RFP_S-44000-00017296_Assigned Claims Processing Agent Services.pdf

RFP#: S-44000-00017296 Assigned Claims Processing Agent

DAS PS V4.5_March 31, 2023 Page 1 of 30

STATE OF OREGON

COVER PAGE

The Department of Consumer and Business Services

Workers’ Compensation Division

Is issuing this Request For Proposals (RFP) under OregonBuys Bid Number S-44000-00017296 for

ASSIGNED CLAIMS AND

CLAIMS PROCESSING AGENT SERVICES

Date of Issue: June 24, 2026

Bid Opening Date and Time: July 30, 2026 at 2:00 PM Pacific Time

Single Point of Contact (SPC): Franie Wilkins, Procurement and Contract Specialist

Address: 350 Winter Street NE

City, State, Zip: Salem, OR 97301

Phone: 971-375-7759

Email: Franie.j.wilkins@dcbs.oregon.gov

The State of Oregon promotes equal opportunity for all individuals without regard to age, color, disability, marital status, national origin, race, religion or creed, sex or gender, sexual orientation, or veteran status.

mailto:Franie.j.wilkins@dcbs.oregon.gov

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TABLE OF CONTENTS

SECTION 1: GENERAL INFORMATION

1.1 INTRODUCTION

1.2 SCHEDULE

1.3 SINGLE POINT OF CONTACT (SPC)

1.4 OREGONBUYS

SECTION 2: AUTHORITY, OVERVIEW, AND SCOPE

2.1 AUTHORITY AND METHOD

2.2 DEFINITION OF TERMS

2.3 OVERVIEW AND PURPOSE

2.4 SCOPE OF WORK/SPECIFICATIONS

SECTION 3: PROCUREMENT REQUIREMENTS

3.1 MINIMUM QUALIFICATIONS (Pass/Fail)

3.2 MINIMUM SUBMISSION REQUIREMENTS (Pass/Fail)

3.3 PROPOSAL REQUIREMENTS

SECTION 4: SOLICITATION PROCESS

4.1 PUBLIC NOTICE

4.2 PRE-PROPOSAL CONFERENCE

4.3 QUESTIONS / REQUESTS FOR CLARIFICATIONS

4.4 SOLICITATION PROTESTS

4.5 PROPOSAL DELIVERY OPTIONS

4.6 PROPOSAL MODIFICATION OR WITHDRAWAL

4.7 PROPOSAL DUE

4.8 PUBLIC OPENING

4.9 PROPOSAL REJECTION

4.10 EVALUATION PROCESS

4.11 RANKING OF PROPOSERS

SECTION 5: AWARD AND NEGOTIATION

5.1 AWARD NOTIFICATION PROCESS

5.2 INTENT TO AWARD PROTEST

5.3 APPARENT SUCCESSFUL PROPOSER SUBMISSION REQUIREMENTS

5.4 CONTRACT NEGOTIATION

SECTION 6: ADDITIONAL INFORMATION

6.1 COMMITMENT TO DIVERSITY, EQUITY, AND INCLUSION

6.2 CERTIFIED FIRM PARTICIPATION

6.3 GOVERNING LAWS AND REGULATIONS

6.4 OWNERSHIP/PERMISSION TO USE MATERIALS

6.5 CANCELLATION OF RFP; REJECTION OF PROPOSAL; NO DAMAGES

6.6 COST OF SUBMITTING A PROPOSAL

6.7 STATEWIDE E-WASTE/RECOVERY PROCEDURE

6.8 RECYCLABLE PRODUCTS

SECTION 7: Attachments Attachment A - Sample Contract Attachment B - Disclosure Exemption Affidavit Attachment C - Proposer Information And Certification Sheet Attachment D - Reference Check Form Attachment E – Price Proposal Submission Form Attachment F - COBID Certification / Outreach Plan Attachment G - Responsibility Inquiry Attachment H – Key Persons Exhibit Attachment I – Assessment Questions

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SECTION 1: GENERAL INFORMATION

1.1 INTRODUCTION

The State of Oregon, acting by and through the Department of Consumer and Business Services, Workers’ Compensation Division, (“Agency”), is issuing this Request for Proposal (“RFP”) under the provisions of ORS 279B.060 for Assigned Claims and Claims Processing Agent Services related to certain Workers’ Compensation Claims as identified in this RFP and Attachment A, Sample Contract.

Agency intends to solicit and contract for assigned claims and claims processing agent services (see ORS 656.054 and 656.443, respectively). On behalf of Agency, the awarded Contractor will process claims belonging to noncomplying employers, defaulted and insolvent Self-Insured Employers, and decertified Self-Insured Employer groups. Additional details on the Scope of the Services are included in Section 2.4, Scope of Work/Specifications.

Agency anticipates the award of one Contract from this RFP. The anticipated start date for these Services will be December 1, 2026. The initial term of the Contract is anticipated to be five (5) years with options to renew up to a cumulative maximum term of ten (10) years.

The anticipated value of the Services described in this RFP is estimated to be $70,000,000.00 for the cumulative Contract term. This estimated payment amount includes the reimbursement of the awarded Contractor for active claim expenses incurred directly by the awarded Contractor.

Notwithstanding the award of a Contract, Agency may conduct separate solicitations or award project-specific contracts for Services similar to what is described within this RFP using any method allowed by law.

1.2 SCHEDULE

The table below represents a tentative schedule of events. All times are listed in Pacific Time. All dates listed are subject to change. N/A denotes that event is not applicable to this RFP.

Event Date Time

Questions / Requests for Clarification Due July 10, 2026 10:00 AM

Answers to Questions / Requests for Clarification Issued (approx.)

July 15, 2026

RFP Protest Period Ends 7 calendar days prior to RFP Bid Opening Date

Bid Opening (Proposal Due) See RFP cover page

Opening of Proposal July 30, 2026 2:30 PM

Issuance of Notice of Intent to Award (approx.) August 21, 2026

Award Protest Period Ends 7 calendar days after Notice of Intent to Award

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1.3 SINGLE POINT OF CONTACT (SPC)

The SPC for this RFP is identified on the Cover Page, along with the SPC’s contact information.

Proposer shall direct all communications related to any provision of the RFP only to the SPC, whether about the technical requirements of the RFP, contractual requirements, the RFP process, or any other provision.

1.4 OREGONBUYS

OregonBuys is the State of Oregon’s procure-to-pay eProcurement solution. All vendors must be registered in OregonBuys to do business with the state. Registration is free. To create a vendor account, click the blue “Register” button in the top right corner of the OregonBuys website:

https://oregonbuys.gov/bso. For registration assistance see vendor registration guidance.

Vendors are responsible for ensuring that their vendor information is current and correct in OregonBuys. Agency will accept no responsibility for incorrect vendor information.

1.4.1 OregonBuys Resources

• For Assistance with OregonBuys (Vendor help Desk):

o Email: support.oregonbuys@das.oregon.gov o Phone: 1-855-800-5046

• For information on how to register as a Vendor/Supplier in OregonBuys:

Supplier Registration Guide

• For guidelines on how to find an open or closed Bid Solicitation in OregonBuys:

How to Find Bid Solicitation Opportunities

• Detailed instructions on how to submit a Proposal in OregonBuys:

Supplier Bid Solicitation Response

SECTION 2: AUTHORITY, OVERVIEW, AND SCOPE

2.1 AUTHORITY AND METHOD

Agency is issuing this RFP under the authority of the Department of Administrative Services (DAS) delegation REQ-DASOBO-00168875 (as amended), Assigned Claims and Claims Processing Agent Services.

Agency is using the Competitive Sealed Proposal method, pursuant to ORS 279B.060 and OAR 125-247-0260. Agency may use a combination of the methods for Competitive Sealed Proposals, including optional procedures: a) Competitive Range; b) Discussions and Revised Proposals; c) Revised Rounds of Negotiations; d) Negotiations; e) Best and Final Offers; and f) Multistep Sealed Proposals.

2.2 DEFINITION OF TERMS

For the purposes of this RFP, capitalized words are defined in OAR 125-246-0110 or as defined below.

https://oregonbuys.gov/bso mailto:support.oregonbuys@das.oregon.gov https://www.oregon.gov/das/ORBuys/Documents/OregonBuys_Registration_Guide.pdf https://www.oregon.gov/das/ORBuys/Documents/How%20to%20find%20open%20or%20closed%20bids.pdf https://www.oregon.gov/das/ORBuys/Documents/OregonBuys%20Vendor%20Formal%20Solicitation%20Response.pdf

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2.2.1 General Definitions

For the purposes of this RFP and Attachment A, Sample Contract, Exhibit A, Statement of Work, capitalized words are defined in OAR 125-246-0110 or as defined below.

• “Assigned Claims Agent (“ACA”)” as defined in ORS 656.054(9) means an insurer, casualty adjuster or a third party administrator with whom the Director contracts with to manage claims of injured workers of noncomplying employers.

• “Claim” is defined in ORS 656.005(6) and is established on the date of written referral from Agency to Contractor or the date received by Contractor if referred by a third party.

A Claim is an industrial claim for purposes of audit calculation. A new or existing Claim assigned or reassigned to, or received by, Contractor becomes a Claim for purposes of processing upon receipt by the Contractor.

See Exhibit A of Attachment A, Sample Contract for additional “Claim” definitions.

• “Claims Processing Agent” as referenced in ORS 656.443(4)(b) is the entity that processes claims belonging to defaulted and insolvent Self-Insured Employers and decertified Self-Insured Employer groups. The Claims Processing Agent may be the Assigned Claims Agent selected under ORS 656.054.

• “Process Claims” as defined in OAR 436-055-0005(6) means the determination of compensability and management of workers’ compensation claims.

• “Self-Insured Employer” for purposes of these Services includes:

o Any Self-Insured Employer group decertified under the provisions of ORS 656.441, and o Any Self-Insured Employer as defined in ORS 656.005(25) that:

▪ Is in default of payment of compensation to workers or other payments due to the Agency under ORS Chapter 656 and is subject to the procedures set forth in ORS 656.443; or

▪ Has filed for bankruptcy or similar actions for protection from its creditors and cannot make payments due workers; or

▪ Agency is responsible for claims administration for any other reason.

• “Director” means the Director of the Department of Consumer and Business Services or the director’s designee.

• “Noncomplying Employer (“NCE”)” as defined in ORS 656.005(18) means a subject employer that has failed to comply with ORS 656.017.

• “Workers’ Compensation Laws” includes ORS chapter 656 and ORS chapter 654, and the Oregon Administrative Rules adopted under those statutes, as the statutes and rules are amended from time to time.

See Exhibit A of Attachment A, Sample Contract for additional definitions.

2.2.2 Crosswalk of Terms used in OregonBuys

• “Bid Amendment” means “Addendum” or “Addenda”, as defined in OAR 125-246- 0110(1); or any form of notice associated with the solicitation, such as intent to award, cancellation, etc., as set forth in the Bid Amendment.

• “Bid Opening” means “Closing” as defined in OAR 125-246-0100(7). In OregonBuys it is the deadline for submitting Quotes (Bids, Offers, Proposals, or other required responses)

DAS PS V4.5_March 31, 2023 Page 6 of 30 required by a Bid Solicitation.

• “Bid Solicitation” means any form of opportunity, solicitation or notice: Request for Proposal, Invitation to Bid, Request for Quote, Request for Information, etc., including notices (sole source notice, intent to participate, etc.). Each Bid Solicitation has a separate page and ID number in OregonBuys.

• “Opening” means when the Proposals are opened by Agency.

• “Quote” means any form of offer submission by vendors; i.e., Bids, Offers, Proposals, Price Proposals, or any other type of offer required by a Bid Solicitation.

• “Vendor” means any form of business entity registered in OregonBuys.

• “Purchaser” means the single point of contact for this RFP is identified as the “Purchaser” along with Purchaser’s “Info Contact” (including email address) in OregonBuys.

2.3 OVERVIEW AND PURPOSE

2.3.1 Agency Overview and Background

The Department of Consumer and Business Services is Oregon’s largest regulatory agency. It administers state laws and rules and protects consumers and workers in the areas of workers’ compensation, occupational safety and health, financial services, insurance and building codes.

The Workers’ Compensation Division under the Department of Consumer and Business Services, administers, regulates, and enforces the law to protect benefits related to workers' on-the-job injuries and illnesses, while maintaining a predictable yet innovative regulatory environment for businesses. Workers, employers, insurance companies, medical and vocational providers, attorneys, service companies, and others participate in the workers' compensation system. The division is led by the Administrator's Office and is organized into four sections: Performance, Resolution, Operations, and Modernization. Its mission is to “ensure an equitable workers’ compensation system for all.”

2.3.2 Project Overview and Background

Under ORS 656.054, the Director must refer the claim for a compensable injury belonging to a Non-Complying Employer (“NCE”) to an Assigned Claims Agent (“ACA”) for compensation within 60 days of the date the Director has received notice of the claim. This requires Agency to contract with at least one insurer, casualty adjuster, or third party administrator to manage workers' compensation claims of injured workers of employers who do not carry the required workers' compensation insurance for their business.

Under ORS 656.443, the Director may determine the claims processing agent for defaulted or insolvent Self-Insured Employers and decertified Self-Insured Employer groups. ORS

656.443 allows for the claims processing agent for Self-Insured Employers to be the ACA selected under ORS 656.054.

Agency is seeking a Contractor that employs certified claims examiners in Oregon for workers’ compensation claims and who is licensed by Agency’s Division of Financial Regulation to adjust general lines insurance claims. Currently, Agency has approximately 140 NCE claims, 18 defaulted or insolvent Self-Insured Employer claims, and nine decertified Self-Insured Employer group claims being processed. Over the past five fiscal

DAS PS V4.5_March 31, 2023 Page 7 of 30 years, the cost for these claims have averaged $5.7 million annually.

When Agency receives NCE claims from injured workers, Agency refers the claims for processing to an ACA, who then determines compensability and manages compensation in accordance with the requirements of Oregon workers’ compensation law. With few exceptions, an ACA will process claims in the same manner as if processing claims for an insured employer. Similarly, the claims processing agent for any claims belonging to Self- Insured Employers will process claims in same manner as if processing claims for an active, non-defaulted Self-Insured Employer or group.

2.3.3 Purpose

The purpose of this RFP is to solicit responses from qualified Proposers for the processing of certain workers’ compensation claims on behalf of Agency.

The intent is to find a Proposer that demonstrates a level of experience, responsiveness, specialized skill, knowledge, and resources to perform the Services described in this RFP.

Qualifications, performance history, expertise, experience, responsiveness, knowledge and the ability to deliver timely and accurate benefits to injured workers, and the ability to control both claim costs and administrative costs are primary considerations in the selection process. Due to the highly technical nature of some of these tasks, the Proposer with the lowest Price Proposal may not necessarily be selected under this RFP. Agency reserves the sole right to determine the best Proposal.

2.4 SCOPE OF WORK/SPECIFICATIONS

The awarded Proposer will become the Agency’s assigned claims and claims processing agent to provide claims management Services on behalf of Agency for NCEs and Self-Insured Employers, which includes defaulted or insolvent Self-Insured Employers and decertified Self-Insured Employer groups.

See Attachment A, Sample Contract for further details.

SECTION 3: PROCUREMENT REQUIREMENTS

3.1 MINIMUM QUALIFICATIONS (PASS/FAIL)

To be considered for evaluation, Proposal must demonstrate how Proposer meets all requirements of this section:

3.1.1 Proposer Minimum Requirements

3.1.1.1 Proposer must have a minimum of ten (10) years’ experience processing Oregon workers’ compensation claims.

3.1.1.2 Proposer must be an Oregon authorized and registered insurer, casualty adjuster, or third party administrator (i.e., service company) as outlined in ORS 731.036, ORS 744.505, OAR 836-072, and OAR 436-050.

3.1.1.3 Proposer must have an Oregon business location for claims processing Services.

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3.1.1.4 Proposer must have funds available to immediately begin Services once the awarded Contract is effective.

3.1.2 Claims Examiner Requirements

3.1.2.1 Proposer’s claims examiner assigned staff must be certified in Oregon for claims processing.

3.1.2.2 Proposer’s assigned claims examiner staff must have a minimum of three (3) years’ experience.

3.1.3 Key Person Requirements

Proposer must employ or subcontract key person(s) that meet all the requirements in this section. Proposer may submit one or more key person(s) so long as all requirements are met.

3.1.3.1 Must have a minimum of five (5) years’ experience processing disabling workers’ compensation claims within the last seven (7) years.

3.1.3.2 Must have and maintain a valid Oregon certification for claims processing throughout the term of the Contract.

3.1.3.3 Must have primary responsibility for all claims examiner trainee or temporary claims examiner activities related to the determination of compensability and management of a claim including, but not limited to, calculating benefits and authorizing payments to workers.

3.2 MINIMUM SUBMISSION REQUIREMENTS (PASS/FAIL)

3.2.1 Proposal Submissions

To be considered for evaluation, Proposal must contain each of the following elements, further detailed in Proposal Requirements, Section 3.3 below:

Mandatory

• Executive Summary

• Administrative Proposal

• Technical Proposal

• Proposer Information and Certification Sheet (Attachment C)

• Reference Check Form (Attachment D)

• Price Proposal Submission Form (Attachment E)

• COBID Certification / Outreach Plan (Attachment F)

• Responsibility Inquiry (Attachment G)

• Key Persons and Resumes

• Key Persons Exhibit (Attachment H)

• Assessment Questions (Attachment I)

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• Financial Statement/Fiscal Responsibility Statement

Optional

• Disclosure Exemption Affidavit (Attachment B)

• Redacted Proposal

Note: Disclosure Exemption Affidavit (Attachment B) is required only if any part of Proposal is exempt from disclosure under Oregon Public Records Law. See Section 3.3.10 for further details.

3.2.2 Proposal Page Limits

There is no page limit for this Proposal.

3.2.3 Proposal Format and Quantity

Proposal should follow the format and reference the sections listed in the Proposal Requirements Section 3.3. Responses to each section and subsection should be labeled to indicate the item being addressed.

Proposer should submit its Proposal electronically through OregonBuys. Proposer should follow the procedures outlined in Section 4.5 for electronic submission.

The Price Proposal must be submitted as a separate electronic response file.

3.2.4 Authorized Representative

A representative authorized to bind the Proposer must sign the Proposal. Failure of Proposer’s authorized representative to sign the Proposal may result in rejection of the Proposal by Agency.

3.3 PROPOSAL REQUIREMENTS

Proposal must address each of the items listed in this Section 3.3 and all other requirements set forth in this RFP. Proposer shall describe the Goods to be provided or the Services to be performed or both. A Proposal that merely offers to provide the goods or services as stated in this RFP may be considered non-Responsive to this RFP and will not be considered further.

Proposal should not include extensive artwork, unusual printing, or other materials not essential to the utility and clarity of the Proposal. Do not include marketing or advertising material in the Proposal, unless requested. Proposal should be straightforward and address the requests of the RFP. Proposal containing unsolicited marketing or advertising material may receive a lower evaluation score if required information is difficult to locate.

3.3.1 Executive Summary (Mandatory, Scored)

Proposals must include an executive summary, no more than two (2) pages, which condenses and highlights the contents of the Proposal, including an overview of the Proposer's understanding of the contents of the RFP, and a description of how the Proposer generally intends to meet the RFP requirements.

The Executive Summary will be evaluated as per Section 4.10.2 and 4.10.2.1.

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3.3.2 Administrative Proposal (Mandatory, Scored)

Describe in detail Proposer’s experience conducting claims processing services as related to the requested Services.

The Administrative Proposal must document in detail how the Proposer meets the minimum Proposer requirements noted in Section 3.1.1 as well as how Proposer meets and will maintain claims examiner requirements as outlined in Section 3.1.2 and responsibilities in compliance with OAR 436-055-0100.

Proposer should describe knowledge, skills, and experience as related to the requested Services, including knowledge of Oregon Workers’ Compensation laws and rules.

Administrative Proposal must include the number of Oregon certified examiners Proposer will assign to the Contract work.

Proposer must provide their Oregon general lines casualty adjuster license number, including a statement that demonstrates the Proposer has at least ten years’ experience in processing and managing workers’ compensation claims in Oregon.

The Administrative Proposal will be evaluated as per Section 4.10.2. and 4.10.2.2.

3.3.3 Key Persons (Mandatory, Scored)

Specify Key Persons to be assigned to these Services and include a current resume (not to exceed two pages each) for each individual that demonstrates qualifications and experience for the Services described in this RFP. Proposer must document in detail how the Key Person(s) meets the minimum requirements of Section 3.1.3.

Key Persons will be evaluated as per Section 4.10.2. and 4.10.2.3.

3.3.4 Key Persons Exhibit (Mandatory, Not Scored)

Proposer must complete and submit the Key Persons Exhibit, Attachment H. Proposer must list Key People responsible for ensuring the Services provided under the Contract are performed in descending order, starting with the Key Person with the highest qualifications, number one (1) Key Person and so forth.

3.3.5 Financial Statement/Fiscal Stability (Mandatory, Scored)

Briefly describe Proposer’s experience with, and current strategies for, ensuring that the Proposer conducts business in a fiscally responsible manner and remains financially solvent through the proposed Contract term. Identify the individuals who have fiscal responsibilities. Any Proposer that has generated financial statements shall submit copies for the most recent period. If financial statements have not been generated, then Proposer may submit an audit or fiscal review by a Certified Public Accountant.

Proposers must verify that they have adequate cash flow available and that the Proposer is willing to expend amounts adequate to meet the weekly obligations before being reimbursed by Agency. The history over the last five years reflects an average weekly cash outflow of about $110,000.00. Individual program amounts have varied from $0.00 to over $500,000.00 per week.

Agency will not provide any advanced fund amounts to the awarded Proposer.

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3.3.6 Technical Proposal (Mandatory, Scored)

Provide a comprehensive management plan that the Proposer intends to follow, including procedures to meet the requirements of Section 2.4, Scope of Work/Specifications, including Exhibit A, Statement of Work of Attachment A, Sample Contract. Illustrate how the plan will serve to coordinate and accomplish the work, including but not limited to meeting the requirements of the Services.

Describe the procedures Proposer will use in making determinations and strategy to meet statutory requirements. Proposal must include details on Proposer’s process for maintaining confidentially of personal claimant data used for these Services.

Proposers must describe their protocol, expectations, and demonstrated experience with the following:

• Best Practices: Establishing contact and communication with workers and responsible parties; reserving workers’ compensation claims; investigations of worker subjectivity and claim compensability; and management of contested cases.

• Cost Containment: Controlling administration costs, indemnity, medical case management; minimizing litigation; assuring third party recovery, and providing bill review.

• Performance: Ensuring timely and accurate claims processing consistent with Oregon’s statutory and administrative rule requirements; providing claims processing reporting, and other required business reporting.

• Staffing: Caseload management, ensuring staff experience and expertise, and responsiveness to inquiries from claimant, Agency, and other parties.

Proposal must include details on how Proposer plans to assume responsibility and management of existing claims, including timelines for preventing delays for Oregon workers. This process will be discussed and approved by Agency during Contract negotiations with the awarded Proposer.

Proposal must include details of Proposer’s data back up and disaster recovery plan for both electronic and hard copy files.

The Technical Proposal will be evaluated as per Section 4.10.2. and 4.10.2.4.

3.3.7 Assessment Questions (Mandatory, Scored)

Proposer must complete and submit the Assessment Questions, Attachment I. Attachment I must be submitted as a separate document from the remainder of the Proposal.

The Assessment Questions will be evaluated as per Section 4.10.2.4.

3.3.8 Proposed Compensation Plan (Mandatory, Scored)

The successful Proposer will be reimbursed for all active claim expenses incurred. Agency requests that Proposers include a Proposed Compensation Plan that allows for a reasonable profit. Since reimbursement will cover the costs of active claim expenses incurred by the awarded Contractor, propose an active claim fee and administrative fees (see Section 3.3.9 below), and any appropriate additional fees that will ensure Proposer is fairly compensated for the time, effort, and resources associated with processing claims. Include details of what services/activities are included in the proposed payment methods.

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Proposer must submit a detailed outline of the compensation plan and justification for the proposed plan. Do not include any dollar amounts in this Proposed Compensation Plan, just the outline and justification of the plan for the evaluation. Pricing must only be included in the Price Proposal, Section 3.3.9.

Agency will evaluate the Proposed Compensation Plan for financial sustainability and completeness of the approach.

The Proposed Compensation Plan will be evaluated as per Section 4.10.2.7.

3.3.9 Price Proposal (Mandatory, Scored)

Agency is electing not to have quotes entered in OregonBuys on the items tab directly. For OregonBuys purposes only, when completing the quote process on the items tab, enter a cost of $1.00.

Proposer must submit one (1) Price Proposal Submission Form, Attachment E. It must be submitted as a separate document from the remainder of the Proposal. Pricing must not be included in any other Proposal sections.

For evaluation purposes, provide a Price Proposal for the following fees:

1. Active Claim Fee

Include an Annual Active Claim Fee for all Unallocated Claims Services and Statistical Report Services.

See Attachment A, Sample Contract, Exhibit A, Section 4.6(1) for more information.

2. Administrative Fee

Include an Administrative Fee for the following Allocated Claims Service Costs.

• Investigative fees, such as surveillance and alive and well checks

• Index fees

• Claim closure specialist services

• Vocational rehabilitation fees

• Attorney consultation

See Attachment A, Sample Contract, Exhibit A, Section 4.6(2) for more information.

Price Proposals must be firm for a period of 180 days from the Bid Opening of the RFP while negotiating the awarded Contract.

If Agency requires clarification of any pricing information included in the Proposer’s Price Proposal, Proposer must provide clarification within two (2) business days (Monday – Friday, State observed holidays excluded) or the Proposal may be rejected as non-responsive at the sole discretion of the Agency.

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The Price Proposal will be evaluated as per Section 4.10.5.

3.3.10 Disclosure Exemption Affidavit (Optional, Not Scored)

All Proposals are public record and are subject to public inspection after Agency issues the Notice of the Intent to Award. Attachment B is required only if Proposer believes any of its Proposal is exempt from disclosure under Oregon Public Records Law (ORS 192.311 through 192.478).

If Proposer believes any of the Proposal is exempt from public disclosure:

• Proposer shall complete and submit the Disclosure Exemption Affidavit, Attachment B.

• Proposer shall submit a fully redacted version of its Proposal, clearly identified as the redacted version. This is in addition to submitting a non-redacted Proposal.

• Proposer shall mark as “Confidential” in OregonBuys all attachments Proposer believes are exempt from public disclosure.

Proposer is cautioned that cost information generally is not considered a trade secret under Oregon Public Records Law and identifying the Proposal, in whole, as exempt from disclosure is not acceptable. Agency advises each Proposer to consult with its own legal counsel regarding disclosure issues.

If Proposer fails to identify the portions of the Proposal that Proposer claims are exempt from disclosure, Proposer has waived any future claim of non-disclosure of that information.

3.3.11 Proposer Information and Certification Sheet (Mandatory, Not Scored)

Proposer shall complete and submit Attachment C, Proposer Information and Certification Sheet. The Proposer Information and Certification Sheet must bear the Proposer’s authorized representative’s Signature.

Failure to demonstrate compliance with Oregon Tax Laws and sign the Proposer Information and Certification Sheet may result in a finding of non-Responsibility.

3.3.12 References (Mandatory, Scored)

Proposer must provide three (3) references on the provided Reference Check Form, Attachment D, from current or former client firms for similar Services performed within the last two (2) years. References must be able to verify the quality of previous, related work.

Proposer is responsible to ensure information provided is accurate and relevant to these requested Services. Agency assumes no responsibility for incorrect contact information.

Agency may check to determine if references provided support Proposer’s ability to comply with the requirements of this RFP. Agency may use references to obtain additional information, or verify any information needed. Agency may contact any reference (submitted or not) to verify Proposer’s qualifications.

Proposer must submit the Reference Check Form, Attachment D, with reference names and contact information. Agency will make three (3) attempts to contact each of the references provided by the Proposer. If these attempts are unsuccessful, the Proposer will receive a score of zero (0) for that reference.

References will be evaluated as per section 4.10.4.

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Note: Three (3) references are required. If the Proposer submits more than three (3) references, only the first three (3) references will be used.

3.3.13 Certified Disadvantaged Business Outreach Plan (Mandatory, Not Scored)

Proposer must complete and submit the Certified Disadvantaged Business Outreach Plan, Attachment F. See Section 6.2 for further details.

Proposer may note the response as “Not Applicable (N/A)” if appropriate.

3.3.14 Proposer Responsibility Inquiry (Mandatory, Not Scored)

Proposer must complete and submit the Proposer Responsibility Inquiry, Attachment F. See Section 4.10.1.2 for further details.

SECTION 4: SOLICITATION PROCESS

4.1PUBLIC NOTICE

The RFP and attachments are published in the State of Oregon’s electronic procurement system OregonBuys at https://oregonbuys.gov/. Documents will not be mailed to prospective Proposers.

Modifications, if any, to this RFP will be made by written Bid Amendment(s) published in OregonBuys. Prospective Proposer is solely responsible for checking OregonBuys to determine whether or not any Bid Amendment(s) have been issued. Bid Amendment(s) are incorporated into the RFP by this reference.

In addition, Agency reserves the right to post information about this RFP on their website, Department of Consumer and Business Services under News & Information.

4.2 PRE-PROPOSAL CONFERENCE

A Pre-Proposal conference will not be held for this RFP.

4.3 QUESTIONS / REQUESTS FOR CLARIFICATIONS

All inquiries, whether relating to the RFP process, administration, deadline or method of award, or to the intent or technical aspects of the RFP must:

• Be delivered to the SPC via email;

• Reference the OregonBuys bid number;

• Identify Proposer’s name and contact information;

• Refer to the specific area of the RFP being questioned (i.e. page, section and paragraph number); and

• Be received by the due date and time for Questions/Requests for Clarification identified in the Schedule in Section 1.2.

https://oregonbuys.gov/ https://www.oregon.gov/DCBS/Pages/index.aspx

DAS PS V4.5_March 31, 2023 Page 15 of 30

4.4 SOLICITATION PROTESTS

4.4.1 Protests to RFP

Prospective Proposer may submit a Written protest of anything contained in this RFP, including but not limited to, the RFP process, Specifications, Scope of Work, and the proposed Sample Contract. This is prospective Proposer’s only opportunity to protest the provisions of the RFP, except that Proposer may protest Bid Amendment(s) as provided below and Proposer may take exception to the terms and conditions of the Sample Contract marked as negotiable as set forth in the Contract Negotiations Section 5.4.

4.4.2 Protests to Bid Amendment(s)

Prospective Proposer may submit a Written protest of anything contained in a Bid Amendment. Protests to a Bid Amendment, if issued, must be submitted by 5:00 p.m. Pacific Time on the second Business Day following the issuance of the Bid Amendment or the date/time specified in the Bid Amendment, or they will not be considered. Protests of matters not added or modified by the Bid Amendment will not be considered.

4.4.3 Requirements for Protests

All protests must:

• Be delivered to the SPC via email;

• Reference the OregonBuys bid number;

• Identify prospective Proposer’s name and contact information;

• Be sent by an authorized representative;

• State the reason for the protest, including:

o the grounds that demonstrate how the Procurement Process is contrary to law, Unnecessarily Restrictive, legally flawed, or improperly specifies a brand name;

and o evidence or documentation that supports the grounds on which the protest is based; and

• State the proposed changes to the RFP provisions or other relief sought.

Protests to the RFP must be received by the due date and time identified in the Schedule.

Protests to a Bid Amendment must be received by the due date identified in the Bid Amendment.

4.5 PROPOSAL DELIVERY OPTIONS

Proposer is solely responsible for ensuring its Proposal is received by the SPC in accordance with the RFP requirements before Bid Opening. Agency is not responsible for any delays in mail or by common carriers or by transmission errors or delays, or for any mis-delivery for any reason. A Proposal submitted by any means not authorized below will be rejected. The following delivery options are permitted for this RFP:

DAS PS V4.5_March 31, 2023 Page 16 of 30

4.5.1 Delivery through OregonBuys

OregonBuys is the only delivery option permitted for this RFP. Proposal submission should be electronically through OregonBuys at OregonBuys.gov. Detailed instructions on how to submit a Proposal can be found below in Section 4.5.1.1.

Proposer must submit one original copy of its Proposal and all other submittal requirements.

Documents must be submitted using one of the following formats: Adobe Acrobat (pdf), Microsoft Word (docx), or Microsoft Excel (xlsx), following the layout indicated below.

Responses to each section and subsection should be labeled to indicate the item being addressed.

Submissions can be a pdf, zip file, etc., but there should only be a total of four or five separate attachments. Each attachment must include the appropriate documents as indicated below.

• Submission 1: Proposal - Sections 3.3.1 through 3.3.6 and Section 3.3.8

• Submission 2: Assessment Questions – Section 3.3.7

• Submission 3: Price Proposal - Section 3.3.9

• Submission 4: Attachments Group - Sections 3.3.11 through 3.3.14

• Submission 5: Redacted Proposal – Section 3.3.10, if applicable

Agency requests that you do not password protect your original submissions. If preferred, provide an additional copy of your submissions that are not password protected. Contact the SPC if you have any questions or concerns.

Failure to demonstrate compliance with these submission requirements may result in a finding of non-Responsiveness.

4.5.1.1 OregonBuys Resources

• For Assistance with OregonBuys (Vendor help Desk):

Email: supplierssupport@periscopeholdings.com

Phone: 1-855-800-5046

• For information on how to register as a Vendor/Supplier in OregonBuys:

https://www.oregon.gov/das/ORBuys/Documents/SupplierRegistrationQuickSteps .pdf

• For guidelines on how to find an open or closed Bid Solicitation in OregonBuys:

https://www.oregon.gov/das/ORBuys/Documents/How%20to%20find%20open% 20or%20closed%20bids.pdf

• Detailed instructions on how to submit a Proposal in OregonBuys:

https://www.oregon.gov/das/ORBuys/Documents/OregonBuys%20Vendor%20Fo rmal%20Solicitation%20Response.pdf

4.6 PROPOSAL MODIFICATION OR WITHDRAWAL

If a Proposer wishes to make modifications to a submitted Proposal, the Proposer must submit https://oregonbuys.gov/bso/view/login/login.xhtml mailto:supplierssupport@periscopeholdings.com https://www.oregon.gov/das/ORBuys/Documents/SupplierRegistrationQuickSteps.pdf https://www.oregon.gov/das/ORBuys/Documents/SupplierRegistrationQuickSteps.pdf https://www.oregon.gov/das/ORBuys/Documents/How%20to%20find%20open%20or%20closed%20bids.pdf https://www.oregon.gov/das/ORBuys/Documents/How%20to%20find%20open%20or%20closed%20bids.pdf https://www.oregon.gov/das/ORBuys/Documents/OregonBuys%20Vendor%20Formal%20Solicitation%20Response.pdf https://www.oregon.gov/das/ORBuys/Documents/OregonBuys%20Vendor%20Formal%20Solicitation%20Response.pdf

DAS PS V4.5_March 31, 2023 Page 17 of 30 its modification in one of the authorized methods listed in Section 4.5 (Proposal Delivery Options). To be effective the modification must include the OregonBuys bid number and be submitted to the SPC prior to Bid Opening.

If a Proposer wishes to withdraw a submitted Proposal, it must submit a Written notice signed by an authorized representative of its intent to withdraw to the SPC via email prior to the Bid Opening in accordance with OAR 125-247-0440. To be effective the notice must include the OregonBuys bid number.

4.7 PROPOSAL DUE

A Proposal (including all required submittal items) must be received by the SPC on or before Bid Opening. All Proposal modifications or withdrawals must also be received prior to Bid Opening.

A Proposal received after Bid Opening is considered LATE and will NOT be accepted for evaluation. A late Proposal will be destroyed.

4.8 PUBLIC OPENING

There will be no public Opening of Proposals. Proposals received will not be available for inspection until after the evaluation process has been completed and the Notice of Intent to Award is issued pursuant to OAR 125-247-0630. However, Agency will record and make available the identity of all Proposers after Opening via Bid Amendment in OregonBuys.

4.9 PROPOSAL REJECTION

Agency may reject a Proposal for any of the following reasons:

• Proposer fails to substantially comply with all prescribed RFP procedures and requirements, including but not limited to the requirement that Proposer’s authorized representative sign the Proposal.

• Proposer has liquidated and delinquent debt owed to the State or any department or agency of the State.

• Proposer fails to meet the responsibility requirements of ORS 279B.110.

• Proposer makes any contact regarding this RFP with State representatives such as State employees or officials other than the SPC or persons authorized by the SPC, or inappropriate contact with the SPC.

• Proposer attempts to influence a member of the Evaluation Committee.

• Proposal is conditioned on Agency’s acceptance of any other terms and conditions or rights to negotiate any alternative terms and conditions that are not reasonably related to those expressly authorized for negotiation in the RFP or Bid Amendment(s).

4.10 EVALUATION PROCESS

4.10.1 Responsiveness and Responsibility Determination

4.10.1.1 Responsiveness determination

A Proposal received prior to Bid Opening will be reviewed to determine if it is

DAS PS V4.5_March 31, 2023 Page 18 of 30

Responsive to all RFP requirements including compliance with Section 3.1, Minimum Qualifications and Section 3.2, Minimum Submission Requirements. If the Proposal is unclear, the SPC may request clarification from Proposer. However, clarifications may not be used to rehabilitate a non-Responsive proposal. If the SPC finds the Proposal non- Responsive, the Proposal may be rejected; however, Agency may waive mistakes in accordance with OAR 125-247-0470.

4.10.1.2 Responsibility Determination

Agency will determine if an apparent successful Proposer is Responsible prior to award and execution of the Contract. Proposers must submit a signed Responsibility Inquiry form, Attachment G, with Proposal.

At any time prior to award, Agency may reject a Proposer found to be not Responsible.

4.10.2 Evaluation Criteria

Proposals received on time and meeting all Responsiveness requirements will be independently evaluated by members of an Evaluation Committee. Evaluation Committee members may change and Agency may have additional or fewer evaluators for optional rounds of competition. The Evaluation Committee will evaluate Proposals in accordance with the evaluation procedures set forth in OAR 137-047-0600 through 137-047-670, ORS 279A and ORS 279B.

Evaluators will assign a score, 0 through 100 as specified in Section 4.10.3, Point and Score Calculation, for each evaluation criterion listed below in this Section 4.10.2.

SPC may request further clarification to assist the Evaluation Committee in gaining additional understanding of a Proposal. A response to a clarification request may only clarify or explain portions of the already submitted Proposal and may not contain new information not included in the original Proposal.

4.10.2.1 Evaluation Item 1: Executive Summary (50 Points)

(1) How well does Proposer demonstrate a clear understanding of the Scope of Work and the Services being requested in this RFP? (25 Points)

(2) How well does Proposer describe how they generally intend to meet the RFP requirements? (25 Points)

4.10.2.2 Evaluation Item 2: Administrative Proposal (300 Points)

(1) How well does Proposal demonstrate how Proposer meets the minimum requirements of Section 3.1.1? (100 Points)

(2) How well does Proposer demonstrate compliance with OAR 436-055-0100 as related to claims examiners? (150 Points)

(3) How many Oregon certified examiners will Proposer assign to the Services? (50 Points)

DAS PS V4.5_March 31, 2023 Page 19 of 30

4.10.2.3 Evaluation Item 3: Key Persons (250 Points)

(1) How well does Proposer demonstrate how Key Persons meet the minimum requirements of Section 3.1.3? (150 Points)

(2) How many years have Key Person(s) been employed with Proposer? (100 Points)

4.10.2.4 Evaluation Item 4: Financial Statement / Fiscal Responsibility (250 Points)

(1) How well does Proposer demonstrate fiscal responsibility expectations for the anticipated Contract term? (100 Points)

(2) How well does Proposer verify that they have adequate cash flow available and that the proposer is willing to expend amounts adequate to meet the weekly obligations before being reimbursed by Agency? (150 points)

4.10.2.5 Evaluation Item 5: Technical Proposal (1,150 Points)

(1) How well does Proposal demonstrate Proposer’s procedures for intake of claim referrals, investigating and determining eligibility of benefits, calculating benefits?

(200 Points)

(2) What method of communication does Proposer utilize to communicate with claims management providers, injured workers, and the Agency? (100 Points)

(3) How well does Proposal demonstrate Proposer’s acknowledgement of setting up and maintaining a specifically funded account for the payment of covered claims?

(50 Points)

(4) How well does Proposal demonstrate Proposer’s plan for assuming the management and payments of existing claims? (150 Points)

(5) How well does Proposal describe Proposer’s process for maintaining confidentiality of personal claimant data? (200 Points)

(6) How well does Proposal demonstrate Proposer’s data back up and disaster recovery plan? (150 Points)

(7) How well does Proposal demonstrate Proposer’s security for hard copy records?

(150 Points)

(8) How well does Proposal demonstrate Proposer’s security for electronic records?

(150 Points)

4.10.2.6 Evaluation Item 6: Assessment Questions (400 Points)

For Evaluation Item 6, scores will either be a “0” for incorrect or “100” for correct.

(1) Question 1 (50 Points)

(2) Question 2 (50 Points)

(3) Question 3 (50 Points)

DAS PS V4.5_March 31, 2023 Page 20 of 30

(4) Question 4 (50 Points)

(5) Question 5 (50 Points)

(6) Question 6 (50 Points)

(7) Question 7 (50 Points)

(8) Question 8 (50 Points)

4.10.2.7 Evaluation Item 7: Proposed Compensation Plan (300 Points)

(1) How well does Proposer outline a Proposed Compensation Plan that aligns with the requested Services? (100 Points)

(2) How well does the Proposed Compensation Plan align with Section 3.3.8 and provide a complete approach? (100 Points)

(3) How well does the Proposed Compensation Plan include details to help control costs over the Contract term? (100 Points)

4.10.2.8 Evaluation Item 8: Overall Proposal (25 points)

(1) How easy was the required information on the Proposal to find and was it clearly identified? (25 Points)

4.10.3 Point and Score Calculations

4.10.3.1 Score Calculations

Evaluators will assign a score, as specified in Section 4.10.3, Point and Score Calculation, for each evaluation criterion listed in Section 4.10.2.

Scores are the values (0 through 100) assigned by each evaluator.

Evaluation Committee Member’s evaluation (scores) of a Proposal; in light of the criteria described in Sections 3.3 and 4.10 is based on the following explanations:

Evaluation Rating Scale for each evaluation criteria listed in

Section 4.10.2 and 4.10.4

Relative

Score Scale

EXPLANATION

81 – 100

OUTSTANDING - Response meets all requirements and has demonstrated in a clear and concise manner a thorough knowledge and understanding of the subject matter and project. The Proposer provides insight into its expertise, knowledge, and understanding of the subject matter.

DAS PS V4.5_March 31, 2023 Page 21 of 30

61 – 80 VERY GOOD – Response demonstrates above average knowledge and ability with no apparent deficiencies noted. Response provides useful information, while showing experience and knowledge within the category.

41 – 60

ADEQUATE – Response meets all requirements in an adequate/average manner. Response demonstrates an ability to comply with guidelines, parameters, and requirements with no additional information put forth by the Proposer.

21 – 40 FAIR – Proposer meets minimum requirements in a below average manner and does not demonstrate sufficient knowledge of the subject matter.

0 – 20 RESPONSE OF LITTLE TO NO VALUE – An unacceptable response that does not meet some or all the requirements set forth in the RFP. Proposer has not demonstrated knowledge of the subject matter.

4.10.3.2 Point Calculations

Points are the total possible for each evaluation criteria as listed Section 4.10.2.

Points are calculated as follows:

Evaluators will evaluate each Proposal and assign a score, 0 – 100 per evaluation criterion as per the rating scale in Section 4.10.3.1. For point calculation purposes, scores are entered as a percentage (i.e., an evaluation score of 75 is calculated as 75%).

➢ Example:

Proposer A receives an evaluation score of 75 (0 – 100) for a criterion worth 50 points. 75% (score) is multiplied by 50 (points possible) for 38 points out of the possible 50 points (whole numbers only) for that evaluation criterion. This method is used for each evaluation criterion, per evaluator.

The SPC will total the points for each evaluation criterion by Evaluator. The average of all the evaluator’s total points will be the Proposer’s Points. This is calculated by dividing the total points, by the number of evaluators.

➢ Example:

The points possible for the technical proposal is 150. There are 3 evaluators.

Proposer A receives points of 125, 134, and 145 for a total of 404. 404 is divided by 3 (number of evaluators) for the points value of 135. Proposer A’s points will be 135 out of 150 for the technical proposal.

4.10.4 References (50 Points)

Proposer must provide references that can describe Proposer’s performance to following questions:

(1) Describe the timeliness and accuracy of Proposer’s services.

(2) Describe the clarity and quality of the work product and communications Proposer had with your firm.

(3) Describe your experience with the Proposer’s compliance of specifications and contractual obligations.

DAS PS V4.5_March 31, 2023 Page 22 of 30

(4) Describe your experience with Proposer’s workers’ compensation claims processing services?

(5) How likely would you be to use Proposer’s services again? Please explain.

Proposer must submit reference names and contact information on Attachment D. Proposer is responsible to ensure information provided is accurate and relevant to these requested Services. Agency assumes no responsibility for incorrect contact information.

Agency will make three (3) attempts to contact each of the references provided by Proposer.

If these attempts are unsuccessful, Proposer will receive a score of zero for that reference.

The Evaluation Committee will evaluate the Proposer on the reference responses.

Evaluators will assign one total…