Q & A-2.pdf
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- Solicitation number
- BPM041172
- Issued by
- Maryland
About this file
This document is a set of Questions and Answers (Q&A) regarding a Request for Proposals (RFP) issued by the Maryland Uninsured Employers' Fund (UEF) for Workers' Compensation Third Party Claims Administration Professional Services (UEF 2024-001). The RFP seeks to obtain third party administrator services to provide the full scope of services necessary for the processing, investigation, and administration of all relevant UEF claims, including workers' compensation claims found compensable by the Maryland Workers' Compensation Commission where the claimant was employed by an uninsured employer or the UEF has been impleaded as a party.
The Q&A addresses various aspects of the RFP, including requests for detailed loss data, current fee structures, claim volume and type breakdowns, medical bill review savings, nurse case management practices, performance metrics, data analytics, invoicing and payment processes, and staffing requirements. The UEF has provided or declined to provide certain information based on the relevance to the proposal process.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| RFP- UEF2024-001.pdf | ||
| Signed fully executed contract UEF.pdf | ||
| loss run-Standard Loss Run.xlsx | XLSX spreadsheet | |
| Pre Proposal Conference Summary.pdf | ||
| UEF 2024-001FP.xlsx | XLSX spreadsheet | |
| Modification contract pdf 2.5.19 (1).pdf | ||
| Q & A-1.pdf | ||
| Amendment 1.pdf | ||
| PPC Attendance List.pdf | ||
| RFP Amendment 2.pdf |
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Text version
Workers Compensa�on Third Party Claims Administra�on Professional Services
UEF 2024-001
QUESTIONS & ANSWERS PART 2
1. Please provide 3-5 years of loss funds. -
ANSWER: See Excel file �tled “loss run-Standard Loss Run”
2. Can you provide detailed loss runs for open and closed claims as well as managed care payments and ancillary cost payments? -
ANSWER: See Excel file �tled “loss run-Standard Loss Run”
3. Please provide the current fee structure and what the State of Maryland is paying for current services in relation to the contract associated with this RFP.
ANSWER: The current contract's value was set at $16,410,311.00 at the 6/19/19 BPW mee�ng
4. Please provide the number of Takeover Claims expected for each claim type, please list separately the number of litigated takeover claims for each claim type.
ANSWER: See Excel file �tled “loss run-Standard Loss Run”
5. Please provide a detailed Medical Bill Review Savings report for each of the past three years including network savings.
ANSWER: See #9 in first set of ques�ons/answers (PDF document �tled “Q & A-1”)
6. What network does the state use for Medical Bill Review services?
ANSWER: The current TPA (CorVel) has its own network.
7. Please provide the current number of nurses assigned to the State of Maryland claims?
ANSWER: Approximately 40
a. Additionally, are these nurses exclusively dedicated to the State of Maryland?
ANSWER: No.
b. Are all new claims triage by a nurse?
ANSWER: No.
8. Regarding the assignment of Nurse Case Managers to cases, could you clarify if this is a standard practice for all cases? If not, what specific criteria determine the assignment of a
Nurse Case Manager?
ANSWER: Cases are reviewed and depending on the extent of injury and the complexity of the treatment, the UEF is consulted for the need of a Nurse Case Manager.
9. Does the State of Maryland utilize Field Case Managers for medical management purposes? If so, what criteria are used for these assignments, and approximately how many claims per year are assigned to Field Case Managers? -
ANSWER: Yes, almost all of the NCM assignments are for field case managers, roughly 10 per year.
10. If we are not accessing the State’s IT proprietary system are we still required to provide a
VPAT? If so, are you able to provide an example template?
ANSWER: Yes, a VPAT is required. The State does not have an example template to provide.
11. With regard to medical bill review for each year of the past five (5) claims years, could you please provide how many bills were reviewed in each claim year, the amount of medical bill review savings for each claim year and the total medical charges for each claim year? If possible, can you include what was Fee Schedule savings and what savings were above fee schedule? -
ANSWER: See #9 in first set of ques�ons/answers (PDF document �tled “Q & A-1”). 4 years of data is all that is available.
12. What are some key objectives, goals, or areas of opportunity you seek to achieve through your Workers’ Compensation TPA partnership?
ANSWER: See #14 in first set of ques�ons/answers (PDF document �tled “Q & A-1”).
13. Please provide any data kept related to recovery efforts made by the UEF as it pertains to collections and outstanding liens?
ANSWER: See #13 in first set of ques�ons/answers. (PDF document �tled “Q & A-1”).
14. Please share any key performance indicators (KPIs) you use to measure the overall success of your program today.
ANSWER: We measure KPIs on the en�re program: case counts, hearings, financials, bill review savings, pharmacy savings, etc.
15. Does the UEF have an actuary reports that it will share that measures the overall success of their current program as it pertains to claim handling?
ANSWER: The state declines to provide this informa�on as it not relevant to the proposal process.
16. How do you use data analytics in meeting your goals and objectives today?
ANSWER: It is summarized in the UEF’s Managing for Results (MFR) and internal confiden�al communica�ons.
17. Can the UEF please provide a detailed loss reports of all claims that are currently handled by
Corvel?
18. Would UEF please provide a one-year check register for 2023 payment?
ANSWER: The State declines to provide that informa�on
19. Does the incumbent TPA take a percentage of collection for liens and/or subtraction recoveries? ANSWER: See #13 in first set of ques�ons/answers. (PDF document �tled “Q &
A-1”).
20. Can you provide detailed loss runs for open and closed claims as well as managed care payments and ancillary cost payments?
21. What is the breakdown of new indemnity claims and new medical only claims?
22. What is the breakdown of open indemnity claims and medical only claims?
23. Pg 19. Invoicing – Can you clarify the below:
a. States email the original of “each” invoice. How many invoices are expected? Do we invoice by each Uninsured employer? It mentions Atlantic vs Pacific cases – what is this referencing?
ANSWER:
-The State does not know how many invoices are processed weekly, however approximately 300 checks are issued for miscellaneous expenses, WCC awards and medical invoices.
-Invoices are prepared by each vendor for the claimant’s treatment.
-Atlan�c vs Pacific cases represents the bankruptcy of A&P Grocery Stores in Maryland. A bond was established from which the UEF is reimbursed for worker comp expenses.
b. States payment invoices are to be sent weekly. Does this mean the client has to approve all payments? And they only issue checks weekly?
ANSWER:
-On a weekly basis, the TPA prepares an excel spreadsheet, lis�ng all current invoices received by the TPA and approved by them for payment. The spreadsheet is emailed to the UEF for review/approval and subsequently emailed to the Comptroller of Maryland for funding. Payment is forwarded to the TPA via direct deposit which is received in about three days.
-If a large invoice is received and the vendor is willing to accept a lesser amount for prompt payment, an expeditated payment can be arranged.
c. Same clarification requested with miscellaneous invoices.
ANSWER: Miscellaneous invoices are included on the weekly excel spreadsheet.
d. Does UEF require approval before any payments are issued?
ANSWER: Invoices listed on the weekly spreadsheet are approved by the TPA, the UEF then approves the spreadsheet payment requested and final approval is made the Comptroller of Maryland.
e. Can the UEF provide a breakdown of both Total Open Claims (monthly average) and New
Claims per Month to show how many of each category are Medical Only vs. Lost Time
(indemnity)
24. Are the adjusters required to be on-site at UEF offices or working in TPA’s office / remotely based on TPA discretion? The question arises because the primary place of performance noted as address in Towson on page iii and “Other State Responsibilities” on page 4 Section
2.2.6 notes State will provide normal office working facilities.
Answer: Please see #33 from the first set of ques�ons/answers. It is mandatory; however, the current TPA is currently working on a hybrid schedule, both in office and remotely.
25. How does the UEF define a “Claims Investigator”? How does that differ from a “Claims
Adjuster”? Can candidate describe how they would propose staffing the account based on their claim handling philosophy?
ANSWER: A claims inves�gator inves�gates claims filed with the WCC that list the
Employer as non-insured to determine if the UEF will poten�ally be triggered by statute before the claim is heard on the merits before the Commission. The UEF is not an Insurer and does not “accept” claims. Inves�gators research issues such as proper employer/proper insurer, precise accident loca�on, any and all poten�al defenses to the claim, coverage issues, the need to implead addi�onal par�es, e.g., statutory and/or dual employers/insurers, etc. A�er the UEF has been poten�ally triggered by an WCC order, the claim is assigned to an adjuster. At that point the Adjuster would perform all adjus�ng du�es i.e. addressing all indemnity and medical payments either due or awarded and provide medical management to get the claimant to MMI, discharge and poten�al permanency.
26. Are recorded statements required on all claims? Or would the UEF allow for the TPA to obtain same based on their respective Claims Best Practices?
ANSWER: No, recorded statements are not required.
27. What type of policies generate claims? Will the UEF be doing the coverage reviews or are the proposers to consider any coverages at issue on new losses?
ANSWER: The UEF is a payor of last resort, and its liability is determined by statute when the Workers’ Compensa�on Commission (WCC) finds that an employer was uninsured on the date of accident or disablement of occupa�onal disease and there is no addi�onal converge through a statutory or dual employer. The UEF is also responsible for claims against self-insured employers that have become insolvent (recent examples are the
Bethlehem Steel Corpora�on and A&P).
28. How are new claims reported to the TPA?
ANSWER: From claims filed with the Maryland WCC.
29. How is the current TPA tracking the individual employer’s claims for the UEF? How is that information being reported back to the UEF?
ANSWER: All employer informa�on is tracked through client specific coding created for the
UEF.
30. Does the UEF have vendor preference on ancillary services (like nurse case management, surveillance, etc.)?
ANSWER: See #30 in first set of ques�ons/answers. (PDF document �tled “Q & A-1”).
31. Can the UEF provide samples of reports they are receiving from the current TPA?
ANSWER: The State declines to provide this informa�on
32. Section 2.3.3, Letter B: Preparation of case management service report: Please provide an example. If no example can be provided, could a description of what information is included in the report be provide?
ANSWER There is no specific report, and case management du�es vary from claim to claim.
33. Page 18, 3.6.1 (C): Would Agency remove the loss retention cap of $10k?
ANSWER: The state declines to remove the loss reten�on cap of $10k
34. #2. Page 26, 3.9.1 (A): Would Agency remove requirement for the Vendor to provide copy of
SOC 2 report?
ANSWER: The state declines to remove the SOC 2 report requirement
35. #3. Page 91, Section 41: Would Agency remove the parental guarantee?
ANSWER: The state declines to remove the parental guarantee
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