Q & A-1.pdf

Workers Compensation Third Party Claims Administration Professional Services

UEF 2024-001

QUESTIONS:

1. To improve our overall service and pricing proposal, we are requesting from Maryland UEF seven years of detailed Workers' Compensation claims data in MS Excel format for the periods 01/01/2017 through 10/01/2023. This loss data should include at a minimum the following information:

a. Types: Indemnity, Medical Only, Incident-Report Only, other

b. Dates: Loss Date, Report Date, Close Date, Coverage Year / Calendar Year

c. Claim Status: Open, Closed, Re-Opened

d. Litigation: Yes or No data

e. Employee: Job Description / Class Code / Department / Class Code / Other

f. Claim Type: Lost Time, Medical-Only, Incident/Report Only, or other

g. Expenses to include:

i. [1] Reserves, [2] Paid, [3] Total Incurred for the following columns:

o (a) Indemnity, (b) Medical, (c) Legal, (d) Other and (e) Total Incurred

ANSWER: See Excel file titled “loss run-Standard Loss Run”

2. Please provide the total number of open WC indemnity claims valued as of 01/01/2024.

ANSWER: 909 indemnity claims

3. Please provide the number of open WC indemnity claims w/ occurrence dates prior to 01/01/2020.

ANSWER: 534 indemnity claims

4. Please provide the total number of open Permanent Partial and Permanent Total WC claims effective 01/01/2024.

ANSWER:

a. 463 Permanent Partial

b. 23 Permanent Total

5. Please provide the number of open Permanent Partial and Permanent Total WC claims with occurrence dates prior to 01/01/2020.

ANSWER:

a. 105 Permanent Partial

b. 21 Permanent Total

6. How many open-litigated cases (by class code), are valued as of 01/01/2024?

ANSWER: 400 files with open litigation

7. Does Maryland UEF utilize the incumbent's Nurse Case Management services?

a. If yes to any NCM utilization, how frequently was NCM utilized [annually] during the past five years? ANSWER: No

b. Aggregated annualized data for 01/01/2020 through 01/01/2024.

o number of telephonic assignments, o number of in-person assignments, o gross annual expense for telephonic o gross annual expense for in-person

8. Does Maryland UEF utilize the incumbent's PBM services or a separate vendor?

ANSWER: Incumbent's PBM services

a. If yes, can Maryland UEF provide detailed PBM statistics?

i. Specifically, aggregated annualized data for 01/01/2020 through 01/01/2024.

o number of prescriptions filled: 3691 o gross annual expense: $21,999.58 o gross savings: $4,764,220.14 o net savings: $4,742,220.36

9. Does Maryland UEF utilize the incumbent's medical bill review or a different vendor?

ANSWER: Incumbent's medical bill review

a. If yes to medical bill review, can you provide detailed annualized medical bill review statistics?

i. Specifically, aggregated annual data for 01/01/2020 through 01/01/2024.

1. number of invoices/number of lines: 29,287

2. gross annual expense:$215,339.14

3. gross savings: $23,041,561.32

4. net savings: $22,826,222.18

5. percentage of saving, average: 74.86%

10. Does Maryland UEF utilize 24/7 Nurse Triage?

a. If yes to triage, does MTA utilize the incumbent TPA's triage or a separate vendor?

ANSWER: Maryland UEF

b. If yes to triage: N/A

i. Number of applicable assigned claims aggregated annual data for 01/01/2020 through 01/01/2024.

ii. Fee per claim?

iii. Flat annual fee if applicable?

iv. Other fee structure?

11. Can Maryland UEF provide detailed utilization review statistics, such as net-gross savings report and utilization review volume for the past five years? If "yes," may we have a copy of that report going back to January 1, 2020? No

i. Specifically, aggregated annual data for 01/01/2020 through 01/01/2024.

o number of assignments, o gross annual expense, o gross savings, o net savings, o percentage of saving

ANSWER: See Excel file titled “loss run-Standard Loss Run”

12. Can Maryland UEF provide annualized MMSEA reporting volume for the past 5-years?

i. Specifically, aggregated annual data for 01/01/20120 thru 01/01/2024.

o number of assignments: 558 o gross annual expense: $17,734.08

13. Does the incumbent pursue subrogation for Maryland UEF?

a. What is the fee structure and is it Gross or Net of recovery?

b. What has been the annual recoveries 01/01/2020 thru 01/01/2024?

c. What is the percentage of savings charged by the incumbent TPA for Subrogation?

i. Is there a maximum or capped dollar amount regarding subrogation fees?

ANSWER: No, the TPA incumbent does not pursue subrogation. Subrogation is pursued by agency staff and the Office of the Attorney General (OAG).

14. What workers' compensation program priorities are most important for Maryland UEF over the next two years?

ANSWER: The efficient administration of claims, including, but not limited to, maximizing finding coverage and minimizing costs to preserve the financial health of the Maryland UEF.

15. Could we please have a detailed 3-year loss run to include claim type, total incurred and total paid amounts, and NCCI class codes?

ANSWER: 5 Year Loss Run Attached Per Question #1. See Excel file titled “loss run-Standard Loss Run”

16. Can we please have a full loss run detailing all open files?

ANSWER: 5 Year Loss Run Attached Per Question #1. See Excel file titled “loss run-Standard Loss Run”

17. What is the total number of open files, valued as of 12/31/2023?

ANSWER: 914 claims

18. Could we please have a bill history report for the past 3 years including total number of bills by bill type, total savings in dollar amount, total percentage of savings and current fee structure?

ANSWER: Please see #9 above

19. The Financial Proposal, including the Excel spreadsheet labeled UEF2024-001FP.xls, calls for Allocated Prices for Independent Medical Examinations. Does the “Price for Service” relate to an administrative fee for the scheduling and coordination of the report, regardless of the type of IME needed?

ANSWER: No, that would go under Miscellaneous Invoicing

20. Can you please provide a full report of all IMEs, including all associated fees over the past three years?

a. Total # of IMEs: 261

b. Total invoiced amount: $1364.49 per IME

21. Given the variable cost of the IMEs, depending on whether they involve disciplines like neuropsychology or orthopedics, how does the UEF recommend the bidders establish a single unit price for the IME?

ANSWER: The pricing for IMEs is described in the definitions section of the RFP (page 97) and also on the instructions for the Financial Proposal Form. The cost of the medical provider would be a pass-through cost and not part of the bid price for scheduling IMEs.

22. What is the average total spend on current open claims?

ANSWER: $44,784.95

23. Regarding Page 3, Section 2.2.3 – Existing Data- ‘Cases Marked Inactive per Month’: Could you please provide a definition of ‘inactive claims’?

ANSWER: Inactive claims are claims closed in the claims system.

24. Could you please describe the current banking and funding process including timelines, bank account owners and funding details?

ANSWER: The TPA submits a weekly spreadsheet of all current claim’s expenditures to the CFO. After review and approval, the spreadsheet is forwarded to the Maryland Comptroller’s Office for processing and funding. The approved funding amount is normally received by the TPA within 3 business days. The TPA is required to establish a Direct Deposit bank account with the State of Maryland. The bank account is funded by and in the name of State of Maryland.

25. With respect to Section 4.26 MBE Participation Goal, does the “Total Contract dollar value” correspond to cell K60 in the UEF’s Excel spreadsheet labeled UEF2024-001FP.xls connected to this solicitation?

ANSWER: YES

26. Two Part (Double Envelope) Submission instructions note the Technical Proposal and all supporting material need to be furnished in Microsoft Word format, version 2007 or greater.

Can you confirm this includes all attachments, too (i.e., the financial statements, SOC1 and SOC2 reports, sample reports, etc.)? Or will the Technical response itself in Word (absent all the attachments) and attachments in PDF be acceptable?

ANSWER: That is acceptable. The requirement of either Word or PDF is only for the Technical proposal.

27. Please confirm this contract does not include a VSBE requirement. (referring to Section 3.13 and 4.27).

ANSWER: Correct, this contract does not include a VSBE subcontracting goal. Please refer to the Key Information Sheet for a list of the subcontracting goals.

28. Who is the state’s current provider for Medical bill Review Services?

ANSWER: CORVEL

29. Who does the state currently work with for Pharmacy Benefit Management Services?

ANSWER: CORVEL

30. Does the UEF have a list of approved vendors that it uses to provide ancillary services including but not limited to nurse case management services, surveillance, vocational rehabilitation, medical bill repricing, prescription benefit management, or Medicare set-aside filing? If so, please provide a list of approved or preferred vendors.

ANSWER: No, the State does not have a list. However, the pre proposal conference attendee list is available on eMMA. Obtaining certified subs and deciding who to work with and what they'll do is up to the prime contractor.

31. Would you expect or like for some of the existing staff to continue to work on the account

ANSWER: The State declines to provide this information

32. Are there any services issues or concerns with the current TPA for the UEF?

ANSWER: The State declines to provide this information

33. Reference 2.2.6 Other State Responsibilities- It is mandatory or the desire for the State to have the Contractor onsite to perform services?

ANSWER: Mandatory. This will allow cooperation, communication and problem solving.

34. Is the expectation to do split billing on IME’s (Administrative fee on one bill and physician invoice on the other) –Will these be on 2 separate invoices?

ANSWER: See section 3.3 of the RFP titled, “Invoicing” .

35. What is the UEF’s expectation with respect to exceptions/comments regarding Attachment

M.Contract? Is there opportunity for negotiation and mark up?

ANSWER: Per section 5.3.2 of the RFP,” Any exception to a requirement, term, or condition may result in having the Proposal classified as not reasonably susceptible of being selected for award or the Offeror deemed not responsible.”

36. What is the UEF’s expectation with respect to exceptions/comments regarding Attachment O.

DHS Hiring Agreement? Is there opportunity for negotiation and mark up?

ANSWER: Per section 5.3.2 of the RFP,” Any exception to a requirement, term, or condition may result in having the Proposal classified as not reasonably susceptible of being selected for award or the Offeror deemed not responsible.”

37. Section 2.3.4, Letters A and B are blank. What (if anything) should be here?

ANSWER: This is a typo and they should remain blank.

38. Should the contract be awarded to the another TPA, is there any contractual provision between the UEF and Corvel that would preclude the new TPA from hiring claims handlers from the incumbent?

ANSWER: NO

39. Tab G, #3: Letters of intended commitment to work on the project: Is one letter from the prime contractor and one letter from the MBE Subcontractor adequate?

ANSWER: YES. *CORRECTION: This refers to Tab F, not G

40. Would the State consider waiving the Word requirement for supporting materials? Or could you please define what is meant by supporting materials? –Please reference the following: 5.2.6 A. 1. A. Technical Proposal consisting of: 1) Technical Proposal and all supporting material in Microsoft Word format, version 2007 or greater.

ANSWER: Yes, the State will be waiving the Word requirement for supporting materials. An Amendment to the RFP to reflect this will follow. Supporting materials refers to any attachments sent with the technical proposal.

41. Section 5.3.2, #5: RFP section 4.33, “Mercury and Products That Contain Mercury” is referenced, is this a requirement?

ANSWER: That is a typo. Section 5.3.2, #5 should reference RFP section 4.32, “Nonvisual Access”. An Amendment to make this correction to follow.

42. Please provide a copy of the current contract in place with your TPA and any amendments.

ANSWER: A copy of the current contract will be posted in the “Documents” tab of the solicitation in eMMA, along with the Modification.

43. Where can a copy of the Maryland Department of Information Technology’s Information

Security Policy be found?

ANSWER: The link is on page 23 of the RFP, in section 3.7.5.B.14