RFP 2025HCA5 EXHIBIT C1.1 Attestations.docx
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- Attached to
- Fully-Insured Medical Plans
- Solicitation number
- 2025HCA5
- Issued by
- Adams County, Asotin County, Benton County, Chelan County, Clallam County, Clark County, Columbia County, Cowlitz County, Douglas County, Ferry County, Franklin County, Garfield County, Grant County, Grays Harbor County, Island County, Jefferson County, King County, Kitsap County, Kittitas County, Klickitat County, Lewis County, Lincoln County, Mason County, Okanogan County, Pacific County, Pend Oreille County, Pierce County, San Juan County, Skagit County, Skamania County, Snohomish County, Spokane County, Stevens County, Thurston County, Wahkiakum County, Walla Walla County, Whatcom County, Whitman County, Yakima County, Asotin City, Clarkston City, Clarkston Heights-Vineland CDP, West Clarkston-Highland CDP, Benton City, Chelan City, Chelan Falls CDP, Clallam Bay CDP, Lewisville CDP, Rock Island City, Pacific Beach CDP, Whidbey Island Station CDP, Mercer Island City, Pacific City, Bainbridge Island City, Kingston CDP, Kitsap Lake CDP, Kittitas City, Klickitat CDP, Okanogan City, Anderson Island CDP, Fort Lewis CDP, Fox Island CDP, Herron Island CDP, Ketron Island CDP, North Fort Lewis CDP, Raft Island CDP, Stevenson City, Hat Island CDP, Lake Stevens City, Snohomish City, Spokane City, Spokane Valley City, Puget Island CDP, Garfield Town, Yakima City, Washington
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Summary of RFP 2025HCA5 Exhibit C1.1 Mandatory Attestations
This document is a mandatory attestation exhibit for Washington State's Health Care Authority (HCA) Request for Proposals (RFP) #2025HCA5 for fully-insured medical health plans. Bidders must complete and submit the attestations to be deemed responsive to the RFP. The exhibit requires bidders to confirm their ability to meet 47 mandatory performance requirements across multiple operational categories, including general RFP comprehension, plan administration, eligibility and file systems management, artificial intelligence tool compliance, enrollment provisions, account management, claims services, member engagement, data reporting and analytics, and financial requirements. Bidders must respond "Yes" or "No" to each requirement, with any response of "No" or any non-binary response rendering the bidder non-responsive and ineligible for further consideration. The attestations confirm that bidders have thoroughly reviewed the RFP sections, draft contract, and statement of work documents during designated bidder question periods before submission.
The mandatory attestations cover comprehensive operational and compliance standards that bidders must affirm, including adherence to federal and state data security and privacy requirements (HIPAA, HITECH Act, WaTech IT Security Chapter), claims payment capabilities, coordination of benefits protocols, prior authorization standards preparation, HIPAA-compliant member identification number generation, artificial intelligence tool compliance, eligibility file management, enrollment procedures, legislative impact analysis capabilities, operational disruption notification protocols, certificate of coverage requirements, claims administration standards, member communications accessibility and translation services, microsite and online portal functionality with multi-factor authentication, member services clinical decision-making, data reporting and analytics capabilities including HEDIS measures and health disparities analysis, Health Information Exchange participation at ninety-five percent provider claims volume, and submission of paid claims data and hospital reimbursement data to HCA's designated actuary. No pricing information, award dates, contract term length, or renewal options are specified within this attestation exhibit document.
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Other files
| File | Type | Posted |
|---|---|---|
| RFP 2025HCA5 Exhibit I - Subc List.xlsx | XLSX spreadsheet | |
| RFP 2025HCA5 Exhibit C1.2 - Written P1.docx | DOCX document | |
| RFP 2025HCA5 Exhibit G - Plan Design Outline.xlsx | XLSX spreadsheet | |
| RFP 2025HCA5 Attachment 1_APM Framework_RFP.pdf | ||
| RFP 2025HCA5 Att 7 - Disaster Plan.docx | DOCX document | |
| RFP 2025HCA5 Att 4 - 834 Companion Guide.xlsx | XLSX spreadsheet | |
| RFP 2025HCA5 Attachment 3_MFT User Guide_RFP.pdf | ||
| RFP 2025HCA5 Exhibit H - Bree Collab.xlsx | XLSX spreadsheet | |
| RFP 2025HCA5 Final 10.12.26.pdf | ||
| RFP 2025HCA5 Exhibit C2 Written P2.docx | DOCX document | |
| RFP 2025HCA5 Exhibit A - Forms and Certs.docx | DOCX document | |
| RFP 2025HCA5 Attachment 9 - claim data.xlsx | XLSX spreadsheet | |
| RFP 2025HCA5 Exhibit E - Service Area.xlsx | XLSX spreadsheet |
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EXHIBIT C1.1 – MANDATORY ATTESTATIONS
Bidders must complete and submit Exhibit C1.1 – Mandatory Attestations for proposal responsiveness review.
Bidder must respond to each requirement. Each row is a minimum requirement.
Any Bidder that responds “no” to a mandatory attestation will be considered non-responsive.
Using the Bidder’s Compliance column, Bidder must select either “Yes” or “No” to indicate the Bidder’s ability to meet the requirement. Any entry that is not either a “Yes” or “No” will be deemed non-responsive and will not be considered any further.
For mandatory attestations, a Bidder’s confirmation indicates that they have reviewed the requirements carefully and sought clarification during the designated Bidder question periods (RFP #2025HCA5, section 2.5 Bidder Question Periods) if any requirement was unclear. HCA expects all Bidders to thoroughly review the RFP and submit questions during the allotted Bidder question periods.
| Question Number |
| Performance Requirement |
| Bidder’s Compliance |
1. General Attestations
| 1.1 |
| Attest that the Bidder has read and understands RFP #2025HCA5 section 1.3 of this RFP on HCA’s Objectives and Purpose in releasing this RFP. |
| ☐ Yes |
☐ No
| 1.2 |
| Attest that the Bidder has read and understands RFP #2025HCA5 section 1.4 on Background of the HCA and ERB Division as well as the Public Employee Benefits Board and School Employee Benefits Board. |
| ☐ Yes |
☐ No
| 1.3 |
| Attest that the Bidder has read and understands the Minimum Qualifications in section 1.6 of this RFP. |
| ☐ Yes |
☐ No
| 1.4 |
| Attest that the Bidder meets all the Minimum Qualifications in section 1.6 of this RFP. |
| ☐ Yes |
☐ No
| 1.5 |
| Attest that the Bidder has read and understands RFP #2025HCA5, section 1.7 Funding. |
| ☐ Yes |
☐ No
| 1.6 |
| Attest that the Bidder has read and understands Exhibit B Draft Contract, and the provisions of RFP #2025HCA5 section 3.4. |
| ☐ Yes |
☐ No
| 1.7 |
| Attest that the Bidder has read and understands Exhibit B, Draft Contract, Attachment 3: Statement of Work, prior to answering the questions in Exhibit C 1.2 Written Proposal Phase 1 and agrees to perform all the required activities identified in Exhibit B Draft Contract, Attachment 3: Statement of Work. |
| ☐ Yes |
☐ No
2. Plan Administration (See Exhibit B, Draft Contract, Attachment 3: Statement of Work)
2.1 Basic Health Plan Operations
| 2.1 |
| Attest that Bidder is in full compliance with all federal and state Data security and privacy requirements, including but not limited to HIPAA, HITECH Act, and WaTech IT Security Chapter (https://watech.wa.gov/policies) as required by Exhibit B Draft Contract, Attachment 3 Statement of Work, section 2.1.B. |
| ☐ Yes |
☐ No
| 2.2. |
| Attest that Bidder has a fully operational Claims payment service that includes the ability to pay Claims electronically as required by Exhibit B Draft Contract, Attachment 3 Statement of Work, section 2.1.I. |
| ☐ Yes |
☐ No
| 2.3 |
| Attest that Bidder can apply standard Coordination of Benefits rules for all Medicare-primary Members’ Claims (consistent with Washington insurance regulations in chapter 284-51 WAC as required by Exhibit B Draft Contract, Attachment 3 Statement of Work, section 2.1.R. (Example: A member diagnosed with ESRD has met the 30-month coordination period and Medicare becomes primary payor for ESRD related services) |
| ☐ Yes |
☐ No
| 2.4 |
| Attest that Bidder can apply standard Coordination of Benefits with Medicare using all Medicare crossover Claims, including those paid in full by Medicare, and Claims from Members or their providers as required by Exhibit B Draft Contract, Attachment 3 Statement of Work section 2.1.S. This applies to services not covered by Medicare that are additional benefits included in the ERB plans. |
| ☐ Yes |
☐ No
| 2.5 |
| Attest that Bidder can prepare medical and pharmacy prior authorization standards and criteria consistent with RCW 41.05.074 and RCW 48.43.016, and to timely provide those prior authorization standards and criteria to HCA in the format set out by HCA, so that HCA may make them publicly available online on the HCA website by no later than the first day of each month as required by Exhibit B Draft Contract, Attachment 3 Statement of Work, section 2.1.T. See Exhibit B Draft Contract, Attachment 15 Prior Authorization Reporting Instructions (Procedures for Compliance With RCW 41.05.074. |
| ☐ Yes |
☐ No
2.2 Eligibility Files and File Systems Bidder Questions
| 2.6 |
| Attest that Bidder will comply with all requirements set forth in Exhibit B Draft Contract, Attachment 3: Statement of Work, subsection 2.2 A-M. |
| ☐ Yes |
☐ No
| 2.7 |
| Attest to Bidder’s agreement to generate unique, permanently assigned, HIPAA compliant, non-Social Security Number (SSN) based Member identification numbers for eligible Members as required by Exhibit B Draft Contract, Attachment 3: Statement of Work, subsection 2.2.J. |
| ☐ Yes |
☐ No
| 2.8 |
| Attest that Bidder’s invoicing systems can accept a non-820 compliant invoicing file from HCA as required by Exhibit B, Draft Contract, RFP #2025HCA5 Exhibit B Draft Contract, Attachment 3: Statement of Work, subsection 2.2.M |
| ☐ Yes |
☐ No
2.3 Use of Artificial Intelligence Tools
| 2.9 |
| Attest that Bidder will comply with all requirements set forth in Exhibit B, Draft Contract, RFP #2025HCA5 Exhibit B Draft Contract, Attachment 3: Statement of Work, subsection 2.3. “Use of Artificial Intelligence Tools” Section A. |
| ☐ Yes |
☐ No
2.4 Enrollment Provisions
| 2.10 |
| Attest that the Bidder will include HCA’s annually updated eligibility and enrollment language into the Bidder’s Certificates of Coverage (COC) verbatim and in its entirety unless HCA has explicitly provided approval in writing for language that meets the definition of “substantially similar” set forth in Exhibit B Draft Contract, Attachment 3: Statement of Work, subsection 2.4.B. |
| ☐ Yes |
☐ No
| 2.11. |
| Attest that the Bidder will accept new Members during a special open enrollment period authorized by HCA at the existing Monthly Premiums set forth in Bidder’s Contract with HCA where HCA has determined that it is cost -effective to enroll an eligible person participating in a medical assistance program in an employer-sponsored health plan as required by Exhibit B Draft Contract, Attachment 3: Statement of Work, subsection 2.4.D. |
| ☐ Yes |
☐ No
| 2.12. |
| Attest that Bidder will comply with the retroactive enrollment requirements set forth in Exhibit B Draft Contract, Attachment 3: Statement of Work, subsection 2.4.E. |
| ☐ Yes |
☐ No
2.5 Account Management Structure Bidder Questions
| 2.13 |
| Attest Bidder will provide responses to HCA requests for Bidder analysis on proposed legislation and potential impacts to finances within the requested timeframes (usually 24-48 hours) during Legislative Session as set forth in Exhibit B Draft Contract, Attachment 3: Statement of Work, subsection 2.5.B.v. |
| ☐ Yes |
☐ No
| 2.14 |
| Attest that the Bidder will notify HCA of any disruption of normal account administration or operational duties under a Contract resulting from this RFP without delay, but in no case more than one (1) business day after discovery by the carrier (whether discovered by the Account Manager or anyone else employed by or reporting to the carrier), investigate the issue and provide reasonable cooperation with HCA's response as required by Exhibit B Draft Contract, Attachment 3: Statement of Work, subsection 2.5.B.vi. At HCA’s discretion, the response may include but not be limited to development of risk assessment, root cause analysis and entering into a corrective action plan, including mitigation and remediation activities. Contractor must provide, at least annually, a detailed review on progress toward meeting previously established goals to the HCA leadership team. |
| ☐ Yes |
☐ No
| 2.15 |
| Attest the Bidder will ensure all the appropriate Bidder personnel will review, in detail, the single point of truth document(s) for creation of HCA benefit comparison materials, as well as HCA’s other member documents for Annual Open Enrollment as required by Exhibit B Draft Contract, Attachment 3: Statement of Work, subsection 2.5.B.xi-xii. |
| ☐ Yes |
☐ No
2.6 Certificates of Coverage
| 2.16. |
| Attest that the Bidder will amend its COC and provide notice of the changes to Subscribers as directed by HCA or the Office of the Insurance Commissioner (OIC) as required by Exhibit B Draft Contract, Attachment 3: Statement of Work, subsection 2.6.B. |
| ☐ Yes |
☐ No
2.7 Claims Services
| 2.17 |
| Attest that Bidder uses only clinicians licensed and located in a state or territory of the United States during any part of the Claims administration process and only physicians who are Participating Providers for consultations during any part of the Claims administration process as required by Exhibit B Draft Contract, Attachment 3: Statement of Work, subsection 2.7.D. |
| ☐ Yes |
☐ No
| 2.18 |
| Attest that, when requested by HCA, Bidder will provide corrective action plan(s) within fifteen (15) Calendar Days of being notified of a Claims adjudication issue, for resolution of such issue as required by Exhibit B Draft Contract, Attachment 3: Statement of Work, subsection 2.7.F. |
| ☐ Yes |
☐ No
| 2.19 |
| Attest that Bidder will make mutually agreed-upon benefit revisions and update its Claims system to pay accordingly on sixty (60) Calendar Days advance notice from HCA as required by Exhibit B Draft Contract, Attachment 3: Statement of Work, subsection 2.7.N. |
| ☐ Yes |
☐ No
2.8 Member Engagement
2.8.A. Paper and Electronic Communications with Members
| 2.20 |
| Attest that Bidder will provide accurate, timely communications to Members and potential Members to enable them to make informed decisions in selecting a Health Plan, appropriately utilize available benefits, and actively engage in managing their health as required by Exhibit B Draft Contract, Attachment 3: Statement of Work, subsection 2.8.A.i. |
| ☐ Yes |
☐ No
| 2.21 |
| Attest that Bidder will adhere to the requirements stated in WAC 182-08-220 (PEBB) and WAC 182-30-120 (SEBB) and abide by procedures set out in the Contract for obtaining HCA’s approval of Bidder’s communication content as required by Exhibit B Draft Contract, Attachment 3: Statement of Work, subsection 2.8.A.iv. |
| ☐ Yes |
☐ No
| 2.22 |
| Attest that Bidder has read and understood the requirements for cobranding documents and communicating with Members as required by Exhibit B Draft Contract, Attachment 3: Statement of Work, subsection 2.8.A.v-vii |
| ☐ Yes |
☐ No
| 2.223 |
| Pertaining to Bidder’s communications as described in Exhibit B, Draft Contract, Attachment 3: Statement of Work, section 2.8.A.xi, attest that: |
Bidder’s communications will comply with the Americans with Disabilities Act (ADA), all subsequent amendments to the ADA, and implementing regulations of ADA; Section 508 of the Rehabilitation Act; Governor’s Executive Order 23-02 (Plain Language), and all other relevant federal and Washington State laws pertaining to equal access to information.
☐ Yes ☐ No
| 2.24 |
| Pertaining to Bidder’s communications as described in Exhibit B Draft Contract, Attachment 3: Statement of Work, section 2.8.A.xii - xiii, attest that: |
Bidder will provide communication materials in other accessible formats (e.g., large print, braille, etc.), upon request from Members or HCA and provide electronic and printed materials translated into HCA’s identified most requested languages at no extra cost. HCA lists language access requirements online at Language Access. At present, the most requested languages are Spanish, Russian, Vietnamese, and Ukrainian.
☐ Yes ☐ No
| 2.25 |
| Attest that Bidder will communicate directly with Members only if approved by HCA and only as reasonably necessary to carry out the Health Plan(s)'s obligations to HCA as required by Exhibit B Draft Contract, Attachment 3: Statement of Work, subsection 2.8.A.xiv., except for communications described in other provisions of the Contract. |
| ☐ Yes |
☐ No
| 2.26 |
| Attest that in years following initial enrollment as required by Exhibit B Draft Contract, Attachment 3: Statement of Work, subsection 2.8.A.xvi-xvii, Bidder will deliver any communications concerning enrollment for the future Plan Year only to Bidder’s current Members. These communications include all topics reasonably related to Members’ decision-making for reenrollment. Further attest that Bidder will maintain communications aimed at recruiting new Members for future Plan Years only on the HCA-specific Microsite, HCA-hosted virtual benefits fair site, social media, and in-person benefits fairs. Communications with PEBB/SEBB Members not enrolled in the Bidder’s health plan are not permitted without a request from the member. |
| ☐ Yes |
☐ No
| 2.27 |
| Attest that Bidder will be responsible for all costs associated with the correction, notification, and distribution if errors are made in Bidder’s branded communications related to benefits, programs, or services as required by Exhibit B Draft Contract, Attachment 3: Statement of Work, subsection 2.8.A.xviii. Corrections must be made in the same format as the original communication was sent (for example, if error was in a mailing, the correction should also be mailed). |
| ☐ Yes |
☐ No
| 2.28 |
| Attest that Bidder will thoroughly review all HCA-produced Member communications related to the Bidder’s benefits and services, including, but not limited to, plan summaries and comparison materials, website, enrollment forms, Benefits 24/7 online language, and newsletters, and, if an error is discovered in HCA materials reviewed by the Bidder after printing, Bidder must cover all costs associated with error correction including, but not limited to, printing and postage (if mailed) as required by Exhibit B Draft Contract, Attachment 3: Statement of Work, subsection 2.8.A.xix. |
| ☐ Yes |
☐ No
2.8.B. HCA Plan Specific Microsite
| 2.29 |
| Attest that Bidder will host an HCA-specific Microsite for the Health Plans offered as a result of this RFP as required by Exhibit B Draft Contract, Attachment 3: Statement of Work, subsection 2.8.B.i. |
| ☐ Yes |
☐ No
| 2.30 |
| Attest that Bidder’s HCA-specific Microsite for the health plans offered as a result of this RFP will abide by the requirements in Exhibit B, Draft Contract, Attachment 3: Statement of Work, section 2.8.B.i.a-d. |
| ☐ Yes |
☐ No
| 2.31 |
| Attest that Bidder will have processes and methods in place to abide by the requirements in Exhibit B Draft Contract, Attachment 3: Statement of Work, section 2.8.B.ii.a-d, and will abide by those requirements. |
| ☐ Yes |
☐ No
| 2.32 |
| Attest that Bidder will provide links to websites as requested by HCA, including those named in Exhibit B Draft Contract, Attachment 3: Statement of Work, section 2.8.B.iv.a-b. |
| ☐ Yes |
☐ No
| 2.33 |
| Attest that Bidder’s HCA-specific microsite for the Health Plans offered as a result of this RFP will abide by the requirements in Exhibit B Draft Contract, Attachment 3: Statement of Work, section 2.8.B.v-viii. |
| ☐ Yes |
☐ No
2.8.C Secure Access Online Member Portal
| 2.34 |
| Attest that Bidder will host secure web-based online Member Portal for enrolled Subscribers and Members of the Health Plans offered as a result of this RFP and provide easily located online services including a robust, accurate, and up-to-date array of web-based tools and information which is reviewed frequently for technical errors and updated regularly with the newest information; and that the Bidder’s online services will at all times meet or exceed the Washington State Technology Standards, or their replacements or successors, found on WaTech’s website: https://watech.wa.gov/policies as required by Exhibit B Draft Contract, Attachment 3: Statement of Work, subsection 2.8.C.i-ii. |
| ☐ Yes |
☐ No
| 2.35 |
| Attest that Bidder’s online Member Portal will require Multi Factor Authentication (MFA) for secure login as required by Exhibit B Draft Contract, Attachment 3: Statement of Work, subsection 2.8.C.iii.a. |
| ☐ Yes |
☐ No
2.8.D Member Services
| 2.36 |
| Attest that Bidder meets the following qualifications as required by Exhibit B Draft Contract Attachment 3: Statement of Work, subsection 2.8.D.i: |
a. All Member clinical decisions are made by clinicians;
b. All clinicians are licensed and located in the United States and its territories;
c. All clinicians will appropriately apply Bidder’s documented decision protocols, clinical criteria, and guidelines; and
d. A clinical case manager or reviewer is available as the first point of contact for Members and Providers for all clinical programs.
☐ Yes ☐ No
| 2.37 |
| Attest to Bidder’s agreement to handle Misquotes of benefits in the manner outlined in B Draft Contract Attachment 3: Statement of Work, subsection 2.8.D.iii. |
| ☐ Yes |
☐ No
2.9 Data Reporting and Analytics Bidder Questions
| 2.38 |
| Attests that Bidder has robust technology and core systems in place to accept, store, process and validate data from various sources (e.g., Claims, clinical data from EHRs, and other HCA vendors) as required by Exhibit B Draft Contract, Attachment 3: Statement of Work, subsection 2.9.B. |
| ☐ Yes |
☐ No
| 2.39 |
| Attests that Bidder has the capabilities for collecting and transmitting to HCA detailed reporting of Health Plan specific measures from the Washington State Common Measure Set and HEDIS® measures for provider groups, including quality, Claims, Member reported Outcomes, hybrid and ECDS measures as required by Exhibit B Draft Contract, Attachment 3: Statement of Work, subsection 2.9.D. |
| ☐ Yes |
☐ No
| 2.40 |
| Attests that Bidder has the capability to conduct analyses of sub-populations and to identify health disparities so that providers have actionable data to care effectively for all Members. The measures will be based on standards created at the state and national level, and the data will be configured in accordance with the applicable specifications as required by Exhibit B Draft Contract, Attachment 3: Statement of Work, subsection 2.9.D. |
| ☐ Yes |
☐ No
| 2.41 |
| Attests that, as required by Exhibit B Draft Contract Attachment 3: Statement of Work, subsection 2.9.E, Bidder has experience, knowledge and expertise to provide appropriate Data and routine, standardized reporting on provider performance regarding various clinical and quality metrics, including Patient Reported Outcomes, patient experience, and population health. This reporting must be understandable and accessible to providers and provider groups. |
| ☐ Yes |
☐ No
| 2.42 |
| Attests that Bidder will participate in the submission of data using the NCQA Data Submission System (IDSS) or other NCQA-approved methods as required by Exhibit B Draft Contract, Attachment 3: Statement of Work, Subsection 2.9.F. |
| ☐ Yes |
☐ No
| 2.43 |
| Attests that Bidder will report HCA-required HEDIS® measures stratified by race and ethnicity as required by the NCQA and as required by Exhibit B Draft Contract, Attachment 3: Statement of Work, subsection 2.9.G. |
| ☐ Yes |
☐ No
| 2.44 |
| Attests that Bidder will submit a summary of primary care expenditures for the PEB and SEB Boards’ fully insured plans using a template provided by HCA as required by Exhibit B Draft Contract, Attachment 3: Statement of Work, subsection 2.9.I and Attachment 16 Primary Care Expenditure Template. |
| ☐ Yes |
☐ No
| 2.45 |
| Attests that Bidder, as required by Exhibit B Draft Contract, Attachment 3: Statement of Work, subsection 2.9.J-K., will meet the requirement for provider participation in Washington State’s Clinical Data Repository (CDR) and Health Information Exchange (HIE). Requirement is ninety-five percent (95%) of ERB Medical Plan Member Claims volume (transactions) is from Participating Providers that are participating in HCA’s Lead Organization HIE and the statewide CDR. |
| ☐ Yes |
☐ No
| 2.46 |
| Attests that Bidder will submit files to HCA’s data warehouse in the form specified upon HCA’s request as required by Exhibit B Draft Contract, Attachment 3: Statement of Work, subsection 2.9.L. |
| ☐ Yes |
☐ No
2.10 Requests for Renewal (RFRs)
| 2.46 |
| Attest that Bidder will carefully read and analyze the RFR each year during the time it contracts with HCA and provide a clear and comprehensive evaluation and implementation plan for each change in the time period allotted as required by Exhibit B Draft Contract, Attachment 3: Statement of Work, subsection 2.10.C. |
| ☐ Yes |
☐ No
| 2.47 |
| Attest that, as required by Exhibit B Draft Contract Attachment 3: Statement of Work, subsection 2.10.D, the Bidder recognizes and understands that Bidder will be responsible for all costs incurred in responding to the RFR. |
| ☐ Yes |
☐ No
7. Financial Requirements
| 7.1 |
| Bidder agrees to submit to HCA’s designated actuary complete paid Claims Data for all non-Medicare Members in its PEBB and SEBB plan(s), as required by Exhibit B Draft Contract, Attachment 3: Statement of Work, subsection 7.1 and Attachment 9: Required Claims Field Data. |
| ☐ Yes |
☐ No
| 7.2 |
| Bidder agrees to submit all required hospital reimbursement data to HCA’s designated actuary to comply with RCW 41.05.028 “Health Plan Reimbursement Rates” as required by Exhibit B Draft Contract, Attachment 3: Statement of Work, subsection 7.2. |
| ☐ Yes |
☐ No
| 7.3 |
| Bidder agrees to comply with HCA’s risk adjustment methodology as required by Exhibit B Draft Contract Attachment 3: Statement of Work, subsection 7.4. |
| ☐ Yes |
☐ No
| 7.4 |
| Bidder agrees to a Risk Adjustment Data Validation Audit (RADV), to be performed by a third party as required by Exhibit B Draft Contract Attachment 3: Statement of Work, subsection 7.5. |
| ☐ Yes |
☐ No
RFP #2025HCA5
Exhibit C1.1 Mandatory Attestations
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