GICPND1601 Bidders Questions.docx

Procuring Auditing Services for Health Care Claims Processing and Related Activities for the Group Insurance Commission– GICPND1601

Bidders’ Questions & Answers

1) Is this a request for an audit of provider bills to detect irregularities to achieve savings, or is it a request for services to audit?

The GIC is procuring an auditor to examine its health plans’ claims processing and related services. It is not a procurement for a firm to audit health care providers’ bills.

2) Can you please inform if the bidder can bid as a Health Care Management Consultant or independent contractor?

The GIC’s goal is to procure audit services, not to procure the services of a health care management consultant. If an independent contractor possesses the requisite health care claims auditing expertise and experience, and the capacity to conduct four health plan audits on a very compressed schedule, he or she may submit a bid for the GIC’s consideration.

3) Where can I locate the attachments and exhibits referenced in this RFR, and are they all available on COMMBUYS?

The attachments and exhibits, including the Commonwealth’s Forms listed on page 15 of this RFR and the attachments and exhibits referenced in the RFR’s table of contents (page 2) have been uploaded and are all available on the COMMBUYS website. Please contact Catherine Moore at Catherine.Moore@state.ma.us or call (617) 727-2310 x7033 if you are unable to locate the documents.

4) Is there a specific cost/price proposal form to use in our response?

You should base your cost proposal on the Sample Cost Proposal Layout provided in Exhibit #1. There may be some variation in what each firm proposes, whether a firm partners with a subcontractor(s), what role the subcontractor fills, etc., and therefore there is not a one-size fits all form.

PLEASE NOTE that cost information MUST be provided separately from all other portions of the response, and MUST NOT be incorporated in any of the other portions of the response to this RFR.

5) Who is the current claim audit vendor?

The GIC’s most recent claim auditor was Claim Technologies Incorporated, of Des Moines, Iowa. Their contract was through June 2015.

6) What is the current annual cost for these specific [audit] services or maximum amount over X years?

The maximum cost of these services is $2,000,000 over four years (the first two years of the contract will be awarded this fall; the final two years are renewal options that the GIC may choose to exercise at a later date).

Bidders’ Questions & Answers (cont.)

7) Will a separate audit of the mental health carve out vendor (Beacon Health Options) also be required?

Yes.

8) For the prescription drug audit, can you confirm that only 12 months of claims data will be audited?

In the RFR the GIC asks for each firm’s recommendation on how to best conduct the audit to achieve the GIC’s objectives and why you recommend the approach you describe in your proposal (in Essay Question #3a through #3d). Your firm may recommend an approach that involves 12 months of claims, 24 months of claims, or a hybrid of the two (e.g. certain elements of the audit might involve the last 24 months of claims data, while other elements might draw only from the most recent 12 months).