RFP 2022-25 Clarifying Questions 2.pdf
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- Attached to
- RFP 2022-25 Prior Authorization Services
- Solicitation number
- S-X26083-00005145
- Issued by
- Multnomah County, Oregon
About this file
This document is a response to clarifying questions regarding RFP 2022-25 for Prior Authorization Services issued by CareOregon, an organization located in Portland, Oregon. CareOregon is seeking a contractor to assist with prior authorization services for their Medicaid (CCO plans) and Medicare (Dual Special Needs Plan) programs. The RFP specifies that the contractor will be expected to review up to 1,000 prior authorization requests per month for completeness, with CareOregon's internal nurses gathering additional information as needed, 1-3 times per week. CareOregon expects a productivity rate of 20 requests processed per day by the contractor's nurses and a cycle time of 1-3 days from assignment to completion. Both CareOregon and the contractor will perform quality audits, and annual interrater reliability assessments will involve all nurses, including CareOregon's internal staff.
The estimated contract value is $250,000 per year. CareOregon is not disclosing the identity of the current vendor or the current fees for these services. The contract will cover Multnomah County and the City of Portland, Oregon.
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Text version
315 SW Fifth Ave, Portland, OR 97204 | 800-224-4840 | TTY 711 | careoregon.org
George Marlton Procurement Director
Procurement Department 503-416-4706 Procurement@careoregon.org
REQUEST FOR PROPOSALS #2022-25
PRIOR AUTHORIZATION SERVICES
RESPONSE TO CLARIFYING QUESTIONS #2
December 21, 2022
Note that these are questions submitted by interested firms to the above referenced solicitation.
The below answers are for clarification purposes only and in no way alter or amend the RFP as published.
1. How many Prior Authorization Request will be reviewed by Vendor for completeness each month?
Answer: All requests will be reviewed by vendor for completeness, all necessary clinical information is included in request. CareOregon is anticipating 1000 per month.
2. How many Prior Authorization Request require additional information from providers each month?
Answer: Most additional information will be gathered prior to sending to the vendor.
Generally, CareOregon RNs need additional information 1-3 times per week.
3. How much total volume is CareOregon planning to dedicate the contractor’s nurses to?
Answer: 1000 per month
4. What is CareOregon’s average cycle time and productivity expectation for Prior Authorization nurses?
Answer: CareOregon’s RN productivity expectation is 20 per day (based on 8 hour day at 2.5 requests processed per hour). The average cycle time may vary based on completeness of request, need for outreach to provider, or need for Medical Director review. Generally, between 1-3 days from assignment to completion.
5. What is the average daily volume a Prior Authorization nurse should expect?
Answer: 20 based on an 8 hour day.
6. Does CareOregon have examples of quality standards they use for their nursing team?
Answer: CareOregon has examples of tools used to audit quality standards. The tools capture both processing steps and verifies if regulatory requirements are being met.
7. Are the monthly performance audits being self-administered by the Contractor’s nurses or is CareOregon performing the audits and sharing the information with the contracted nurses?
Answer: Both. In the beginning both vendor and CareOregon will audit to ensure process and regulatory requirements are being met. The expectation is to move to vendor continuing statistically valid sample audits with CareOregon auditing the auditor.
http://careoregon.org/ mailto:Procurement@careoregon.org
315 SW Fifth Ave, Portland, OR 97204 | 800-224-4840 | TTY 711 | careoregon.org
8. Are the annual interrater reliability assessments being performed by the Contractor’s nurses or by CareOregon?
Answer: All RNs, contractor and CareOregon, must complete the annual interrater reliability assessments. CareOregon will initiate the IRR activity.
9. What is the duration of the Quarterly Business Review meeting and weekly check-in?
Answer: Duration of QBR and weekly check-in will depend on topics to be discussed.
QBR would generally not be longer than 60 minutes, weekly check in no longer than 30 minutes.
10. Can you please clarify what you mean by “Develop escalation pathway for requests that the Contractor’s team is unable to complete?”
Answer: CareOregon expects the contractor to have an internal pathway for escalation prior to escalation to CareOregon.
11. What is the estimated value of the initial term of the contract?
Answer: Estimated budget is $250,000 per contract year.
12. Who is the current Vendor providing the requested services in this RFP?
Answer: CareOregon is not disclosing this information.
13. What are the current fees for the services being requested in this RFP?
Answer: CareOregon is not disclosing this information.
End of Clarifying Questions #2 http://careoregon.org/
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