
	9.50%
	10%
	other - please specify

type of Data File Format:		dBase (Janice is this the right way to do a dBase file??)
		Excel
		Access
		pdf
		other - please specify
ListRatedNotRated	Rated	Not Rated

refreshScreen

	-1	Request for PPO Proposal (RFP) for State of South Dakota			Request for Proposal (RFP) for State of South Dakota
	-1	State of South Dakota hereinafter referred to as "The Client."			Single Location: SI PPO
	-1		Single Location: SI PPO
		BACKGROUND AND ADMINISTRATIVE INFORMATION			To Vendor: Use Column Q to provide a brief explanation. However if the length of the explanation is greater than 400 characters, you must use the "Explanation" worksheet to provide your detail explanation.
		Introduction
3	1	The Client is seeking proposals from qualified managed care organizations to provide a(n) PPO program for their active employees, retirees and/or COBRA participants effective on July 01, 2016. Proposals are due from interested vendors by July 01, 2016.		Header = 14 pts	MEDICAL RFP	List/Expected Response	Answer Format	Field Names	Format Type	Response	Explanation

The State of South Dakota is requesting proposals to secure competitive administrative fees, provider contracts, the ability to administer the State's direct provider contracts for the State's health plan.

Section Title = 12 pts, All Capital

GENERAL PLAN INFORMATION

List/Expected Response

Answer Format

Field Names

Format Type

Response

Explanation

Vendor Brand Name

Text

text

respCompCarrName

Text

Comments: The following applies to Self with stop loss.

Parent Co. Legal Entity Name

Text

text

respLegalEntityName

Text

FALSE

In addition, a stop loss quote is requested. The bid specifications are contained in the worksheet, "StopLoss."

d/b/a (Name in Marketplace)

Text

text

respMarketName

Text

FALSE

Year Established/Incorporated

mm/dd/yyyy

Month Day, Year

respYear

Date

Company Description

NAIC Code

Number

numeric

respNAIC

Number

The State of South Dakota Health Plan is authorized to administer the state employee health benefits program.

Industry Classification

Text

text

respIndustry

Text

Stock Ticker #

Text

text

respStockTicker

Text

FALSE

FEIN (Federal Employer Identification Number)

Text

text

respFEIN

Text

FALSE

Tax Status

ListTaxStatus: For-Profit; Not-For-Profit

drop down box

respTaxStatus

ListBox, ListTaxStatus

The location of The Client's headquarters is: Pierre, South Dakota, 57501

10.

Public or Privately-Held

Listrngpub: Privately-Owned; Publicly-Held

drop down box

respPublicPrivate

ListBox,Listrngpub

11.

Ownership/Controlling Interest Structure

Text

text

respOwnership

Text

Comments: The Following Title will hide when Are SI and No Variable 4 requested

12.

Comment: Description of how the organization is structured (operating companies, wholly-or partially-owned subsidiaries, etc.). Provide information on all organizations with more than a 7.5% stake in your firm, including legal and financial arrangements with these organizations.

Comment

FALSE

Compensation

13.

Mergers, acquisitions, spin-off's, significant organizational changes in past 2 years.

Text

text

respchanges

Text

This is the start of the file's text. The full file is on GovTribe.

File details come from the government source that posted it. Updated Nov 17, 2025.