Industry Day Questions-Medical Provider Network-Medical Bill Processing (MPN-MBP).pdf

Request for Information / Industry Day Notice for

U.S. Department of Labor (DOL) Office of Workers’ Compensation Programs (OWCP)

Questions for the Industry

1. Given the pricing approach included in the draft SOO and the potential difference between OWCP fixed FS rates and your network fee agreements (presumably lower), how do we jointly prevent providers from leaving your network and just billing OWCP as OON providers? We are looking for recommendations to maximize network usage/billing.

2. A significant value you deliver to OWCP is the provider network that increases provider access to our claimants. What value will you offer providers to join your network?

3. What are the challenges to using the pricing model outlined in the SOO - including development, implementation, and post-operational service enhancements?

4. Are the service levels in the SOO regarding access to a requested specialty reasonable (for example an appointment within 2 weeks within less than 50 miles from claimant;

90% of the time)?

5. How frequently is your physician database updated, to accurately reflect physician availability? What percentage of accuracy of this database is reasonable (e.g 98%, 90%, 70%, etc.)?

6. One of OWCP’s biggest challenges is having physicians turn away claimants from being seen (e.g. “we’re not seeing new OWCP claimants.”). We understand that network agreements may not mandate that providers have to accept patients from all the MPN vendor's customers. This situation causes claimant frustration as it would force them to continue to search for other providers/specialties. How can we eliminate or significantly reduce this challenge?

7. What government expectations are reasonable for improving provider coverage in rural/underserved areas?

8. If OWCP required the vendor to process bills for its network providers, with federal employees processing OON bills using the contractor’s system, would there be a charge for OWCP staff to use the contractor’s systems/software? If so, what would the cost model look like?

9. What information about in-network providers is available to customers (e.g. licenses, suspensions, and debarment)?

10. OWCP plans to implement a connection with CMS to obtain CMS-enrolled provider data, as it will allow OWCP to greatly reduce the volume of information we ask the providers to submit during our enrollment process. Do you see any challenges with connecting and/or ingesting the CMS PECOS data into your system?

11. What type of information or enrollment process is reasonable for out of network providers?

12. Are there any challenges to giving out-of-network providers access to eligibility, prior authorizations, etc.?

13. How are the costs of creating and mailing benefit cards normally handled with your customers?

14. What are your capabilities in supporting multilingual communication in multiple medias for claimants and for providers?

15. Do you see any issues in utilizing NPI as a provider identifier including for group providers for bill processing?

16. If the Government removed some of the services (i.e. call center) how will that impact your pricing?