RFP_5800_SLW3030_PAC2_v1.xlsx
XLSX spreadsheet 32 KB Posted
- Attached to
- Self Insured Dental Plan (Active & Retiree)
- Solicitation number
- RFP 5800 SLW3030
- Issued by
- Texas
About this file
This is a Request for Proposal (RFP) issued by the City of Austin for Self-Funded Dental Plan Administration Services (RFP 5800 SLW3030). The RFP solicits proposals from vendors to provide comprehensive dental plan administration services, including claims processing, customer service, eligibility management, provider network management, and reporting. Prospective vendors must submit detailed information across nine evaluation tabs covering business organization details, references, account team composition, customer service capabilities, system capabilities, claims administration processes, performance measures, and provider network information. The proposal requires vendors to demonstrate operational experience in Texas dental plan administration, current client portfolios, staffing levels, and technological infrastructure. Vendors must provide website and mobile application demonstrations, describe their claims processing and eligibility verification procedures, and detail their provider credentialing and quality audit processes.
The RFP establishes specific performance standards with associated financial penalties for non-compliance, including requirements for customer service response times (30 seconds or less), claims processing timelines (10 business days for complete claims with minimum 90% compliance), accuracy thresholds (97-98% for claims and processing accuracy), and system uptime commitments. Vendors must address their disaster recovery plans, encrypted communication protocols, and ability to generate quarterly and annual management reports. The RFP requires vendors to maintain a contracted dental network across the Central Texas region (ten counties) and out-of-state, with detailed provider statistics by specialty including general dentistry, orthodontistry, periodontistry, prosthodontistry, endodontistry, and pediatric dentistry. Proposers must clearly identify any exceptions to the solicitation requirements or risk rejection, and the City reserves the right to conduct reference interviews with finalist candidates' current or previous public-sector clients.
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Other files
| File | Type | Posted |
|---|---|---|
| RFP_5800_SLW3030_ATT_2_v1.pdf | ||
| RFP_5800_SLW3030_0600_v1.xlsx | XLSX spreadsheet | |
| RFP_5800_SLW3030_ATT_1_v1.pdf | ||
| RFP_5800_SLW3030_ADD_1_v1.pdf | ||
| RFP_5800_SLW3030_ATT_4_v1.pdf | ||
| RFP_5800_SLW3030_PAC1_v1.pdf | ||
| RFP_5800_SLW3030_ATT_5_v1.xlsx | XLSX spreadsheet | |
| RFP_5800_SLW3030_ATT_8_v1.xlsx | XLSX spreadsheet | |
| RFP_5800_SLW3030_ATT_9_v1.docx | DOCX document | |
| RFP_5800_SLW3030_ATT_6_v1.xlsx | XLSX spreadsheet | |
| RFP_5800_SLW3030_ATT_3_v1.pdf | ||
| RFP_5800_SLW3030_ATT_7_v1.xlsx | XLSX spreadsheet | |
| RFP_5800_SLW3030_PAC1_v2.pdf | ||
| RFP_5800_SLW3030_ATT_6_v2.xlsx | XLSX spreadsheet | |
| RFP_5800_SLW3030_ATT_5_v2.xlsx | XLSX spreadsheet |
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Text version
Cover
The City of Austin
| Request for Proposal # RFP 5800 SLW3030 |
| for |
| Self Funded Dental Plan Administration Services |
Tab 1
BUSINESS ORGANIZATION
| # | Question | Vendor Response |
| 1 | Name of Company? | |
| 2 | Name of Parent Company (if applicable)? | |
| 3 | Location of corporate office? | |
| 4 | Legal form of organization (corporation, partnership, non-profit, etc.)? | |
| 5 | Years of operation in Texas as a dental plan? | |
| 6 | How long has your company provided dental services as outlined in this Proposal? | |
| 7 | Number of participating dental employer group clients under 5,000 lives? Over 5,000 Lives? | |
| 8 | Number of dental public sector clients? | |
| 9 | Total number of dental covered lives in: 2023, 2024 and 2025? | |
| 10 | Has your company experienced any security breaches where Protected Health Information was obtained from your system in the last 24 months? If yes, how long did it take for you to notify impacted participants and their employer? | |
| 11 | Describe any subcontractor relationships your company intends to utilize in the performance of services proposed and how long the relationship has been in place. |
Tab 2
REFERENCES
| Provide a list of three current or previous public-sector clients. Reference contacts must be aware that they are being used and should be agreeable to City interview for follow-up. References will only be contacted if the Proposer is selected as finalist. | |||||
| Agency | Agency Contract Manager Name and Title | Number of Covered Persons | Year Contract Was Awarded and Length | Contact Phone | Contact Email |
Tab 3
| ACCOUNT TEAM INFORMATION | ||||||
| Add rows as necessary | ||||||
| Staff Name, Title and Location Address | Years with the Company | Years Handling Dental | Total Number of Accounts Serviced | Percent of Time Dedicated to the City | Contact Phone | Contact Email |
Tab 4
| CUSTOMER SERVICE | ||
| # | Question | Vendor Response |
| 1 | Location of customer service unit? | |
| 2 | Total number of Customer Service Representatives (CSR)? | |
| 3 | Total number of Spanish-speaking CSRs? | |
| 4 | Target ratio of CSRs to enrolled participants? | |
| 5 | Do you record all incoming calls? | |
| 6 | How many months of claims history are available to CSRs? | |
| 7 | What is the average speed to answer calls in seconds for each year: 2023, 2024, 2025? | |
| 8 | What is the average number of daily calls for each year: 2023, 2024, 2025? | |
| 9 | What is the average number of daily calls per CSR for each year: 2023, 2024, 2025? | |
| 10 | What is the average hold time before a CSR is available for each year: 2023, 2024, 2025? | |
| 11 | What is the percentage of calls abandoned for each year: 2023, 2024, 2025? | |
| 12 | What is the member satisfaction level for each year: 2023, 2024, 2025? | |
| 13 | What is the first call resolution rate for each year: 2023, 2024, 2025? | |
| 14 | What is the average response time for resolving customer inquiries and complaints for each year: 2023, 2024, 2025? |
Tab 5
| SYSTEM CAPABILITIES | ||
| # | Question | Vendor Response |
| 1 | Provide a website link to demo the employee facing website. Include any login information. | |
| 2 | Describe your company’s online website for Covered Persons and/or providers to utilize for eligibility, claim status, ordering ID cards, etc. | |
| 3 | Provide a website link to demo the employer facing website. Include any login information. | |
| 4 | Does your organization have a mobile app available? |
Is the mobile app available in the Play Store and the Apple App Store?
| 5 | Provide the name, description, and any required login information needed to demo the app. |
| 6 | Does the mobile app have the same access to features as the website – e.g., network provider locator, cost estimator, claims tracker, member ID card, etc.? If not, how is it different? |
| 7 | What demograpic or personal data is required for a member to register for an online acount? |
| 8 | Is your application web-based or client-based? |
| 9 | Do you provide web services or custom interfaces to interact with your system? |
| 10 | What is your uptime percentage? |
| 11 | Do you have a disaster recovery plan? |
| 12 | How quickly can your system be up and running in case of downtime? |
| 13 | What is your process for sending encrypted email information? |
| 14 | Can your system send Explanations of Benefit (EOBs) to participants’ email addresses? |
Tab 6
| SELF-FUNDED DENTAL CLAIMS ADMINISTRATION | ||
| # | Question | Vendor Response |
| 1 | Location of claims processing unit? | |
| 2 | Total number of claims processors? | |
| 3 | Target ratio of claims processors to enrolled participants? | |
| 4 | Describe the process for how providers verify eligiblity and submit claims. | |
| 5 | Can your system capture Current Dental Terminology (CDT) procedure codes using the full 5-digit code? | |
| 6 | Do you issue an identification (ID) card per Subscriber or per Covered Person? | |
| 7 | Provide a sample of the management reporting provided on a quarterly and annual basis. |
Tab 7
| PERFORMANCE MEASURES | |||||
| # | Performance Measure | Acceptable Performance | Penalty | Agree | |
| Yes/No | If no, proposed penalty | ||||
| 1 | City’s satisfaction with implementation | 100% | $5,000 paid by end of 1st quarter | ||
| 2 | Plan Documents provided within 30 days of approval from the City | 100% | 4% of annual fees paid by end of 1st quarter | ||
| 3 | Customer service | Must be operational January 1st | $5,000 paid by end of 1st quarter | ||
| 4 | Average apeed to answer telephone calls | 30 seconds or less | 1% of annual fees paid annually | ||
| 5 | Telephone abandonment rate | Less than 3% | 1% of annual fees paid annually | ||
| 6 | First telephone call resolution | At least 80% | 1% of annual fees paid annually | ||
| 7 | Eligibility system updated within two business days of receiving weekly enrollment file. | 99% | .25% annual fees per report up to a maximum of .5% annual fees for each plan year paid quarterly. | ||
| 8 | Eligibility system updated within five business days of receiving Open Enrollment file. | 99% | .25% annual fees per report up to a maximum of .5% annual fees for each plan year paid quarterly. | ||
| 9 | Claims processed within 10 business days of receiving acomplete claim. | Minimum of 90%. | 4% of annual fees paid annually | ||
| 10 | Payment accuracy. | 97% | 2% of annual fees paid annually. | ||
| 11 | Processing accuracy. | 97% | 2% of annual fees paid annually | ||
| 12 | Overall accuracy. | 94% | 2% of annual fees paid annually | ||
| 13 | Initial identification cards for newly eligible Employees and Retirees. | Must be 100% error free and sent within 10 business days from notice of eligibility. | .25% annual fees per occurrence up to a maximum of .5% annual fees for each plan year paid quarterly. | ||
| 14 | Open Enrollment identification cards. | 100% must be received on or before December 31st each year. | .25% annual fee per occurrence up to a maximum of .5% annual fee for each plan year. | ||
| 15 | Quarterly and annual reports provided within 15 business days after the reporting period. | 100% | $1,000 paid monthly | ||
| 16 | Reporting Accuracy | 97% | 2% of annual fees paid annually |
Tab 8
| PROVIDER NETWORK INFORMATION | ||
| # | Question | Vendor Response |
| 1 | Describe your credentialing (and re-credentialing) process(es) for dentists and other facilities. | |
| 2 | How often is each dentist and dental group re-credentialed? | |
| 3 | Is the proposed dental network owned or leased? If leased, who owns the network contracts? | |
| 4 | Do you have the flexibility to move procedures from one benefit category to another? For instance, are you able to move deep sedation for oral surgery from Basic to Major, or vice versa, if directed by the City? | |
| 5 | What is your standard out-of-network payment methodology – percentile of R&C, or MAC? | |
| 6 | What is your standard percentile of R&C for adjudication of out-of-network claims? | |
| 7 | Are you able to adjudicate out-of-network claims, based on the City’s desired percentile of R&C? | |
| 8 | Are you willing to offer an audit allowance? If yes, how much? | |
| 9 | Other than provider directories and access to providers via your website, what quality or practice pattern data about your contracted providers do you make available to plan participants? | |
| 10 | Provide the latest statistics regarding on-site clinical quality audits of your contracted providers. Provide detail on the scope of work for these audits: |
Percent of Dental groups Audited Annually Percent of Dentists Audited Annually Percent of Ancillary Providers Audited Annually 11 Describe your process for electronically auditing the following:
Claims payment accuracy Claims coding accuracy Provider credentials Abusive provider practice patterns Provider sanctions
| 12 | Confirm “right to audit” is at no cost to the plan and included in your standard provider contracts. |
| 13 | Provide a directory of participating providers and facilities in the Central Texas area (Bastrop, Blanco, Burnet, Caldwell, Fayette, Hays, Lee, Llano, Travis and Williamson counties); as well as out of these areas and out of state. Include a link and password to your online provider directory. |
| 14 | Specialty |
| a. | General Dentistry: |
Number of Contracted Dentist Number Accepting New Patients Number of Board Certified Dentist
b. Orthodontist:
Number of Contracted Dentist Number Accepting New Patients Number of Board Certified Dentist
c. Periodontist:
Number of Contracted Dentist Number Accepting New Patients Number of Board Certified Dentist
d. Prosthodontist:
Number of Contracted Dentist Number Accepting New Patients Number of Board Certified Dentist
e. Endodontist:
Number of Contracted Dentist Number Accepting New Patients Number of Board Certified Dentist
f. Pediatric Dentistry:
Number of Contracted Dentist Number Accepting New Patients Number of Board Certified Dentist
g. Other: (please list)
Tab 9
| EXCEPTIONS TO SOLICITATION | ||
| Be advised exceptions to any portion of this Solicitation may jeopardize acceptance of the Proposal. The Proposer must clearly indicate each exception taken and indicate the alternative language. Failure to identify exceptions or proposed changes with a full explanation will constitute acceptance of the Solicitation. The City reserves the right to reject a Proposal containing exceptions, additions, qualifications, or conditions not called for in the Solicitation. | ||
| Requirement | Exceptions | Proposed Change or Alternative |
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