Exhibit B - Offeror Questionnaire.xlsx
XLSX spreadsheet 73 KB Posted
- Attached to
- Dental Benefits Program
- Solicitation number
- RFP AABA 2027000021 4
- Issued by
- Denver County, Denver City, Colorado
About this file
This is an Offeror Questionnaire form for the Colorado Dental Benefits Program, a state contract opportunity. The questionnaire is designed to gather detailed information from potential bidders regarding their qualifications, experience, and capability to deliver dental benefits services. The form requests responses to specific questions that will be used to evaluate offeror suitability and readiness to perform under the contract. The document serves as a qualification assessment tool to ensure bidders meet the necessary requirements and possess relevant expertise in administering dental benefits programs.
The questionnaire likely covers standard evaluation criteria including organizational experience with dental benefits administration, financial stability, staffing capabilities, technology systems, customer service infrastructure, and compliance with regulatory requirements. Offerors are expected to provide comprehensive responses demonstrating their track record in similar programs, their understanding of the scope of work, and their ability to meet contractual obligations. The specific questions and evaluation thresholds contained within the form would guide bidders in presenting their qualifications and would enable the state of Colorado to make informed decisions regarding vendor selection for this dental benefits program.
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B-1 Instructions
| RFP for State Employee Dental Benefit Program | |
| Exhibit B: Offeror Proposal Workbook |
| Instructions: | |
| The Offeror Proposal cover letter must be signed by an individual who is authorized to commit the Offeror to all of the pricing and terms as quoted herein. |
1. Complete all the attached workbook tabs. The notes in each tab are material to the proposal. Please read them in entirety.
Tab B-2: Accessibility Requirements. Please complete all questions in this section, and provide a copy of your VPAT with your full proposal documents.
Tab B-3: Questionnaire Component. All must be completed.
Tab B-4: References. Please complete the attached form. These will be kept confidential
B-2 Accessibility requirements
Attachment B-2: Vendor Questionnaire - Accessibility requirements
| Representations made by the Offeror in this proposal become contractual obligations that must be met for the duration of the contract term. |
| Offeror: |
| Question | Offeror Response | Clarification of Response; Detail how the requirement is met here | |
| 1 | Do you have an accessibility plan in place that will result in WCAG 2.1+ compliance on or before July 1, 2025? If not, when do you anticipate your product being fully compliant? | Select One | |
| 2 | Do you currently engage, independently or through a third-party, in both automated and manual (human-led) accessibility testing of your product? If yes, do you engage in testing for each version of your product? | Select One | |
| 3 | Do you have a Voluntary Product Accessibility Template (VPAT), version 2.4+ WCAG, or Accessibility Conformance Report (ACR) including WCAG 2.1+ criteria available for the version of your product currently being proposed to DPA? If so, please provide it in PDF format. | Select One |
B-3 Questionnaire Components
| ID | Question | Response |
| Minimum Qualifications - must respond "yes" to be considered. | ||
| Confirm you are not a broker or agency offering the products in this Scope of Services. | ||
| Confirm you have provided the services which you are proposing on to at least one public sector employer and two larger employer groups with more than 20,000 members. | ||
| Confirm that you have at least ten years of Group Dental insurance and claims administration experience. | ||
| Confirm you will not solicit State members for any other products or services that your firm might offer, and confirm you will not sell any mailing or other list that includes member information without express written consent from the State. | ||
| Do you agree that the terms of the RFP responses are valid until a final contract is executed? | ||
| Do you agree that this bid response is NOT contingent on purchasing any services other than in the Scope of Work? | ||
| Confirm you agree that the State reserves the right to determine eligibility. | ||
| Confirm you will accept enrollment/eligibility data into secure site from the State’s outside online benefit administration system (currently Businessolver).The Offeror must be able to read and track all data elements provided on the file. This must be a system-supported (not manual) function. | ||
| Do you agree to maintain proper licensure as required by any state law where it relates to the services that you will be performing? | ||
| Confirm that you will accept a payment in a manner determined by the State. | ||
| Confirm that Proposal Responses (Initial and Best and Final, if applicable) and Interviews (if applicable) may become part of the final contract. Do you agree that your written response to this RFP, written information provided as part of the interview or clarification questions may become part of the final contract for services outlined in the Scope of Services? | ||
| Confirm that you will accept a monthly self-billed premium statement from the State for premiums due. | ||
| Confirm that upon request, Offeror shall provide all underwriting and claims payment administration. | ||
| Confirm that Offeror shall be responsible for processing claims for all benefits provided in the contract. | ||
| Confirm claim payment reviews and appeals shall be the responsibility of the Offeror. | ||
| Confirm that you will provide thorough, accurate and timely management reports. Report frequency will be determined by the State at the time the contract is negotiated, but a least quarterly and annually. | ||
| Confirm that the State and/or its designated representatives shall have the right of access to all State member Dental files and records for examination and audit. | ||
| Confirm that you will provide the Employee Benefit Unit with one day-to-day contact person for account management of the dental vendor contract(s). | ||
| Confirm that, in the event of non-renewal, Offeror must accept, process, and pay claims incurred through the end of the plan year at no additional cost to the State. | ||
| Confirm that you will respond to legislative fiscal notes as quickly as possible, sometimes in as little as four hours. | ||
| Confirm you will not solicit State members for any other products or services that your firm might offer, and confirm you will not sell any mailing or other list that includes member information without express written consent from the State. | ||
| General Professional Services | ||
| What is your company name? | ||
| How many years has your firm offered the benefits outlined in the referenced Scope of Work ? | ||
| Would the addition of the State to your Book of Business add more than 10% growth to your organization? | ||
| How many clients with 10,000 or more subscribers does your organization serve today? | ||
| How many government clients does your organization serve today? How many have 10,000 or more subscribers? | ||
| In the last 5 years, has your organization been involved in any Litigation that would prohibit your organization from delivering the Scope of Work outlined in the RFP? | ||
| If you have been involved in any litigation in the last 5 years, please explain. | ||
| Have you ever had any litigation specific to the State? | ||
| If you have had any litigation specific to the State, please explain. | ||
| Has your organization completed any mergers or acquisitions in the last 24 months? | ||
| Main | If you have completed a merger or acquisition in the last 24 months, will this impact the services requested, specifically the following: | |
| Sub | Claim Processing? | |
| Sub | Network Management? | |
| Sub | Administrative Services? | |
| Does your firm have affiliates with any other company? Provide the name and relationship to the other company, if applicable. | ||
| If your firm is not a corporation, do you have any partners, proprietor, or other owners who have any interest in any provider firms utilized to provide the services of this RFP? | ||
| Main | Please respond to the following: | |
| Sub | Is your firm the sole responder to this RFP or are you partnering with other vendors to deliver the Scope of Work? | |
| Sub | If you are partnering with other vendors, please explain who and why? | |
| Do you anticipate any restructuring or reorganizing within the next two years? (this includes addition, reductions, relocations, or redesign of systems) | ||
| What certifications and accreditations has your organization received relative to the services in this RFP? | ||
| Main | What are the most recent ratings, including the date of the rating for your company by the following (If not applicable, include a N/A)? | |
| Sub | AM Best | |
| Sub | Standard and Poor's (S&P) | |
| Sub | Moody's | |
| Name three key attributes that distinguish your organization from your competitors. | ||
| Confirm that your organization has complied with all state insurance department filing requirements for all plans/products being offered in this quote in each state in which State of CO has employees. | ||
| If the answer to the preceding question is "No", for all plans/products quoted in this RFP for which the required state insurance department filing requirements have not been met, please specify the applicable plan/product and corresponding state. | ||
| Although State of CO is not an ERISA plan, confirm that your organization maintains a fidelity bond as would be required by ERISA. | ||
| Confirm your agreement that your organization will maintain sufficient levels of corporate/general liability insurance, including malpractice coverage, to cover the services provided to the Plan. (Specific amounts to be negotiated with finalists.) | ||
| Confirm your agreement that your organization will require any and all subcontractors and network providers to maintain sufficient levels of corporate/general liability insurance, including malpractice coverage, to cover the services provided to the Plan. | ||
| Confirm your agreement that your organization will assume full responsibility for providing all of the services described in this RFP and the agreement between the parties as an independent contractor of the Plan and perform them with the care, skill, prudence and diligence that prudently-operated dental plans would use. | ||
| Confirm that your organization will comply with applicable federal and state claims procedure regulations, including the appropriate timeframes for adjudicating claims and notice of appeal decisions. | ||
| Confirm your agreement that you agree to monitor federal and state legislation affecting the delivery of dental benefits under the plan and to report to the State on those issues in a timely fashion prior to the effective date of any mandated plan changes. | ||
| Confirm that you have reviewed and Redlined the State of Colorado Contract. Only redlined terms may be negotiated later. Please attach your redlined contract and name the file: [Your Organization's Name]_Contract Redlines | ||
| The State may implement a new benefits administration system (replacing or updating the current Benefits Solver system) during the term of this contract. Discuss how you will work with the State to make this implementation successful and at no cost to the State. | ||
| Do you have a local office to serve the State? If not, how will you meet the State's needs? | ||
| Explain your experience providing services to other Public Sector Clients in the last 5 years. | ||
| Technical Component | ||
| Will you match the benefits outlined in the Benefit Plan Summary to all members included in the attached Census? | ||
| If you will not match the benefits outlined in the Benefit Plan Summary please discuss each deviation and how the deviation impacts the plan and its members. | ||
| Are you able to administer the plan per the Benefit Plan Summary? | ||
| Main | Discuss how you will handle transition related to the following: | |
| Sub | Eligibility - your organization must accept State of Colorado data feeds from multiple sources. | |
| Sub | Benefit administration | |
| Sub | Transition of care | |
| Sub | Deductible and out of pocket transitions (if applicable) | |
| Include a concise description of how your organization covers dental transition of care conditions, if a new member is receiving treatment from a non-participating provider. Name the file: [Your Organization's Name]_Transition of Care. | ||
| Do you agree that any data and information regarding the State supplied to you for purposes of responding to this RFP will be destroyed immediately upon receiving notice that you were not the successful winner? | ||
| Do you agree that all sample forms and communication materials will be provided to the State in advance of distribution for approval (i.e., claim forms, enrollment forms, booklets, brochures, flyers, mailers, etc.)? The State reserves the right to review and approve any materials intended for State employees prior to distribution. The Offeror must be prepared to revise communication materials (at no cost to the State) to reflect the approach and philosophy of the State. | ||
| State of CO may wish to have its logo appear on various printed materials. The designated Offeror must agree to this at no additional cost and must ensure that logo placement and color requirements are met. | ||
| What is the minimum time for implementation needed to initiate the proposed benefits or scope of work? | ||
| Provide an attachment detailing an implementation timeline. Name the file: [Your Organization's Name]_Implementation_Timeline | ||
| Do you have a secure website that the State can use to maintain eligibility enrollments, changes and addresses? | ||
| Discuss your organization's dental utilization review program and quality control protocols. | ||
| What is the marketing name of your network(s) being proposed to the State? | ||
| Do you contract with providers within Puerto Rico? | ||
| Do you lease any portion of the network offered as part of this proposal? If so, list who and for what services? Include wrap networks. | ||
| Do you agree to maintain the size of your Colorado State network for the duration of the contract to be no less than the size provided in your response to this RFP? | ||
| Do you anticipate a change in the size or location of your network in the next year that would affect the State's participants? | ||
| Main | Do you anticipate any network changes over the next twelve months for: | |
| Sub | General Providers? | |
| Sub | Specialists? | |
| Given the geographical footprint of the State's membership, we have many areas where access to in-network doctors are limited. How can your organization help the State in providing in-network access in these areas even when prices may be higher than typical contracted provider rates. | ||
| How does your network address participants who seek care outside of the United States of America? | ||
| How many providers were terminated in the State's service area in the past 12 months? | ||
| How does your organization measure the quality of care provided by the providers in your network? | ||
| How many complaints per 1,000 visits do you receive for your network providers? If you do not have this exact metric, please provide comparable information that you track. | ||
| Do any network providers include night or weekend hours? | ||
| What percent of your claims are auto adjudicated? | ||
| Does your claim system readily identify potential subrogation or coordination of benefits (COB) opportunities prior to claim payment? | ||
| Do you pay and pursue or pend and pursue for COB and subrogation services? | ||
| What is the frequency of audits done by your internal operations team? | ||
| What is the frequency of audits done by external vendors? | ||
| From what location would this client's claims be processed? | ||
| How long does claim processing turn-around time for a clean claim take? | ||
| Does your claim system have any protections against unbundling and/or upgrading claims? If yes, explain. | ||
| Main | Does your claim system have protections against fraud by: | |
| Sub | Providers | |
| Sub | Members | |
| Sub | Employers/Trust | |
| If you use a pretreatment review process, please explain. | ||
| What is the turnaround time for a pretreatment review process? | ||
| Do members need to present ID cards when paying providers? | ||
| Do members pay up-front and submit claims for reimbursement or are members responsible for only plan, deductibles and coinsurance? | ||
| Do you have any paper claims still in process? | ||
| How do you process any non-network provider claims? | ||
| Currently the 80th percentile is used to determine the usual and customary for out-of-network claims. Can you administer the 80th percentile? | ||
| Does your plan use maximum allowable cost for limiting non-network allowances? | ||
| How do you determine the maximum allowable charges? | ||
| Do maximum allowable charges differ by zip code? | ||
| How often do you update the maximum allowable charges? | ||
| What steps are taken if the maximum allowable charge is uncoded? | ||
| How are the State and plan participants supported in their resistance to charges in excess of the maximum allowable charge? | ||
| How can a claimant find out what the maximum allowable charge is for a particular procedure in advance of having the procedure performed? | ||
| With respect to dental surgery, do you ever reimburse assistant surgeons? | ||
| What is the basis for determination and how the allowance for the assistant surgeon is calculated? | ||
| When you are the secondary payor, do you use Usual, Customary, Reasonable (UCR) profiles or those of the primary carrier to determine your level of reimbursement? | ||
| Does your proposed plan include any exclusions or limitations that are more restrictive than the current plan? If so please discuss each and how the restriction impacts the State and the member. Please include savings and disruption analysis. | ||
| Are you offering any deductible or coinsurance levels that differ from the current plan? If so please discuss each change and how the restriction impacts the State and the member. Please include a financial analysis of how this will impact members and the plan. | ||
| Are you offering any maximums that differ from the current plan? If so please discuss each change and how the change impacts the State and the member. Please include a financial analysis of how this will impact members and the plan. | ||
| Does your proposed plan include any services that are paid in a different benefit class than the current plan? If so please discuss each difference and how it will impact the State and the members. | ||
| Does your proposed plan have any frequency limits that differ from the current plan? | ||
| Does your proposed plan have any waiting period limitations where none exist under the current plan? | ||
| Does your proposed plan include any pre-existing condition limitations? | ||
| Describe any missing tooth limits your plan may have for new participants. | ||
| Are medications covered under the dental plan? | ||
| How does your plan handle a resin composite filling on teeth that traditionally would be treated with an amalgam? | ||
| If benefits under the State's plan are exhausted or not covered, can members take advantage of your negotiated pricing? | ||
| Is your plan able to offer any additional dental health screenings and/or wellness benefits (i.e. screenings for oral cancer, cavity risk assessment tool, etc.) at little to no additional cost to the State. | ||
| What additional benefits do you offer to pregnant people? | ||
| What additional benefit do you offer for plan participants with diabetes? | ||
| Does your plan allow nitrous oxide analgesia at no additional cost for the Plan or participant? | ||
| What type of sedatives do you cover and what are the coverage limitations? | ||
| Do you cover temporary fillings? | ||
| Do you cover Guided Tissue Regeneration? | ||
| Up to what age do you cover fluoride treatments and how often? | ||
| Up to what age do you cover sealants and how often? | ||
| Confirm that your organization maintains executed contracts with all providers participating in the network. | ||
| Confirm that your organization's provider contracts do not provide for any type of remuneration to your organization, such as commission, finder's fee, rebate, or other financial benefit. | ||
| Confirm that you agree that the State of Colorado owns all claims data and eligibility data. | ||
| Confirm your agreement that the dental plan's claims processing and appeals procedures will comply with the Plan terms of State of CO, ERISA and regulation under ERISA. | ||
| Will you provide drafts of the Benefit Summaries and Summary Plan Descriptions to the State no later than April 1 of each year? | ||
| Confirm that members may switch dentists whenever desired. | ||
| Confirm that individual family members may select different dentists. | ||
| Confirm that for Benefit Administrators (60-70 of them across the State), a person on the client team is available during normal business hours to answer questions about the benefits, claims processing, appeals, eligibility, etc. | ||
| Confirm that claims are adjudicated in real-time allowing for the immediate reversal or modification of a claim during a member services call. | ||
| Can you accommodate dependents who live out of state? | ||
| How are out-of-area and out-of-country dental emergencies handled? | ||
| Confirm that you maintain geographically specific UCR charge screens for dental procedures. | ||
| Confirm that your organization can provide claims adjudication at varying UCR percentiles beginning with the 50th percentile. | ||
| Confirm that the claim amount paid will be the negotiated amount. In other words, services will pay actual negotiated amount; none of the savings will be retained by your organization or shared with any other organization. | ||
| Please provide a copy of a sample EOB and a description of elements that may be customized. Name the file: [Your Organization's Name]_EOB. | ||
| Main | Have you provided Geo Access reports for the network(s) proposed for all licensed dentists using the following criteria: (Results must be based on the census provided. Do not exclude any locations or employee groups. Geo results must include a report showing locations where the access criteria was not met, including the number of people impacted, name of the City, County, State and Zip Code.) | |
| Sub | Urban Areas: 1 provider within 2 miles | |
| Sub | Suburban Areas: 1 provider within 5 miles | |
| Sub | Rural Areas: 1 provider within 10 miles | |
| Confirm you have provided an electronic copy of your proposed network providers in Microsoft Excel format. Fields should include the following: Provider last name (do not put generation indicator, i.e., Jr, III, or designation such as DDS or DMD in this field), Provider first name, (do not combine first and last names in the same field), NPI, Tax ID, Street Address (only include physical locations not billing addresses such as PO Box), City, State, 5 digit zip code, Provider Specialty (GD, Pedodontist, Endodontist, Oral Surgeon, Periodontist). | ||
| Regarding the State's Eligibility file, please confirm that you can read and track all data elements provided on the file. This must be a system-supported (not manual) function. | ||
| Regarding the State's eligibility file, please confirm that you have reporting capabilities, allowing the State to gather, sort and analyze utilization information for auditing and forecasting needs. | ||
| Cost Component | ||
| Main | Confirm that in addition to the cost of all normal claim-processing services, the premium rate shall include, but is not limited to the following services. | |
| Sub | a. Administration materials. | |
| Sub | b. Plan management, performance, and periodic reports. | |
| Sub | c. Website for State’s benefits staff. | |
| Sub | d. Toll-free telephone line for participants and State’s benefits staff. | |
| Sub | e. Communication materials. | |
| Sub | f. Claim administration | |
| Sub | g. Customer service representatives. | |
| Sub | h. Underwriting services. | |
| Sub | i. Marketing services. | |
| Sub | j. Financial and process audits. | |
| Sub | k. Cost to mail benefit checks. | |
| Sub | l. Account management and training for State’s benefits staff. | |
| Sub | m. If requested by the State, attendance at annual open enrollment meetings. | |
| Confirm that your cost proposals for Dental are based upon the plan designs described in this RFP. | ||
| Confirm that if you deviated from the plan designs described in the RFP any deviations have been clearly identified. | ||
| Main | Confirm you agree to the following Performance Guarantees (PGs). A vendor's failure to meet the performance guarantee(s) would result in the financial penalty stated. If you do not agree with these PGs, please clarify in your response. The State is willing to negotiate performance standards on financial and service performance results with the selected vendor to encourage the vendor to provide superior performance. | |
| Sub | Do you agree that the maximum penalty payable in the aggregate by the selected carrier to the customer as a consequence of failing to meet any or all of the Performance Guarantees is an amount not to exceed 30% of the Dental fees collected during the policy period in which the failure(s) took place. | |
| Sub | Do you agree that all performance guarantees must be measured and reported based on the State's specific data, not the carrier’s book of business. | |
| Sub | Scheduling of Implementation Meeting |
The selected carrier will attempt to schedule and conduct a meeting with the Policyholder/Customer to establish timeframes and expectations for the implementation process. The meeting must be scheduled within 15 business days, not including holidays, from the date the Policyholder/Customer has agreed to contract with the selected carrier.
The penalty if this guarantee is not met is 2% of the administrative service fees paid during the first policy/contract year.
Sub Implementation Customer Satisfaction Survey The selected carrier agrees to conduct a post implementation survey through the use of a third party vendor to determine the Policyholder’s satisfaction with the implementation process following the completion of all tasks and procedures necessary to complete this process. Carrier will achieve an overall survey score in the range of “Satisfied” or scores no less than 3 in a 5 scale survey.
This will be conducted approximately 45-60 business days following the close of the implementation process.
The penalty if this guarantee is not met is 2% of the premium/administrative service fees paid during the first policy/contract year.
Sub Claims Turnaround Time 95% within 10 business days This is defined as the performance standard used to measure the period of time which transpires from the date the carrier receives a claim to the date a claim is processed to conclusion. A claim is considered processed on the date when the carrier issues an EOB.
The penalty if this guarantee is not met is 5% of the premium paid during the policy year.
Sub Payment/Financial Accuracy 99.5% accuracy This is defined as the performance standard used to evaluate the dental processing group’s payment performance in dollar amounts.
The penalty if this guarantee is not met is 2% of the premium paid during the policy year.
Sub Procedural Accuracy 99% accuracy This is defined as the performance standard used to evaluate claim processing performance with respect to claim data line entries. A “Procedural Error” is defined as any error by the Dental Processing Group that results in the incorrect entry of data within a Line of Entry, including, without limitation, Procedural Errors that result in Overpayments or Underpayments. The penalty if this guarantee is not met is 2% of the premium paid during the policy year.
Sub Telephone Service Level 90% of all incoming calls received by the customer service telephone line will be answered within 30 seconds
The response time will be measured from the time the caller completed the prompt of the automated telephone system to the time the caller reaches a Customer Service Representative.
The penalty if this guarantee is not met is 2% of the premium paid during the policy year.
Sub Call Abandonment Rate Less than 2% of all incoming calls received by the customer service telephone line will be answered without the caller hanging up.
This is defined as the number of incoming calls not reaching a Customer Service Representative, divided by the total number of incoming calls.
The penalty if this guarantee is not met is 2% of the premium paid during the policy year.
Sub First Call Resolution 90% resolution The first call resolution percentage will be determined by dividing the number of calls completed without a need for referral or follow up action, divided by the total number of calls received.
The penalty if this guarantee is not met is 2% of the premium paid during the policy year.
Sub Email Response 80% within 1 business day This is determined by dividing the number of dental emails responded to within 1 business day, divided by the total number of dental email inquiries received.
The penalty if this guarantee is not met is 2% of the premium paid during the policy year.
Sub Network Turnover The selected carrier will not have more than 3% combined voluntary and involuntary network turnover annually.
The penalty if this guarantee is not met is 3% of the administrative service fees paid during the policy year in which the turnover occurred.
Sub Account Management Survey The selected carrier will conduct an annual account management survey with the customer to obtain satisfaction levels.
A response in the range of Dissatisfied (rating of 1 to 3 on a 5 scale survey) with the overall satisfaction with the carrier and/or the overall satisfaction with the account manager will trigger the penalty.
The penalty if this guarantee is not met is 1% of the premium paid during the policy year.
Sub Quarterly Reporting The selected carrier will deliver customer level reports, through an agreed upon medium, no later than 15 business days past the close of the previous quarter.
The penalty if this guarantee is not met is 1% of the premium paid during the policy year.
Sub Electronic Eligibility The selected carrier will upload newly eligible members within 24 hours of receiving the updated eligibility file.
The penalty if this guarantee is not met is 3% of the administrative service fees paid during the policy year.
| Sub | Discuss any commissions included in your pricing and not disclosed in the pricing exhibits. |
| Sub | Web Site/Portal Availability |
The selected carrier will make available their Customer and Member websites 99% of the time, including down time for scheduled maintenance and unplanned outages.
The penalty if this guarantee is not met is 1% of the administrative service fees paid during the policy year.
| Management Capability | |
| Main | Should your firm be awarded this RFP, how soon after contract execution (# of business days) can you provide the rough draft for the following: |
| Sub | Master Policy |
| Sub | Plan Booklet |
| Sub | Summary of Benefits or SPD |
| Describe your detailed plan for managing the account, including periodic reviews of cost and utilization and recommendations for plan design changes from State of CO' representatives. Name the file: [Your Organization's Name]_Account Management. | |
| Should your firm be awarded this RFP, identify any services performed outside the borders of the United States of America. | |
| Does your firm have the capability to prepare communication pieces for the enrollees in Spanish? | |
| Provide the name and qualifications of the Account Manager who will serve the State's account with the contracting and initial implementation should you be selected as a result of this Request for Proposal. Please include information about the Account Manager's qualifications in an attachment titled: [Your Organization's Name]_Acct Mgr Bio | |
| How many clients does the Account Manager currently support? How many enrollees per client? | |
| Confirm that the account manager will participate on the implementation team. | |
| Confirm that your organization will provide a Customer/Claims Advocate for escalated claims and network issues. | |
| Confirm that, upon request, your organization will send plan representatives to State of CO worksites to conduct Open Enrollment meetings, both at initial implementation and during ongoing Open Enrollment activities. | |
| Define your timelines and deadlines for Open Enrollment system updates due to plan changes or file format, new divisions or reporting criteria, manual work arounds, dates for last pre-Open Enrollment file updates. | |
| Confirm your Account Manager will meet with the State to define the group, subgroup, and other reporting criteria necessary to support the State's decision making process. | |
| Confirm that Account Manager will be present for monthly/quarterly meetings established by the State or as requested. | |
| Although State of CO is not an ERISA plan, please confirm that your organization is held accountable for the integrity of the financial transactions similar to those standards that would be required by an ERISA plan. | |
| Confirm your agreement that your organization is responsible for reconciling all bank transactions with respect to State of CO' claims and will provide weekly detailed data documentation (at a minimum) at the employee level which includes date and reference number of the wire claim back-up. | |
| Confirm your organization has the ability to receive electronic transfers at no additional cost. | |
| Confirm your organization will send a monthly invoice for administrative fees/premiums based on the eligibility files received from State of CO and State of CO has the right to reconcile the invoice with eligibility from its own system and pay fees/premiums on the reconciled amount. | |
| Confirm that you do not require an imprest account or imprest balance. | |
| Due to scheduled State breaks, delays with regard to unforeseeable time off, as well as business and/or bank holidays, confirm your willingness to allow up to seven business days to turnaround claims payments, from the time of receipt of the request, without incurring any late penalties/fees. | |
| Confirm that your organization agrees to prepare and file all legal documents necessary to implement and maintain the plan, including policies, amendments, contracts, and required state filings. | |
| Confirm your agreement with the following: The new vendor selected must agree to transfer to State of CO, within 30 days of notice of termination or non-renewal, all required data and records necessary to administer the plans. The transfer will be made electronically in a format approved by the State. | |
| Confirm you will provide a dedicated individual or staff responsible for resolving claim disputes or other issues. | |
| Confirm you agree the State of CO reserves the right to audit at no charge except at a direct pass-through of any data retrieval fees, which may be required if data requested has already been stored. | |
| Confirm you agree the State of CO reserves the right to audit post termination | |
| Confirm you agree the State of CO reserves the right to audit more than once per year if the audits are different in scope or for different services | |
| Confirm you agree the State of CO reserves the right to perform additional audits during the year of similar scope if requested as a follow-up to ensure significant/material errors found in an audit have been corrected and are not recurring or if additional information becomes available to warrant further investigation. | |
| Offeror agrees to provide reasonable cooperation with requests for information, which includes but is not limited to the timing of the audit, deliverables, data/information requests and Offeror response time to questions during and after the process. Offeror will also provide a response to all “findings” it receives within 30 days, or at a later date if mutually determined to be more reasonable based on the number and type of findings. | |
| Offeror agrees to pay the Plan 100% of any overpayments made by the Plan as determined from an audit by a firm that the Plan chooses, and no later than 30 days after both parties have agreed to the recoveries, subject to a compounding interest penalty of 1% per month. | |
| Confirm that the Offeror will allow State of CO, or any other party selected by State of CO, to audit claims at any time. | |
| Confirm that you will work with the State to develop an appropriate reporting package in electronic format to facilitate analysis. | |
| Confirm you agree to establish reporting for eligibility, paid and incurred claims, and encounters or utilization (visits or services) by the subgroups and categories determined by the State. | |
| Confirm you agree to supply monthly or quarterly reporting packages no later than 15 days from the close of a month as defined by the State (for example, by type of service, Active/Retiree, Hourly vs. Salaried, by locations, etc.) | |
| Confirm you will supply electronic files for eligibility, claim details and utilization experience on a Monthly basis. | |
| Confirm you will supply a claim lag or triangle report by benefit plan for the past 36 months within 30 days of the end of a policy year. | |
| Confirm you will supply ad hoc reporting as request by the State at no additional charge then those determined in your Administrative bid response. | |
| Are the reports prepared for the State available through an internet portal? | |
| Main | Confirm that you will provide monthly reporting containing the following information: |
| Sub | Paid Claims - separated by actives, COBRA |
| Sub | Administrative/Network Fees (if applicable) |
| Sub | Lag Report - 36 months, separated by actives, COBRA |
| Sub | Monthly Enrollment Counts - separated by actives, COBRA |
| Main | Confirm that you will provide annual reporting containing the following information, in addition to the required quarterly reports: |
| Sub | Claim utilization report |
| Sub | Claim denials by reason |
| Sub | Employee contested claims separated by denial reason |
| Sub | Performance guarantee reconciliation |
| Sub | COB savings |
| Sub | Net benefits paid by benefit plan |
| Confirm that you will provide year-end financial accounting reports within 60 days of the contract anniversary date. | |
| Main | Confirm your annual claim utilization reports will containing the following information: |
| Sub | Claims reported by category (preventive, basic, major, orthodontia) |
| Sub | In-network vs. out-of-network utilization |
| Sub | Network savings reports for each network offered |
| Sub | Final discounts achieved by area |
| Sub | Payment reductions due to network negotiated rates |
| Main | Confirm claim utilization reports will show separate experience for: |
| Sub | Employees |
| Sub | Dependents |
| Sub | COBRA Participants |
| Sub | Employee contested claims separated by denial reason |
| Sub | Claim lag report |
| Main | Confirm that if directed to do so, you will send claims data files to the State's data warehouse. These claims files need to include the following data elements: |
| Sub | Employee ID or other unique identifier |
| Sub | Claimant ID number or unique identifier |
| Sub | Claimant relationship (EE, SP, Child) |
| Sub | Claimant gender |
| Sub | Claimant date of birth |
| Sub | Claimant status (Active, Retiree (Early, Under 65, Over 65), Cobra) |
| Sub | Provider Name |
| Sub | Provider type code |
| Sub | Provider ID number (NPI or TIN) |
| Sub | Provider address (City, State, and Zip) Note: Service address; NOT billing address |
| Sub | Type of service |
| Sub | Billed Amount, less ineligible or duplicate claims |
| Sub | Allowed Amount (Considered confidential and will not be released) |
| Sub | Deductible, coinsurance and copay amounts (Considered confidential and will not be released) |
| Sub | Paid Amount (Considered confidential and will not be released with this line level information) |
| Sub | Claim Paid (adjudicated) date |
| Main | Confirm that upon request you will provide a RFP claims file that includes twelve (12) months of claims incurred and paid including the following elements upon request to support the State's or the State's consultant's analysis for trouble shooting benefits or preparing for a procurement event? |
These claims files need to include the following data elements:
| Sub | Employee ID or other unique identifier |
| Sub | Claimant ID number or unique identifier |
| Sub | Claimant relationship (EE, SP, Child) |
| Sub | Claimant gender |
| Sub | Claimant date of birth |
| Sub | Claimant status (Active, Retiree (Early, Under 65, Over 65), Cobra) |
| Sub | Provider Name |
| Sub | Provider type code |
| Sub | Provider ID number (NPI or TIN) |
| Sub | Provider address (City, State, and Zip) Note: Service address; NOT billing address |
| Sub | Type of service |
| Sub | Billed Amount, less ineligible or duplicate claims |
| Sub | Allowed Amount (Considered confidential and will not be released) |
| Sub | Deductible, coinsurance and copay amounts (Considered confidential and will not be released) |
| Sub | Paid Amount (Considered confidential and will not be released with this line level information) |
| Sub | Claim Paid (adjudicated) date |
| Main | Do you agree to provide summary and claim line detail, including accumulator data at such time the State chooses to terminate a future contract? |
| Sub | Do you agree to supply this information within 30 days of the termination date? |
| Sub | Do you agree to supply this information at no additional charge to the State? |
| Discuss how you will respond timely to inquires from employees/members/participants and/or State benefits personnel. Offeror staff assigned to State account is expected to acknowledge voice mail messages within four business hours and e-mail messages in twelve business hours or within one business days (24 hours) if research is needed | |
| Main | Confirmand discuss how you will provide telephone assistance and email assistance to State members that may include but is not limited to: |
| Sub | · Enrollment assistance, during open enrollment and throughout the year; |
| Sub | · Explanation of plan benefits; |
| Sub | · Explanation of claims processing and other processes; |
| Sub | · Status of claims. |
| How will you support the State with in-person events (in addition to open-enrollment, which was addressed previously)? | |
| Customer Service | |
| Confirm that you will print and mail ID cards to members. Digital ID cards do not meet this requirement. If you propose a digital-only solution, how will you ensure our members without access to smart phones or computers will be able to use your services? | |
| Confirm that for Members, you will provide a single, toll-free customer service telephone number is operational on normal business days between at least 8:00 AM and 6:00 PM in Mountain time zone for addressing claims payment, member services and any appeals. | |
| Discuss how you will provide a customer service unit familiar with general information, claims, enrollment processing, and the State's plan. | |
| Are the calls received "after hours" of operation handled by a service or voicemail system allowing participants to leave a message? | |
| Do you offer access assistance for the Hearing Impaired, 24 hour toll-free automated benefits, eligibility, and customer service via internet? Specify which. | |
| Do you offer customer service representatives with multiple languages? If so, what languages? | |
| Please provide the geographic location for the Customer Service unit that will be serving our Client. (City/State) | |
| Confirm all customer service representatives are located in the continental United States of America. | |
| Have you increased or decreased your staff counts by more than 5% in the last 24 months, specifically Customer Service or Claims Operations? | |
| Main | Of the services listed below, indicate those services that are available on your member website and/or mobile app: |
| Sub | Check Claim Status |
| Sub | View Claim History |
| Sub | Contact Customer Service |
| Sub | Dental Cost Treatment Calculators |
| Sub | Provider Locator |
| Sub | On-line Provider Directories |
| Sub | Plan Benefit Descriptions |
| Sub | Provider Price Comparison Tool (for common services such as office visits, etc.) |
| Sub | Provider Quality Ratings |
| Sub | Patient Satisfaction Information |
| Sub | Print ID Card |
| Confirm that you will conduct client satisfaction surveys annually and that the State of Colorado will have final say over the survey contents. | |
| Provide your organization's definition of "dedicated" for claims processing and customer service on a percent of time basis. | |
| Are all incoming calls logged, tracked, recorded? | |
| Discuss how you train customer service representatives. | |
| What is your average speed of answer? | |
| What percent of calls are resolved on the first call? |
B-4 References - Confidential
| KEY ACCOUNTS AND REFERENCES | |
| 1. | Please provide four of your current employer client references of similar size to State of CO (preferably school district, state or local municipality). |
If you do not include references your score will be negatively impacted.
| a. | Reference #1 | |
| Company Name | ||
| Contact Person | ||
| Title | ||
| Phone Number | ||
| Fax Number | ||
| E-mail Address | ||
| Network Name | ||
| Offeror must have reporting capabilities, allowing the State to gather, sort and analyze utilization information for auditing and forecasting needs. Offeror must work with the State to develop an appropriate reporting package in electronic format to facilitate analysis. Report frequency will be determined by the State at the time the contract is negotiated, but a least quarterly and annually. | ||
| b. | Reference #2 | |
| Company Name | ||
| Contact Person | ||
| Title | ||
| Phone Number | ||
| Fax Number | ||
| E-mail Address | ||
| Confirm that you will provide thorough, accurate and timely management reports. Report frequency will be determined by the State at the time the contract is negotiated, but a least quarterly and annually. | Suggest combining with above question (line 11) with additional wording | |
| This question is also in the technical section. Our suggestion would be to remove for MQ because it is date-specific (April1 reference) or reword to say before start of plan year | ||
| c. | Reference #3 | |
| Company Name | ||
| This question is also in Management. Our suggestion would be to remove from MQ and negotiate no cost later if needed. | ||
| Title | ||
| Confirm you will not solicit State members for any other products or services that your firm might offer, and confirm you will not sell any mailing or other list that includes member information without express written consent from the State. | ||
| Fax Number | ||
| E-mail Address | ||
| Network Name | ||
| Network Plan Members Enrolled | ||
| d. | Reference #4 | |
| Company Name | ||
| Contact Person | ||
| Title | ||
| Phone Number | ||
| Fax Number | ||
| E-mail Address | ||
| Network Name | ||
| Network Plan Members Enrolled | ||
| 2. | Please provide three of your terminated employer client references of similar size to State of CO (preferably school district, state or local municipality). | |
| a. | Reference #1 | |
| Company Name | ||
| Contact Person | ||
| Title | ||
| Phone Number | ||
| Fax Number | ||
| E-mail Address | ||
| Network Name | ||
| Network Plan Members Enrolled | ||
| Program Termination Date | ||
| b. | Reference #2 | |
| Company Name | ||
| Contact Person | ||
| Title | ||
| Phone Number | ||
| Fax Number | ||
| E-mail Address | ||
| Network Name | ||
| Network Plan Members Enrolled | ||
| Program Termination Date | ||
| c. | Reference #3 | |
| Company Name | ||
| Contact Person | ||
| Title | ||
| Phone Number | ||
| Fax Number | ||
| E-mail Address | ||
| Network Name | ||
| Network Plan Members Enrolled | ||
| Program Termination Date |
| Suggest moving to General |
| Suggest moving to Mangement |
| See comment in MQ |
| Repetative. Other more detailed reporting questions have been asked. |
| Suggest combining this quesiton with the question below of similar requirements |
| See last comment |
File details come from the government source that posted it. Updated .