BCBS - compressed.pdf

TECHNICAL Proposal Response for

RFP 120174 O3

State of Nebraska Department of Correctional Services

Administrative Healthcare Claim Invoice Processing Services Effective Date (To Be Determined)

Submitted To:

Julie Schiltz Nebraska Department of Correctional Services 801 W. Prospector Place, Bldg. #1 Lincoln, NE 68522

TECHNICAL RESPONSE TABLE OF CONTENTS RFP 120174 O3

TECHNICAL PROPOSAL

Table of Contents

SECTION

Main RFP Subsection(s) Noting Requirement

SIGNED FORMS

Contractual Agreement Form………………………..

NDCS Supplemental Information…………………… Addenda…………………………………………………

(See Sections I – VI below for initialed sections.)

RFP 120174 O3 (Pg. 31) RFP 120174 O3 (Pg. 32) Addendum 1 – 12.9.2024 Addendum 2 – 12.13.2024 Addendum 3 – 1.7.2025

CORPORATE OVERVIEW

Overview………………………………………………… Personnel Management Approach………………….

Subcontractors…………………………………………

Corporate Overview Items (VI.A.1.a - VI.A.1.h) Proposed Personnel Approach (VI.A.1.i) Subcontractor List (VI.A.1.j)

RFP SECTIONS I. – VI.

RFP Sections I – VI (Initialed)………………………..

Section I Procurement Procedure Section II Terms and Conditions Section III Vendor Duties Section VI Payment Section V Project Description and Scope of Work Section VI Solicitation Response Instructions

TECHNICAL RESPONSE

Understanding of Project Requirements…………..

Developmental Approach…………………………….

Attachment A – Bidder Questionnaire……………..

Project Work Plan……………………………………...

Deliverables/Due Dates……………………………….

Understanding of Project Requirements (VI.A.2.a) Proposed Developmental Approach (VI.A.2.b) Attachment A Questionnaire (VI.A.2.c) Detailed Project Work Plan (VI.A.2.d.)

Deliverables and Due Dates (VI.A.2.e.)

TECHNICAL RESPONSE TABLE OF CONTENTS RFP 120174 O3

EXHIBITS

Description

A…………………………………………………………..

B…………………………………………………………..

C…………………………………………………..………

D…………………………………………………………..

RFP Deviations (I.G.)

Provider Listings (V. E.7.)

Sortable Medical and Dental Provider Listings

(Electronic)

BCBSNE Financial Statements (VI.1.b.)

SOC2 Report and Certification (Attachment A Q&A)

State of Nebraska Department of Correctional Services CORPORATE OVERVIEW Items a. - h.

Corporate Overview 1 | P a g e

1. CORPORATE OVERVIEW Items a. - h.

The Corporate Overview section of the solicitation response should consist of the following subdivisions:

a. BIDDER IDENTIFICATION AND INFORMATION The bidder should provide the full company or corporate name, address of the company's headquarters, entity organization (corporation, partnership, proprietorship), state in which the bidder is incorporated or otherwise organized to do business, year in which the bidder first organized to do business and whether the name and form of organization has changed since first organized.

Company Name Blue Cross and Blue Shield of Nebraska Headquarters Address 1919 Aksarben Drive, Omaha NE 68180 Entity Organization Not-for-Profit Corporation State Incorporated Nebraska Year Company Organized 1939 Change of Organization Name Since Inception

1939 – Associated Hospital Service of Nebraska established

1944 – Blue Shield of Nebraska established 1974 – Merger of the above entities into Blue

Cross and Blue Shield of Nebraska 1987 – Blue Cross and Blue Shield of

Nebraska becomes a mutual company 2018 – Blue Cross and Blue Shield of

Nebraska was reorganized into a mutual holding company, Goodlife Partners, Inc., as well as an intermediate holding company, Goodlife Solutions, Inc.

b. FINANCIAL STATEMENTS The bidder should provide financial statements applicable to the firm. If publicly held, the bidder should provide a copy of the corporation's most recent audited financial reports and statements, and the name, address, and telephone number of the fiscally responsible representative of the bidder’s financial or banking organization.

Corporate Overview 2 | P a g e

If the bidder is not a publicly held corporation, either the reports and statements required of a publicly held corporation, or a description of the organization, including size, longevity, client base, areas of specialization and expertise, and any other pertinent information, should be submitted in such a manner that solicitation evaluators may reasonably formulate a determination about the stability and financial strength of the organization. Additionally, a non-publicly held firm should provide a banking reference.

Please refer to EXHIBIT C - BCBSNE Financial Statements.

BCBSNE’s Banking Reference:

Oscar Gonzalez First National Bank of Omaha 1620 Dodge Rd Stop 3306 Omaha, NE 68197

(402) 602-5397 ogonzalez@fnbo.com

The bidder must disclose any and all judgments, pending or expected litigation, or other real or potential financial reversals, which might materially affect the viability or stability of the organization, or state that no such condition is known to exist.

At this time, BCBSNE knows of no judgement, either pending or under expected litigation, or other real or potential financial reversal which might materially affect the viability or stability of our company.

The State may elect to use a third party to conduct credit checks as part of the corporate overview evaluation.

Acknowledged

c. CHANGE OF OWNERSHIP If any change in ownership or control of the company is anticipated during the twelve (12) months following the solicitation response due date, the bidder should describe the circumstances of such change and indicate when the change will likely occur. Any change of ownership to an awarded bidder(s) will require notification to the State.

BCBSNE is not anticipating a change in ownership or control of the company during the twelve months following the proposal due date.

Corporate Overview 3 | P a g e

d. OFFICE LOCATION The bidder’s office location responsible for performance pursuant to an award of a contract with the State of Nebraska should be identified.

Blue Cross and Blue Shield of Nebraska 1919 Aksarben Drive Omaha, NE 68180

e. RELATIONSHIPS WITH THE STATE The bidder should describe any dealings with the State over the previous three (3) years. If the organization, its predecessor, or any Party named in the bidder’s solicitation response has contracted with the State, the bidder should identify the contract number(s) and/or any other information available to identify such contract(s). If no such contracts exist, so declare.

Within the previous three years, BCBSNE has had the following contracts with the State of Nebraska:

STATE OF NEBRASKA DEPARTMENT OF CORRECTIONAL SERVICES HEALTHCARE BILL

PROCESSING:

Beginning Ending BCBSNE Group Number(s) April 1,2004 October 1, 2011 January 1, 2020

Sept. 30, 2011 December 31, 2019 To Present

04541 300207 103822

STATE OF NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHHS)

BEHAVIORAL HEALTH REGIONAL CENTER HEALTHCARE BILL PROCESSING:

April 1, 2009 October 1, 2011 January 1, 2020

Sept. 30, 2011 December 31, 2019 To Present

04944 300150 103821

f. BIDDER’S EMPLOYEE RELATIONS TO STATE If any Party named in the bidder’s solicitation response is or was an employee of the State within the past six (6) months, identify the individual(s) by name, State agency with whom employed, job title or position held with the State, and separation date. If no such relationship exists or has existed, so declare.

BCBSNE confirms no party mentioned within this proposal response was an employee of the State within the past six (6) months.

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If any employee of any agency of the State of Nebraska is employed by the bidder or is a subcontractor to the bidder, as of the due date for solicitation response submission, identify all such persons by name, position held with the bidder, and position held with the State (including job title and agency). Describe the responsibilities of such persons within the proposing organization. If, after review of this information by the State, it is determined that a conflict of interest exists or may exist, the bidder may be disqualified from further consideration in this solicitation. If no such relationship exists, so declare.

BCBSNE confirms that, at this time, no employee or any agency of the State of Nebraska is employed by BCBSNE as a subcontractor.

g. CONTRACT PERFORMANCE If the bidder or any proposed subcontractor has had a contract terminated for default during the past three (3) years, all such instances must be described as required below. Termination for default is defined as a notice to stop performance delivery due to the bidder’s non-performance or poor performance, and the issue was either not litigated due to inaction on the part of the bidder or litigated and such litigation determined the bidder to be in default.

It is mandatory that the bidder submit full details of all termination for default experienced during the past three (3) years, including the other Party's name, address, and telephone number. The response to this section must present the bidder’s position on the matter. The State will evaluate the facts and will score the bidder’s solicitation response accordingly. If no such termination for default has been experienced by the bidder in the past three (3) years, so declare.

If at any time during the past three (3) years, the bidder has had a contract terminated for convenience, non-performance, non-allocation of funds, or any other reason, describe fully all circumstances surrounding such termination, including the name and address of the other contracting Party.

Neither BCBSNE nor any subcontractor of BCBSNE has been terminated for default during the past three (3) years.

h. SUMMARY OF BIDDER’S CORPORATE EXPERIENCE The bidder should provide a summary matrix listing the bidder’s previous projects similar to this Solicitation in size, scope, and complexity. The State will use no more than three (3) narrative project descriptions submitted by the bidder during its evaluation of the solicitation response.

The bidder should address the following:

i. Provide narrative descriptions to highlight the similarities between the bidder’s experience and this Solicitation. These descriptions should include:

a) The time period of the project, Corporate Overview 5 | P a g e

b) The scheduled and actual completion dates,

c) The bidder’s responsibilities,

d) For reference purposes, a customer name (including the name of a contact person, a current telephone number, a facsimile number, and e-mail address); and

e) Each project description should identify whether the work was performed as the prime

Vendor or as a subcontractor. If a bidder performed as the prime Vendor, the description should provide the originally scheduled completion date and budget, as well as the actual (or currently planned) completion date and actual (or currently planned) budget.

ii. Bidder and Subcontractor(s) experience should be listed separately. Narrative descriptions submitted for Subcontractors should be specifically identified as subcontractor projects.

iii. If the work was performed as a subcontractor, the narrative description should identify the same information as requested for the bidders above. In addition, subcontractors should identify what share of contract costs, project responsibilities, and time period were performed as a subcontractor.

BCBSNE has experience in administering the health plans of many large, complex employer accounts from both the public and the private sectors. These accounts are similar in size and/or scope to the State of Nebraska Department of Correctional Services’ (NDCS’) administrative services account.

As requested, the following table includes two project narratives of large, complex BCBSNE clients. Please note that these narratives represent accounts where BCBSNE is the primary contractor (we are not including narratives involving Subcontractors).

Account Narratives

City of Lincoln and Lancaster County 555 S. 10th Street Lincoln, NE 68508

Time Period: March 2024 (RFP Receipt) to January 2025 (Implementation

Melissa Zahourek Human Resources Manager mzahourek@lincoln.ne.gov

(402) 441-7883

Description of the Dual Project

In March 2024, the City of Lincoln and Lancaster County initiated a comprehensive process to secure self-funded medical, pharmacy, and dental administration services. They issued Requests for Proposals (RFPs) to potential vendors, seeking competitive bids that would align closely with their existing benefits structures.

Proposal activities included thorough responses to RFP questionnaires, inclusion of analytics, as well as other exhibits requested within the RFPs. A thorough review of the existing benefits was also conducted to ensure that the proposed benefits would be as close to the incumbent’s offerings as possible.

Corporate Overview 6 | P a g e

City of Lincoln 1,997 Subscribers 5,372 Members

Lancaster County 798 Subscribers 1,900 Members

Deviations from the current benefits were clearly identified and detailed in the exhibits accompanying each bid. This meticulous approach ensured transparency and allowed for an accurate comparison of the proposals. In April 2024, initial proposals were produced and delivered by BCBSNE, for effective start dates of January 1, 2025, for both accounts.

In June 2024, finalist presentations were held, providing an opportunity for the top contenders to showcase their proposals in detail. Following these presentations, Best and Final proposals were submitted, refining the bids based on feedback and further negotiations. By July 2024, the City and County received notification of the successful sale, marking the beginning of the implementation phase.

Completion Date of Implementation Tasks

Upon receiving the notification of sale, implementation activities were promptly initiated. Onboarding tasks involving all key internal departments of BCBSNE were addressed by BCBSNE’s Strategic Business Integration team of implementation specialists, and ongoing communication with the benefit staff at the City and County allowed for complete transparency with these new (returning) accounts. BCBSNE’s implementation project managers followed a well-defined set of policies and procedures to ensure all required tasks were completed for a successful transition to BCBSNE’s systems. This structured and diligent approach allowed for a smooth transition to BCBSNE’s administration systems and services on January 1, 2025.

University of Nebraska 3835 Holdrege Street c/o Varner Hall Lincoln, NE 68503

Time Period: January 2024 to Present

Description of the Project

On January 1, 2024, the University of Nebraska (the University) transitioned to BCBSNE for its self-funded medical and dental benefits administration. This transition began with the issuance of a Request for Proposal (RFP) in January 2023, which detailed the University’s requirements and expectations for its complex benefits program. The University’s deadline for RFP responses was February 10, 2023.

Corporate Overview 7 | P a g e

Brian Schlichting Director of Universitywide Benefits, bschlichting@nebraska.edu

(402) 472-5258

11,673 Subscribers 27,785 Members

‘BCBSNE submitted our bid on February 8, 2023, which included comprehensive responses to the RFP questionnaire, required exhibits, online attestations, and analytics output. Our proposal also featured a thorough review of existing benefit documents and an accompanying Plan Deviation exhibit, ensuring all potential deviations were clearly identified and addressed.

BCBSNE’s meticulous approach ensured that all portions of the RFP were addressed for compliance.

Completion Date of Implementation Tasks

In March 2023, finalist presentations were conducted. After finalist presentation follow-up questions were addressed, BCBSNE submitted our Best and Final Offer on March 23, 2023.

BCBSNE received notification of the sale in early April 2023, and implementation tasks were promptly initiated. The onboarding process for the January 1, 2024, effective date was largely successful, apart from an error in ID card printing, which was quickly remedied.

Since the implementation on January 1, 2024, the University’s benefits and account services have run smoothly, demonstrating the effectiveness of BCBSNE’s project management staff which handled the transition to our self-funded health benefits claim administration. This transition has brought enhanced efficiency and tailored health benefits management to the University, benefiting both the institution and its employees.

BCBSNE has experience in providing group administration to governmental employer groups throughout Nebraska, including the City of Lincoln, Lancaster County, Douglas County and the City of Omaha. We also administer county groups through our Nebraska Association of County Officials (NACO) account, and, as mentioned previously within this document, we currently administer the State’s self-funded DHHS Behavioral Health Regional Centers account. We also currently provide health care administrative services to several utilities, including the Omaha Public Power District (OPPD), Nebraska Public Power District (NPPD) and the Metropolitan Utilities District (MUD). BCBSNE is also a federal government contractor, providing insurance coverage to 26,900 Federal Employee Plan (FEP) members.

BCBSNE’s significant experience and persistency with governmental accounts mentioned above is a testament to our company’s ongoing “Customer First” approach to providing service to our clients.

Corporate Overview 8 | P a g e

i. SUMMARY OF BIDDER’S PROPOSED PERSONNEL/MANAGEMENT APPROACH

The bidder should present a detailed description of its proposed approach to the management of the project.

As the incumbent administrator for the State of Nebraska Department of Correctional Services (NDCS) health care invoice processing, BCBSNE looks forward to continuing our valued relationship with the NDCS by providing the administrative services and account management the NDCS expects from its health and dental claims administrator.

Health Care Invoice Processing We recognize the importance of providing timely, accurate claim administrative services for the inmate population, and we have established internal claim system processes and procedures to accommodate the payment requirements set forth in this RFP (see Section IV, Project Description and Scope of Work, located within the TECHNICAL RESPONSE section of our bid response).

The RFP included additional requirements to the intended services regarding client reporting and analytics, excluded services, utilization review, and potential preauthorization requirements. While our proposal does not include preauthorization services as priced, BCBSNE has indicated in our response where additional personnel would be required depending on the final confirmation of service requirements from the NDCS. Our proposal’s pricing includes post-claim inpatient review for medical necessity and length of stay criteria.

The personnel within BCBSNE’s internal operational departments currently ensure overall NDCS administration is performed according to NDCS specifications, including compliance with all federal and state statutes.

For year-to-date 2024 through November 30th, NDCS medical claims were paid by BCBSNE with the following timeframes:

Within Seven Days

Within 14 Days Within 30 Days

Percentage of Medical Claims Processed for the NDCS

84.10% 85.38% 99.39%

Corporate Overview 9 | P a g e

For year-to-date 2024 through November 30th, NDCS dental claims were paid by BCBSNE

Within 14 Days Within 30 Days

Percentage of Medical Claims Processed for

76.00% 78.86% 98.29%

Administrative Claims and Fee Billings BCBSNE’s Finance department will continue to submit monthly invoices to the NDCS based on the invoice processing fee basis selected by the NDCS, as offered within our COST PROPOSAL. BCBSNE provides administrative per member per month fee invoicing based on the eligible population submitted to BCBSNE by the NDCS, and we use this information on which to base our monthly administrative fee billings. We do not use the NDCS’ quarterly ADP membership for invoicing fees. BCBSNE finance department has an assigned accountant who handles these billings, with regular leadership review and approval of the invoicing.

BCBSNE currently bills the NDCS for claims on a weekly basis, with the NDCS providing claim reimbursement to BCBSNE on a bi-weekly basis. BCSBNE provides a supporting Claim Analysis report of the claim activity billed to the NDCS through the standard client reporting delivery to the NDCS.

Provider Network BCBSNE maintains extremely competitive Nebraska medical and dental provider networks, with discounts and cost of care information being provided through our standard NDCS client reporting. BCBSNE’s Health Network Services department actively and continually pursues competitive provider discounts from Nebraska-based facilities and professionals, as well as dentists, orthodontists and dental surgeons.

BCBSNE also offers nationwide in-network coverage through the BlueCard PPO program, should any NDCS members require services outside of Nebraska.

Local Account Management The current NDCS account team will remain in place if BCBSNE is awarded the renewal contract for the NDCS. Our account executive and account specialist are local, allowing them to facilitate onsite meetings with the NDCS as needed. In addition, the assigned client consultant for the NDCS is also local, allowing for onsite meetings to discuss analytics results and requirements.

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The bidder should identify the specific professionals who will work on the State’s project if their company is awarded the contract resulting from this Solicitation. The names and titles of the team proposed for assignment to the State project should be identified in full, with a description of the team leadership, interface, and support functions, and reporting relationships. The primary work assigned to each person should also be identified.

The bidder should provide resumes for all personnel proposed by the bidder to work on the project.

The State will consider the resumes as a key indicator of the bidder’s understanding of the skill mixes required to carry out the requirements of the Solicitation in addition to assessing the experience of specific individuals.

Resumes should not be longer than three (3) pages. Resumes should include, at a minimum, academic background and degrees, professional certifications, understanding of the process, and at least three (3) references (name, address, and telephone number) who can attest to the competence and skill level of the individual. Any changes in proposed personnel shall only be implemented after written approval from the State.

As a full service insurance carrier and administrator, BCBSNE employes over 1,200 employees. Some of these employees provide indirect support for the NDCS account.

In the pages that follow within this Corporate Overview document, only the biographies of BCBSNE personnel who currently work (or who will work) directly on the NDCS account are included. This includes the account team as well as BCBSNE’s director of medical management.

j. SUBCONTRACTORS

If the bidder intends to subcontract any part of its performance hereunder, the bidder should provide:

i. name, address, and telephone number of the subcontractor(s)

ii. specific tasks for each subcontractor(s),

iii. percentage of performance hours intended for each subcontract; and

iv. total percentage of subcontractor(s) performance hours.

In the pages that follow within this Corporate Overview document, BCBSNE’s current subcontractor list is provided. Please note this list is all inclusive and most of these subcontractors will not apply to the NDCS account.

Julie Klein Manager, Large Group Accounts Julie.Klein@NebraskaBlue.com │ (402) 982-7690

BLUE CROSS AND BLUE SHIELD OF NEBRASKA

Julie’s Role

Julie is a dedicated professional with over 22 years of experience in the insurance industry. As the Manager of Large Group Accounts, she excels in business operations and account management. Julie leads a team of account executives, collaborates closely with clients, brokers, and consultants, negotiates renewal terms, and introduces new products and services.

Additionally, she provides strategic analysis and consultations to her accounts and actively participates in special projects.

Professional Background

Julie joined Blue Cross Blue Shield of Nebraska (BCBSNE) in June 2008 as an individual sales representative, assisting clients with purchasing individual products, Medicare supplement policies, and prescription drug plans. Her success in individual product sales led to her transition to BCBSNE’s small group account management team in May 2013.

In August 2017, Julie advanced to the large group account management team as an account executive, where she effectively communicated and provided direction to her assigned group clients and team of account executives. In June 2022, she was promoted to Manager of the Major Account Service Specialists while maintaining her role as a Strategic Account Executive. Demonstrating strong leadership and strategic oversight, Julie was promoted to her current position as Manager of Large Group Accounts in 2024.

Education, Certifications and Professional Affiliations

Julie has her Nebraska Department of Insurance Producer’s License in Accident, Annuities, Health, Life and Sickness, and Property and Casualty Insurance. She is a Blue Cross and Blue Shield Certified Health Consultant and is also a current member of the National Association of Health Underwriters (NAHU).

Reference #1 Reference #2 Reference #3

Nicole Creamer Omaha, NE

PH: (402) 669-2976

Kathie Krawczyk

PH: (402) 982-6018

Holly Kovy Bellevue, NE

PH: (402) 982-7816

Dan Erker Account Executive, Major Accounts Dan.Erker@NebraskaBlue.com | (402) 982-8308

BLUE CROSS AND BLUE SHIELD OF NEBRASKA

Dan’s Role

Dan is responsible for providing overall account management of his assigned employer groups, beginning with onboarding of new accounts during the initial implementation process, as well as the development of benefit strategies and recommendations that allow his employers to achieve their benefit and cost objectives. Dan works closely with his clients, brokers and consultants by delivering and negotiating renewal terms, introducing new products and services, and providing strategic analysis and consultation.

Professional Background

Dan has an extensive history of sales and account management experience covering over 30 years. Prior to joining BCBSNE’s Major Accounts team in 2017, Dan held key account manager and regional manager positions with a large business data and marketing company based in Omaha, managing major clients throughout a nine-state region. He has also worked in a similar capacity with a business intelligence and analytics firm, as well as an Omaha-based voting registration and election management company.

Throughout his career, Dan has worked at cultivating relationships while managing blocks of clients, positioning him as a perfect fit for BCBSNE’s Major Accounts business segment.

Education, Certifications and Professional Affiliations

Dan earned his Bachelor of Science degree in business administration from Creighton University in Omaha.

He holds his Nebraska Department of Insurance producer’s license in sickness, accident and health.

Reference #1 Reference #2 Reference #3

Aaron Schmid Grand Island, NE PH: (308) 685-5444 (ext. 199)

Marsha Bartek Lincoln, NE

PH: (402) 904-8052

Amy Miller Aurora, NE

PH: (402) 964-5101

Christa Hofferber Strategic Account Specialist, Large Group Christa.Hofferber@nebraskablue.com | (402) 458-4883

Christa’s Role

As a strategic account specialist, Christa’s main duties involve handling day-to-day escalated service issues concerning matters such as electronic enrollment, membership and claims. She completes new business and renewal benefits for her groups and handles exceptions and escalated service work. She has an excellent knowledge base for assisting her group customers, brokers and consultants, and she truly goes the extra mile to ensure that her clients are happy and their issues are quickly resolved.

Professional Background

Previously, Christa held the position of precertification/pre-authorization specialist while working for another independent Blue Cross and Blue Shield company. When she began her employment with BCBSNE, she worked as both a customer service representative and group leader representative, gaining insight from a variety of different internal departments before transitioning to the large group account team.

Education, Certifications and Professional Affiliations

Christa attended the University of Northern Iowa from 1991-1994 and graduated with a Bachelor of Arts in social work and a minor in substance abuse counseling. She has held her producer’s license in life and health in Iowa and Nebraska since March 2002.

Jennifer Muehlhausen

PH: (402) 474-1555

PH: (402) 472-5258

Karen Coufal

PH: (402) 904-7025

Alyssa Perrigo Client Consultant Alyssa.Perrigo@NebraskaBlue.com │ (402) 982-6057

Alyssa’s Role

As a client consultant, Alyssa performs analysis that incorporates an employer’s membership, claim costs and utilization. She analyzes medical trends, plan benefits and plan design, in addition to evaluating market and provider network changes to determine the impact on member enrollment and utilization.

Professional Background

Alyssa has held industry-related positions at several employers, beginning in the retail pharmacy arena from 2008 to 2014 as a pharmacy technician. She then held a position in customer relations at a third-party benefits administrator for five years, assisting customers and troubleshooting pharmacy claim issues for clients and internal teams, as well as identifying prescription drug trends and analyzing pharmacy reports. In 2019, she became a Sales Coordinator for a craft tools and accessories company supporting both the business and finance teams, where she remained until arriving in her current position with BCBSNE in August of 2022.

Education, Certifications and Professional Affiliations

In 2012, Alyssa obtained a Bachelor of Science in Nursing from Clarkson College in Omaha, NE.

Lori Fischer

PH: (402) 982-8724

Stephanie Francl

PH: (402) 312-7901

Ashlie Peters

PH: (402) 982-8762

M. Renee Beacom Director, Medical Management Services Michelle.Beacom@NebraskaBlue.com │ (402) 982-6040

Renee’s Role

Michelle Renee (Renee) serves as the Director of Medical Management Services at BCBSNE, providing leadership and oversight to BCBSNE’s integrated utilization and care management programs. Renee provides strategic direction for the development and management of clinical programs to enhance healthcare delivery. Additionally, she provides guidance on the implementation of new clinical products and programs, and ensures her teams administer our programs effectively and efficiently while following compliance standards.

Professional Background

Prior to joining BCBSNE in January of 2023 in her current role, Renee served in a variety of health related positions over a diverse and extensive career in healthcare. She has served as a registered nurse working in various healthcare facilities where she honed her clinical skills and patient care expertise, transitioning into manager and director roles in community engagement.

Her career progressed as she took on the role of Manager of Community Engagement for a health plan, where her impactful work led to a promotion to Director within the same organization. Additionally, Renee served as a Medicaid Strategy Consultant, providing valuable guidance on clinical and member engagement strategies for a consulting firm. Her multifaceted experience highlights her dedication to improving healthcare delivery and community health outcomes.

Certifications and Professional Affiliations

In addition to her professional achievements, Renee is a Certified Professional in Healthcare Quality (CPHQ) and remains a registered nurse with a master’s degree in public health from the University of Nebraska Medical Center. She is also actively involved in multiple local and national healthcare related associations.

Dr. Debra Tomek

PH: (402) 306-3573

Jeanee Weiss

PH: (402) 740-5182

Carey Potter Deadwood, SD

PH: (402) 890-2782

Subcontractors

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Subcontractor Name Description of Services Inception of Subcontract Expiration Address & Telephone Task

Accolade 2nd.MD LLC Accolade Expert MD (also referred to as 2nd.MD) provides second opinion medical consultations for members enrolling in the program.

2023: MSA remains in effect until such time as there have been no active order forms for 12 consecutive months.

660 West Germantown Pike

Suite 500 Plymouth Meeting, PA

19462 610.834.2989

Second Opinion Consultations

AllMed Healthcare Management, Inc.

Independent review organization for medical management.

2013: 3-year initial term with automatic 1-year renewal

621 SW Alder Street Suite 740

Portland, OR 97205 800.400.9916

Independent Claim Reviews

Altruista Health, Inc. (a wholly owned subsidiary of HealthEdge Software, Inc.)

Portal utilized to create pre-authorizations for providers.

2020: 2-year initial term with automatic 1-year renewal

11800 Sunrise Valley Drive

Suite 1100 Reston, VA 20191

703.707.8890

Preauthorization Portal

B2E Direct Marketing, Inc.

Data/list management and procurement.

2024: Perpetual 307 E Court Avenue Des Moines, IA 50309

515.282.4933

Medicare Advantage Supplemental Benefit

Benefitfocus.com, Inc. Provides web-based tools and services to process group eligibility, enrollment transactions, electronic billing, and assisted underwriting.

2003: 5-year initial term with automatic 1-year renewal

100 Benefitfocus Way Charleston, SC 29492

843.375.4950

Electronic Enrollment and Data Exchange Services

Cardinal Colorprint Printing Corporation a/k/a

Cardinal ColorGroup

Print and mail vendor also used for Medicate Advantage marketing.

2024: Perpetual 1601 Rohlwing Road Rolling Meadows, IL

60008 630.467.1000

Print and Mail Services

Subcontractors 2 | P a g e

CDR Associates, LLC (a subsidiary of

Conduent)

CDR works with participating hospitals to review BCBSNE member accounts to ensure there are no positive balances where BCBSNE may have overpaid on claims.

2007: 1-year initial term with automatic 1-year renewal

307 International Circle Cockeysville, MD 21030

410.560.6700

Provider Balance Audit Services

Change Healthcare Technologies, LLC

Coding advisor and DRG audit program to identify whether institutional providers are inappropriately inflating their claim costs.

2018: Perpetual 100 Airpark Center Drive East

Nashville, TN 37217

Claim Audit Services

Concert Genetics, Inc. Provides data analytics on medical conditions and offer guidance and savings opportunities; reviews BCBSNE medical policies and offers suggestions, changes, and updates.

2017: 3-year initial term with automatic 1-year renewal

3011 Armory Drive Suite 290

Nashville, TN 37204 615.861.2634

Analytics Services

ConnectureDRX f/k/a Connecture, Inc. and DestinationRX, Inc.

("DRX")

Single source for all 65+ medical and add-on dental applications.

2009: 4-year initial term with automatic 1-year renewal

1433 North Water Street Suite 400

Milwaukee, WI 53202 800.379.9060

Enrollment Tasks

Cotiviti, Inc. Receives membership and claims information and reviews for billing anomalies to identify claims that were overpaid.

2014: Perpetual One Glenlake Parkway Suite 1400

Atlanta, GA 30328 770.379.2800

Claims Editing Services

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Council for Affordable Quality Healthcare, Inc.

("CAQH")

CAQH designed and launched COB Smart. Health plans directly contribute to a registry of coverage information that helps health plans and providers correctly identify COB situations for accurate claims processing.

2017: 3-year initial term with automatic 1-year renewal

2020 K Street Suite 900

Washington, DC 20004 202.517.0400

Coordination of Benefits Registry

Empowered Margins, Inc. Hosts an online risk evaluation and enrollment tool.

2018: 1-year initial term with automatic 1-year renewal

2605 W. Colorado Avenue

Suite 219 Colorado Springs, CO

80904 719.581.2221

Underwriting Risk Evaluation

Empyrean Benefit Solutions, Inc. f/k/a

Enspire Healthcare, LLC

Cloud based solution for employee engagement.

2025: 2-year initial term with automatic 1-year renewal

411 Brazos Street Austin, TX 78701

515.299.4926

App offered that consolidates an employer’s benefit offerings for its population

Evolent Specialty Services, Inc. f/k/a Evolent Health, Inc.

Spine/pain management preauthorization program.

2015: 3-year initial term with automatic 1-year renewal

6950 Columbia Gateway Drive

Suite 400 Columbia, MD 21046

888.656.2170

Utilization Management Services

Service Level Agreements

G.A. Food Services of Pinellas County, LLC

Provide post-discharge meals to our MA members following an inpatient stay in the hospital.

2025: 1-year initial term with automatic 1-year renewal

12200 32nd Court North St. Petersburg, FL 33716

800.852.2211

Medicare Advantage Supplemental Benefit

Subcontractors 4 | P a g e

HealthEdge Software, Inc.

BCBSNE core claims processing, billing, and payment platform.

2017: 10-year initial term with automatic 1-year renewal

30 Corporate Drive Burlington, MA 01803

781.285.1300

Claims Processing Software as a Service

Healthways, Inc. a/k/a American Healthways

LLC (a Sharecare Company)

Disease management and wellness services.

2009: 5-year initial term and consecutive 5-year renewal terms

701 Cool Springs Boulevard

Franklin, TN 37067 615.614.4255

Disease Management

Highmark Inc. Surrogate claims processor used by BCBSNE under certain circumstances for BCBSNE-branded national account business.

2010: 3-year initial term with automatic 1-year renewal

Fifth Avenue Place 120 Fifth Avenue

Pittsburgh, PA 15222-

412.544.7000

Claims Processing Services

Infocrossing, LLC "IFOX" a/k/a WIPRO

Wipro provides CMS compliant services (e.g., CMS eligibility verification, application processing, Transaction Reply Report (TRR) management, membership management, etc.).

2024: 5-year initial term with no automatic renewal

2 Tower Center East Brunswick, NJ

08816 971.763.2139

CMS Services

Kyruus Health f/k/a HealthSparq, Inc.

Solution for transparency in coverage mandate and used for certain online member tools (directory of providers, maximum out-of-pocket estimates, and patient reviews of providers).

2015: Perpetual 100 SW Market Street

M/S WW3-31

Portland, OR 97201 855.772.7748

Member Tools Vendor

Subcontractors 5 | P a g e

LanguageLine Solutions Member interpretation services for Customer Service operations.

2012: 2-year initial term with automatic 1-year renewal

1 Lower Ragsdale Drive Building 2

Monterey, CA 93940 800.752.6096

Translation Service and Service Level Agreements

Luxottica Retail North America d/b/a Contacts Direct on behalf of itself and EyeMed Vision Care and Glasses.com, Inc.

Provide white-labeled products for BCBSNE as well as supplemental vision benefits for Medicare Advantage.

2025: 3-year initial term with automatic 1-year renewal

4000 Luxottica Place Mason, OH 45040

513.765.6000

Medicare Advantage Supplemental Benefit

MCMC, LLC Independent review organization for medical management.

2021: Perpetual term 300 Crown Colony Drive Suite 203

Quincy, MA 02169 617.375.7700

Independent Claim Reviews

Medical Review Institute of America, LLC

("MRIoA")

Independent review organization for medical management.

2020: Perpetual term 2875 South Decker Lake Drive

Suite 300 Salt Lake City, UT 84119

800.654.2422

Independent Claim Reviews

NationsBenefits Sales call center that will be providing services specifically for Medicare Advantage.

They will perform triage and services for prospective members responding to marketing as well as overflow enrollment services as necessary.

2024: Perpetual 1700 N. University Drive Plantation, FL 33322

877.439.2665

Subcontractors 6 | P a g e

NetCentric Technologies Inc., an Allyant Company

PDF remediation services/ alternative formats for accessibilit.

2024: 1-year initial term with no automatic renewal

1200 G Street NW Suite 800

Washington, DC 20005 800.563.0668

Medicare Advantage Supplemental Benefit

PayFlex Systems USA, Inc

FSA vendor for ASO group (This is BCBSNE's 4th party)

- BCBSNE sends claims data

2017: Perpetual term 10802 Farnam Street Suite 100

Omaha, NE 68154 855.542.5988

Flexible Spending Account Administrator

(optional)

PayForward LLC OTC and flex card benefits. 2024: June 1, 2024, through December 31, 2026, with no automatic renewal

27200 Tourney Road Valencia, CA 91355

310.904.9763

Medicare Advantage Supplemental Benefit

Prest & Associates Inc.

a/k/a ExamWorks

Independent review organization for medical management.

2002: Perpetual term 401 Charmany Drive Unit 305

Madison, WI 53719 800.358.5129

External Review Consultant Services

Prime Therapeutics LLC Pharmacy benefit management administrator.

2010: 3-year initial term with automatic 1-year renewal

1305 Corporate Center Drive

Eagan, MN 55121-1204 800.858.0723

Pharmacy Benefit Management Services

(BCBSNE has an ownership interest.)

RX

Service Level Agreements

Service Quality Measurement Group Inc.

(“SQM”)

Third party member survey software.

2017: 1-year initial term with automatic month-to-month renewal

7400 No. Mineral Drive Suite 600

Coeur d'Alene, ID 83815 888.972.0844

Survey Software

Subcontractors 7 | P a g e

Simplify Healthcare Technology

Source for provider credentialing and reimbursement data.

2020: 3-year initial term with automatic 1-year renewal

600 N. Commons Drive Suite 110

Aurora, IL 60504 844.720.6678

Provider Network Credentialing

Solventum Health Information Systems f/k/a

3M Health Information Systems, Inc.

Provides our inpatient grouper software, outpatient grouper/price software analytics for reimbursement, and the calculation of our value-based program performance (hosted).

2022: 3-year initial term with automatic 3-year renewal

575 West Murray Blvd.

Murray, UT 84123

801.265.2000

Data Analytics

Symphony Performance Health, Inc. d/b/a SPH

Analytics

Vendor for Customer Service member satisfaction surveys.

2023: 3-year initial term with automatic 1-year renewal

11605 Haynes Bridge Road

Suite 400 Alpharetta, GA 30009

866.460.5681

Survey Vendor

The Vitality Group, LLC Group Wellness member portal for groups with 100+ members who are interested in wellness. We will utilize their platform in combination with Health Fitness.

2020: 1-year initial term with automatic 1-year renewal

200 West Monroe Street Suite 1900

Chicago, IL 60606 312.224.7100

Wellness Provider

United Language Group (“ULG”) f/k/a Via, Inc.

(viaLanguage, Inc.)

Vendor producing translated materials.

2012: 2-year initial term with automatic 1-year renewal

700 SW Taylor Suite 300

Portland, OR 97205 855.786.4833

Translation Service

Subcontractors 8 | P a g e

Virta Health Corp. Diabetic disease management consulting services.

2021: Perpetual term 501 Folsom Street 1st Floor

San Francisco, CA 94105

Diabetes Management

Welltheos LLC d/b/a

W3LL

Enhanced Direct Enrollment platform for Individual ACA line of business.

2021: Perpetual 1500 Stony Brook Road Cewit R&D Park

Stony Brook, NY 11794 800.236.7941

Enrollment Services

WEX Health, Inc. d/b/a WEX f/k/a Discovery Benefits, LLC f/k/a

Discovery Benefits, Inc.

Vendor partner offering FSA, HRA, HSA, COBRA and Telecommuter benefits.

2013: 1-year initial term with automatic 1-year renewal

4321 20th Avenue SW Fargo, ND 58103

866.451.3399

Administration of FSA, HRA, HSA, COBRA and

Telecommuter benefits.

Corporate Overview 1 | P a g e

1. CORPORATE OVERVIEW Items a. - h.

The Corporate Overview section of the solicitation response should consist of the following subdivisions:

a. BIDDER IDENTIFICATION AND INFORMATION The bidder should provide the full company or corporate name, address of the company's headquarters, entity organization (corporation, partnership, proprietorship), state in which the bidder is incorporated or otherwise organized to do business, year in which the bidder first organized to do business and whether the name and form of organization has changed since first organized.

Company Name Blue Cross and Blue Shield of Nebraska Headquarters Address 1919 Aksarben Drive, Omaha NE 68180 Entity Organization Not-for-Profit Corporation State Incorporated Nebraska Year Company Organized 1939 Change of Organization Name Since Inception

1939 – Associated Hospital Service of Nebraska established

1944 – Blue Shield of Nebraska established 1974 – Merger of the above entities into Blue

Cross and Blue Shield of Nebraska 1987 – Blue Cross and Blue Shield of

Nebraska becomes a mutual company 2018 – Blue Cross and Blue Shield of

Nebraska was reorganized into a mutual holding company, Goodlife Partners, Inc., as well as an intermediate holding company, Goodlife Solutions, Inc.

b. FINANCIAL STATEMENTS The bidder should provide financial statements applicable to the firm. If publicly held, the bidder should provide a copy of the corporation's most recent audited financial reports and statements, and the name, address, and telephone number of the fiscally responsible representative of the bidder’s financial or banking organization.

Corporate Overview 2 | P a g e

If the bidder is not a publicly held corporation, either the reports and statements required of a publicly held corporation, or a description of the organization, including size, longevity, client base, areas of specialization and expertise, and any other pertinent information, should be submitted in such a manner that solicitation evaluators may reasonably formulate a determination about the stability and financial strength of the organization. Additionally, a non-publicly held firm should provide a banking reference.

Please refer to EXHIBIT C - BCBSNE Financial Statements.

BCBSNE’s Banking Reference:

Oscar Gonzalez First National Bank of Omaha 1620 Dodge Rd Stop 3306 Omaha, NE 68197

(402) 602-5397 ogonzalez@fnbo.com

The bidder must disclose any and all judgments, pending or expected litigation, or other real or potential financial reversals, which might materially affect the viability or stability of the organization, or state that no such condition is known to exist.

At this time, BCBSNE knows of no judgement, either pending or under expected litigation, or other real or potential financial reversal which might materially affect the viability or stability of our company.

The State may elect to use a third party to conduct credit checks as part of the corporate overview evaluation.

Acknowledged

c. CHANGE OF OWNERSHIP If any change in ownership or control of the company is anticipated during the twelve (12) months following the solicitation response due date, the bidder should describe the circumstances of such change and indicate when the change will likely occur. Any change of ownership to an awarded bidder(s) will require notification to the State.

BCBSNE is not anticipating a change in ownership or control of the company during the twelve months following the proposal due date.

Corporate Overview 3 | P a g e

d. OFFICE LOCATION The bidder’s office location responsible for performance pursuant to an award of a contract with the State of Nebraska should be identified.

Blue Cross and Blue Shield of Nebraska 1919 Aksarben Drive Omaha, NE 68180

e. RELATIONSHIPS WITH THE STATE The bidder should describe any dealings with the State over the previous three (3) years. If the organization, its predecessor, or any Party named in the bidder’s solicitation response has contracted with the State, the bidder should identify the contract number(s) and/or any other information available to identify such contract(s). If no such contracts exist, so declare.

Within the previous three years, BCBSNE has had the following contracts with the State of Nebraska:

STATE OF NEBRASKA DEPARTMENT OF CORRECTIONAL SERVICES HEALTHCARE BILL

PROCESSING:

April 1,2004 October 1, 2011 January 1, 2020

Sept. 30, 2011 December 31, 2019 To Present

04541 300207 103822

STATE OF NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHHS)

BEHAVIORAL HEALTH REGIONAL CENTER HEALTHCARE BILL PROCESSING:

April 1, 2009 October 1, 2011 January 1, 2020

Sept. 30, 2011 December 31, 2019 To Present

04944 300150 103821

f. BIDDER’S EMPLOYEE RELATIONS TO STATE If any Party named in the bidder’s solicitation response is or was an employee of the State within the past six (6) months, identify the individual(s) by name, State agency with whom employed, job title or position held with the State, and separation date. If no such relationship exists or has existed, so declare.

BCBSNE confirms no party mentioned within this proposal response was an employee of the State within the past six (6) months.

Corporate Overview 4 | P a g e

If any employee of any agency of the State of Nebraska is employed by the bidder or is a subcontractor to the bidder, as of the due date for solicitation response submission, identify all such persons by name, position held with the bidder, and position held with the State (including job title and agency). Describe the responsibilities of such persons within the proposing organization. If, after review of this information by the State, it is determined that a conflict of interest exists or may exist, the bidder may be disqualified from further consideration in this solicitation. If no such relationship exists, so declare.

BCBSNE confirms that, at this time, no employee or any agency of the State of Nebraska is employed by BCBSNE as a subcontractor.

g. CONTRACT PERFORMANCE If the bidder or any proposed subcontractor has had a contract terminated for default during the past three (3) years, all such instances must be described as required below. Termination for default is defined as a notice to stop performance delivery due to the bidder’s non-performance or poor performance, and the issue was either not litigated due to inaction on the part of the bidder or litigated and such litigation determined the bidder to be in default.

It is mandatory that the bidder submit full details of all termination for default experienced during the past three (3) years, including the other Party's name, address, and telephone number. The response to this section must present the bidder’s position on the matter. The State will evaluate the facts and will score the bidder’s solicitation response accordingly. If no such termination for default has been experienced by the bidder in the past three (3) years, so declare.

If at any time during the past three (3) years, the bidder has had a contract terminated for convenience, non-performance, non-allocation…