EXHIBIT 3 - EVALUATION CRITERIA.pdf

EXHIBIT 3 - EVALUATION CRITERIA

Proposals resulting from this RFP will be evaluated according to the following criteria.

Phase I: Minimum Qualification Requirements Metro shall perform an initial responsiveness review to determine compliance with the RFP administrative requirements and the minimum qualification requirements as defined herein and notify all disqualified Proposers. Proposers that are deficient in meeting the minimum qualifications at the time of Proposal submittal shall be deemed non-responsive to this RFP, and no further consideration shall be granted.

Phase II: Technical Evaluation Proposals that meet the Phase I Minimum Qualifications Requirements shall be evaluated based on the Phase II evaluation criteria herein.

PHASE I - Minimum Qualification Requirements – Pass/Fail

Proposer must meet all the following Minimum Qualifications Requirements at the time of proposal submittal:

1. Proposer must have a minimum of (5) years of experience with claims administration (workers' compensation).

2. Proposed key personnel must have a minimum of three (3) years of direct experience handling workers’ compensation claims on a self-insured program.

3. Proposer must be authorized and/or licensed to manage claims in the State of California.

Phase II - Technical Evaluation

Proposals that meet the Phase I Minimum Qualifications Requirements shall be scored based on the following Phase II Technical Evaluation criteria and their indicated weights. Each sub-criterion in the following numbered sections has been assigned a corresponding weight.

A. Qualifications of the Proposer 20%

1. Depth of Proposer’s capacity, corporate skill, and qualifications in performing all tasks specified in the Scope of Services (SOS), including firm’s experience with California labor code and understanding of applicable laws and regulations.

2. Depth of Proposer’s direct relationships with the Medical Provider Network, Pharmacy Benefit Management and ancillary vendors.

3. Depth of Proposer’s experience and track record in the industry, including the number of years they have been in business, the types of clients they serve, and their familiarity with the specific needs and challenges of self-insured employers.

4. Depth of Proposer’s experience managing and servicing claims for similar-sized or complex organizations and accounts.

5. Depth of Proposer’s experience in handling and responding to customer service inquiries in a timely manner.

6. Depth of Proposer’s experience in working with iVOS claims system and systems integration capabilities between proposer’s system(s), Metro’s iVOS claims system and Metro’s bill review vendor.

B. Qualifications of Proposed Key Personnel 30%

1. Depth of key personnel’s ability to handle both routine and complex claims, including litigation management.

2. Degree of key personnel’s experience dealing with workers compensation claims on a self-insured program.

C. Management Plan/Approach 20%

1. Effectiveness of proposed organizational capacity to provide claim administration for outlined claims and new volume.

2. Capability and feasibility of the proposed approach to manage all assigned claims for entire duration, from inception through settlement or other form of discharge.

3. Viability of Proposer’s methods for ensuring internal quality control and correcting any problems when they arise.

4. Sufficiency of Proposer’s performance guarantees that claims will be completed within the requested time frame.

D. Price Proposal 30%

The Price Proposal will be factored into Proposer’s final evaluation score in the following manner:

Proposer Score = Lowest Proposed Price x 30% Proposer’s Price Proposal