Question and Response Addendum 2 071422.docx

Question and Response Addendum 2 B-30194 CPOGS: RFP Worker's Compensation Third Party Administrator

Questions/Responses:

1. With the tight time frame, many of our references sent their document to the attention of Tom Sestak, as shown on the reference letter. Will these be sent to you or is Tom the correct person with respect to the reference submittal? We would like to make sure that you receive these on a timely basis and prior to July 22nd.

Response: References may be submitted electronically. The single point of contact for this solicitation is Diana Siegrist. Diana.siegrist@illinois.gov

2. For questions 29 and 39 regarding open pending, these answers appear to conflict. Question and Answer 29 states: Pricing Proposal. In reviewing the worksheet, we don’t find a line item(s) for the handling of open file being currently handled by the incumbent? Will the State be revising the worksheet to include this line-item(s)? If not, then please explain why not? Response: No, pending inventories will be transferred to the successful vendor. Question 39 states: Should the “One Time Implementation Fee” included in Year 1 include the cost of taking over the existing open claims files? Please confirm the current inventory? Although worded slightly differently, we interpret this as the successful TPA will need to take the pending claims over if awarded the contract. Please clarify these two questions.

Response: Correct. The successful vendor will be responsible for taking over the pending claim volume.

3. What system or systems does CMS currently use that will require a data interface? Could you please provide loss runs for 3-5 prior years?

Response: We currently use secured Servers to transfer confidential information and a web based claims system that is owned by incumbent contract holder. Refer to Appendix 5 SOI Reported Claims CY 2017 – 2021.xls.

4. We currently have an office in the Chicagoland area, and there is a requirement to have an office and team located in the Springfield area by Feb 1, 2023. If we commit to having an office within Springfield, will we meet the requirement?

Response: Yes, if occupied and staffed within 90 days of Contract start date.

5. D.2.2.80. Vendor shall include in the electronic claims file accessible by the state physician reports. Would you please define this process and or detail of this expectation? We do not understand the terminology of reports having access.

Response: The Vendor shall include physician reports in the electronic claims file that is accessible to the State.

6. D.2.2.82. Vendor Claims Managers with familiarity with the claims shall schedule and lead a monthly telephone conference with each employing agency representative and the Agency to discuss all open claims, next steps and strategies for improvement. Can you please confirm the expectation is to review all open claims (5,160) on a monthly basis?

Response: No, claims open greater than 90 days and litigated should be reviewed every month. CMS and the employing Agency will determine an agreeable time interval to review all other claims.

7. Can you please define the use of the terms, and or differences between each of the following?

Clinical Review - information about an individual claimant is collected and reviewed against established criteria to determine if the service, treatment or supply is Medically Necessary.

Response: See above for each respective definition.

8. D.2.2.104. Vendor shall ensure that file sequence codes and documents are in accordance with State requirements as defined by Agency. Vendor shall provide the Agency with a plan for accomplishing the transfer of all files and a time schedule for said transfer. Can you please define sequence codes and the state requirements for sequence codes and documents, as well as, how these are presently applied?

Response: The Agency and successful vendor will work with DoIT to define sequence codes and the format required to transfer data.

9. D.2.2.120. Vendor shall work with the Department of Innovation and Technology (DoIT) to develop customized guidelines for sharing and transporting data as well as all software and network requirements. The electronic transferring of data between the State of Illinois and the vendor will be via a secure FTP connection and data will be transferred in the State’s format. Can you please provide a sample of the State’s format?

Response: The Agency and successful vendor will work with DoIT to define the format required to transfer data.

10. D.3.1.2.1 Vendor shall provide the following reports to Agency on a monthly basis. Please provide sample layouts.

Response: The successful vendor and Agency will work together to define the report layouts. The Agency currently receives the following monthly reports and are subject to change in resulting contract depending on needs:

· # New Claims by Type

· # New Claims by Type – Year to Date

· # Closures by Type

· # Closures by Type – Year to Date

· # Denied by Type

· # of New/Denied Claims

· Open Claims by Claim Type – Total Pending

· Adjuster Pending

· Adjuster IND paid

· Payment Hold Report

· Agency Breakdown - Spend

· Savings Report (Med Savings)

· Priority Care Solutions

· Vocational Report

· Overpayment Report

· Subrogation Report

· Investigation Reports

· Reserve Notification Report

· TCM Assignments (medical referral summary)

· Bank Statement

· Bank Reconciliation / Expenditure Report( Financial spending)

· RX –Report

· Absolute Solutions Report

· One Call Medical Report- Med bill review service

· Rehabilitation Report

11. D.3.1.2.3 Please provide sample of current performance standards outcomes.

Response: This information is confidential and not available.

12. D.3.2 Please provide sample of current performance standards.

Response: The following is a listing of current performance standards.

· Completion of CMS Packet on all claims

· All medical bills reviewed within 30 days

· Adjuster assigned within 1 business day of Notice

· Contact within 2 business days of Notice

· Initial Review within 15 business days of Notice

· Claims Status Reviews updated every 60 days

· Compensability decisions made with 3 business days of completion of investigation

· Inquiries (phone or e-mail) responded to within 1 business day

· All priority payments issued within 7 days

· All documents labeled within 7 days of receipt

· Indemnity adjuster caseloads of 150 open active indemnity claims and medical claim adjusters 250 open active medical claims

· All reports issued timely and accurately

· Escalated Issue Resolution

· Account Management/overall Service Performance

· Account Management/overall Service Performance

· System Up Time

· System Incident Notification

· Delivery of Quarterly Plan Performance Report to State

· Delivery of Monthly Return to Work Status Report Performance Measurement Report Card to the State

13. D.3.2.2 Please provide current performance standards and reduction process/amounts.

Response: Current performance standards are listed above. Contractual reduction amounts are confidential and not available.

14. PG 1 Will you please provide implementation evaluation measurements?

Response: All administrative functions completed for a successful program implementation as of the effective date of the contract. One time measurement after the first quarter of the initial plan year by State of Illinois staff using implementation evaluation.

15. D.4.3.2 Please provide current staffing and management plan?

Response: The current plan is no more than 150 open indemnity claims per claims representative and no more than 250 Med only claim per claims representative. The Span of supervision is the responsibility of the bidder.

16. D.6.1 Subcontractors. Do you consider those services that fall under allocated expenses (ALAE) considered subcontractor, i.e., IME, Peer Review.

Response: Yes.

17. Vocational Rehabilitation Can you please advise how many annually you anticipate?

Task Full Placement - 29 Job Coaching - 29 Labor Market Surveys - 38

Response: See above for volumes.

18. Number of Case Management broken out by?

Field Case Management - 43 Telephonic Case Management - 937 IME referrals Per year - 981 PBM Scripts Per Year - 3,279 Non PBM Script per year – 2,325

Response: See above for volumes.

19. Please explain the difference between the following sections related to pricing. E.5.2.1. Agency Formula for Determining Annual and Renewal Compensation: For each contract renewal year(s), the maximum renewal rates will be calculated as the applicable rate for the immediately preceding contract year times the lesser of (a) 3% or (b) the annual Consumer Price Index Inflation factor. For the purpose of this Contract, the Consumer Price Index Inflation factor shall be developed from the “Consumer Price Index Urban Wage Earners and Clerical Workers”: All items are as published by the U.S Department of Labor, Bureau of Labor Statistics.

Response: This section provides renewal compensation language for the potential renewal years 6-10 of any resulting contract. The Agency will limit annual renewal compensation to the lesser of (a) 3% or (b) the annual Consumer Price Index Inflation factor.

20. Appendix 4 Pricing Proposal c. For each following year, if a price increase is submitted in Bid Buy, it cannot exceed 2%. For contract years 3-5, any pricing submitted in Bid Buy with an increase must be accompanied by documentation supporting the price increase and any further documentation as requested by the State.

Response: Section c of Appendix 4 Pricing Proposal has been removed. Please see attached Appendix 4 Pricing Proposal revised 071422.xls.