Exhibit_5_-_Reference_Form.docx
DOCX document 95 KB Posted
- Attached to
- EDE-first State Based Exchange
- Solicitation number
- EV00000956
- Issued by
- Oklahoma
About this file
This is a Reference Questionnaire form designed to evaluate vendor performance on large-scale public sector or health insurance marketplace system projects. The form requests reference contact information including the company or organization name, contact person, title, email address, and phone number. Projects must meet specific criteria, including the vendor's direct responsibility for full lifecycle delivery and operations of a large-scale public sector or health insurance marketplace system supporting at least 100,000 enrollees, and direct experience designing and operating eligibility determination and enrollment systems within ACA or comparable regulated environments, including reconciliation, data migration, issuer coordination, and post-enrollment account maintenance processes. References are asked to provide a project summary and rate vendor performance across ten evaluation areas: understanding of program and business needs, ability to deliver against scope and requirements, schedule adherence, quality of deliverables, project management and governance, communication and responsiveness, issue and risk management, staffing stability and continuity, technical competence, and operational performance.
The questionnaire includes three key performance questions requesting brief responses regarding how effectively the vendor managed project risks and changes, vendor responsiveness to requests and emerging needs, and integration with the reference's team and other contractors or partners. References conclude the evaluation by providing an overall satisfaction rating on a scale of one to five and answering yes or no questions regarding whether they would hire the vendor again and recommend the vendor for similar work. The form includes fields for project name, start date, end date, contract value, and contract type designation as DDI, M&O, or Hybrid.
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Text version
Exhibit 5 – Reference Questionnaire
Reference contact information Company / Organization Name:
Reference Contact Name:
Title / Role:
Email Address:
Phone Number:
project INFORMATION Project Name
Project Start Date
Project End Date
Contract Value (Approximate)
Contract Type (DDI, M&O, Hybrid)
Does this project meet the following criteria? (Yes / No)
The project included the Vendor’s direct responsibility for full lifecycle delivery and operations of a large-scale public sector or health insurance marketplace system, supporting at least 100,000 enrollees.
Does this project meet the following criteria? (Yes / No)
The project included the Vendor’s direct experience designing and operating eligibility determination and enrollment systems within ACA or comparable regulated environments, including reconciliation, data migration, issuer coordination, and post-enrollment account maintenance processes.
pROJECT DESCRIPTION Summary of the Project reference evaluation Please rate the Vendor’s performance using the rating below:
1 = Poor | 2 = Below Expectations | 3 = Meets Expectations | 4 = Exceeds Expectations | 5 = Significantly Exceeds Expectations
| Evaluation Area |
| Rating (1-5) |
Understanding of Program and Business Needs
Ability to Deliver Against Scope and Requirements
Schedule Adherence
Quality of Deliverables
Project Management and Governance
Communication and Responsiveness
Issue and Risk Management
Staffing Stability and Continuity
Technical Competence (Architecture, Integration, etc.)
Operational Performance (if applicable) key performance questions Please provide brief responses.
How effectively did the Vendor manage project risks, issues, and changes?
How responsive and understanding was the Vendor to requests, questions, or emerging needs?
How well did the Vendor integrate with your team and other contractors or partners?
Overall assessment
| Question |
| Response |
Overall Satisfaction (1-5)
Would you hire this vendor again? (yes / no)
Would you recommend this vendor for similar work? (yes / no)
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