Exhibit B_Performance Requirements.docx
DOCX document 281 KB Posted
- Attached to
- Medical Invoicing Review Services
- Solicitation number
- RFQQ 2025 0131
- Issued by
- Adams County, Asotin County, Benton County, Chelan County, Clallam County, Clark County, Columbia County, Cowlitz County, Douglas County, Ferry County, Franklin County, Garfield County, Grant County, Grays Harbor County, Island County, Jefferson County, King County, Kitsap County, Kittitas County, Klickitat County, Lewis County, Lincoln County, Mason County, Okanogan County, Pacific County, Pend Oreille County, Pierce County, San Juan County, Skagit County, Skamania County, Snohomish County, Spokane County, Stevens County, Thurston County, Wahkiakum County, Walla Walla County, Whatcom County, Whitman County, Yakima County, Asotin City, Clarkston City, Clarkston Heights-Vineland CDP, West Clarkston-Highland CDP, Benton City, Chelan City, Chelan Falls CDP, Clallam Bay CDP, Lewisville CDP, Rock Island City, Pacific Beach CDP, Whidbey Island Station CDP, Mercer Island City, Pacific City, Bainbridge Island City, Kingston CDP, Kitsap Lake CDP, Kittitas City, Klickitat CDP, Okanogan City, Anderson Island CDP, Fort Lewis CDP, Fox Island CDP, Herron Island CDP, Ketron Island CDP, North Fort Lewis CDP, Raft Island CDP, Stevenson City, Hat Island CDP, Lake Stevens City, Snohomish City, Spokane City, Spokane Valley City, Puget Island CDP, Garfield Town, Yakima City, Washington
About this file
This performance requirements document (Exhibit B) is for a Washington State Department of Transportation (WSDOT) solicitation for Medical Invoicing Review Services. The document outlines eight key performance requirements that bidders must address, including demonstrating experience in reducing medical bills, processing volume and savings history, methodology for reviewing medical procedure codes, experience with pre-authorization negotiations, and network relationships with specific Northwest Washington healthcare providers. The requirements emphasize the need for quick turnaround times, with pre-authorization negotiations expected within 48 hours of WSDOT's request.
The scoring system is based on Mandatory Pass/Fail (M) and Mandatory Scored (MS) criteria, with most requirements worth 10 points each. Bidders must provide detailed written responses explaining their capabilities and experience for each requirement. The document requires bidders to demonstrate relationships with major healthcare providers including Virginia Mason Medical Center, Swedish Medical Center, The Everett Clinic, and several other specific facilities. Additionally, bidders must ensure that a minimum of three client references submit completed reference forms directly to the RFQQ Coordinator.
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Other files
| File | Type | Posted |
|---|---|---|
| Exhibit G_Data Sharing Agreement.docx | DOCX document | |
| Exhibit A-3_Client Reference.docx | DOCX document | |
| Exhibit D-1_Contract Issues List.docx | DOCX document | |
| Exhibit F_Scope of Work.docx | DOCX document | |
| Exhibit A-1_Bidders Certification.docx | DOCX document | |
| Exhibit A-2_Bidders Profile.docx | DOCX document | |
| Exhibit D_Contract.docx | DOCX document | |
| RFQQ 2025 0131_Medical Invoicing Review.pdf | ||
| Exhibit C_Bid Price.docx | DOCX document | |
| RFQQ 2025 0131 - Amendment1.docx | DOCX document | |
| S2501 Market Conduct Continuum Activities.pdf | ||
| Exhibit E_DiverseBusinessInclusionPlanSubs.docx | DOCX document | |
| Exhibit H_Business Associate Agreement.docx | DOCX document | |
| RFQQ 2025 0131_Questions & Answers.docx | DOCX document |
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Text version
EXHIBIT B – PERFORMANCE REQUIREMENTS
| Competitive Solicitation: |
| No. RFQQ – 2025 0131 |
| Bidder: |
| _________________________________ |
Type/print full legal name of bidder company
Instructions:
Bidders submitting a proposal must complete and submit an Exhibit B for evaluation purposes.
Performance Requirements: Bidder must respond to each requirement as noted in the instructions below.
1. Review all requirements, priorities and provided definitions:
· Mandatory Pass/Fail (M): Minimum requirement; Bidder that does not meet this requirement will not be considered any further.
· Mandatory Scored (MS): Critical requirement; evaluators will score based on the degree to which Bidder's response meets the requirement.
· Desirable Scored (DS): Desirable requirement; evaluators will score based on the degree to which Bidder's response meets the requirement.
1. Using the Bidder Meets Requirement column, Bidder must select either a "Yes" or "No" to indicate the Bidder's ability to meet the requirement. Any entry that is not either a "Yes" or "No", may be deemed non-responsive and will not be considered any further.
1. Bidder must respond in the Written Response column for every requirement that indicates a "Written Response Required”. Written responses must not reference any material present elsewhere. The written response shall be considered complete and stand on its own merits or may be deemed non-responsive.
PERFORMANCE REQUIREMENTS AND FACTORS
| REQ ID |
| Performance Requirement and |
Stated Business Need
| Points Available |
| Priority |
| Bidder’s Compliance |
| Written Response |
| 1. |
| Describe the vendor’s experience in successfully reducing medical bills and having the payment recommendations accepted by providers. |
| 10 points |
| MS |
| ☐ Yes |
☐ No Written Response Required.
| 1.1 |
| Include how many bills you process per year on average and how many years your company has been doing this type of work. Indicate your average percentage of savings per invoice and the percentage of invoices that were discounted without appeal in the past year. |
| 10 points |
| MS |
| ☐ Yes |
☐ No
| 2. |
| Describe project approach and work plan. Vendor should explain in detail the methodology used in reviewing medical procedures codes to reduce and re-price medical invoices. Explain if and how different methods are used for different types of medical codes and medical providers. |
10 points
| MS |
| ☐ Yes |
| 3. |
| Describe vendor’s experience negotiating medical and facility costs for procedures and surgeries prior to authorization of treatment. Under most circumstances medical treatment cannot be delayed and requested turn-around time for successful negotiations should be no more than 48 hours once WSDOT has requested the services from the vendor. Provide two examples/descriptions of this type of work Vendor has successfully completed in the past year. |
| 10 points |
| MS |
| ☐ Yes |
| 4. |
| Describe project approach and work plan for pre-negotiations. Include Vendor’s current medical procedure fee schedule for pre-negotiations. |
| 10 points |
| MS |
| ☐ Yes |
| 5. |
| Identify (by name, address and city) what Northwest Washington networks and providers Vendor currently has contracted fee schedules with and expiration date of said agreements. Please indicate which of these providers is part of the following businesses: |
· Virginia Mason Medical Center
· Swedish Medical Center
· The Everett Clinic
· The Doctors clinic
· Seattle Hand Surgery Group
· Proliance Surgeons
· Kaiser Permanente
· Northwest Orthopedic Surgeons
· Island Hospital
· Harrison Medical Center
· Harborview Medical Center
| 10 points |
| MS |
| ☐ Yes |
| 6. |
| Describe historical timelines in processing complete claims once submitted. How long does it generally take vendor to complete their review and offer a recommended payment? |
Does initial invoice cost have any bearing on the review and general timelines?
Can timelines be reduced for quicker turn-around times for specific claims upon WSDOT’s request? If yes, please explain this process and potential timelines.
| 10 points |
| MS |
| ☐ Yes |
| 7. |
| Describe vendor’s standard processes and communication when recommended payment amounts are questioned by a provider. Does vendor inform WSDOT of their communication with providers? Please explain in detail vendor’s process when dealing with providers on disputed claims. |
| 10 points |
| MS |
| ☐ Yes |
| 8. |
| Vendor must ensure that a minimum of three (3) of its clients submit completed reference forms (see Exhibit A-3) directly to the RFQQ Coordinator by the deadline set forth in the Schedule (Section 1.1). |
| Pass/Fail |
| M |
| ☐ Yes |
Return this exhibit to Procurement Coordinator at:
chase.johnson@wsdot.wa.gov
EXHIBIT B – PERFORMANCE REQUIREMENTS PAGE 2
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