RFP S-44300-00010245 Final Questions and Answers.pdf

RFP S-44300-00010245 Final Questions & Answers

Questions & Answers

Question 1- Avg. Monthly Deposits?

Answer:

Oregon State Public Health Laboratory (OSPHL) is not sure whether the question is asking about the average number of deposits or the revenue from the deposits per month.

• OSPHL does not have ready access to the number of deposits into our accounts per month.

• For fiscal year 2025, OSPHL communicable disease services monthly deposits averaged approximately $52,900, based on date of service, not posting date.

o Some payments for the fiscal year are still being received.

o This represents billings to and payments from approximately 115 submitting facilities and 50 payers.

• Newborn bloodspot screening services deposits are not currently managed by the vendor under this solicitation but may be added in the future.

Question 2- The Laboratory Information System (LIS) replacement project has selected LabVantage. Will you continue to deliver data in a flat file to us?

Answer:

• The current plan is to continue to export a flat file for delivery of lab services, insurance, and claims information to the chosen proposer regardless of the LIS in use.

• Data headers and elements within the file may change depending on the LIS. For this reason, the RFP mentions that the format of the file may change during the project period (2.4.1.7.c.).

Question 3- What is the Order Management System?

Answer:

• The OSPHL communicable disease services test orders and insurance information are currently entered into the Orchard Outreach (formerly Orchard Copia) data system.

o The flat file (.csv) containing testing and claim data for the vendor is currently exported from Orchard Harvest.

• Newborn bloodspot screening orders are currently entered into the Neometrics data system.

Question 4- What are your Top 5 Denials?

The most frequent five denial reasons for fiscal year 2025 are as follows:

Transaction Code

Description

22 This care may be covered by another payer per coordination of benefits.

24 Charges covered under a cap agreement 31 Patient cannot be identified as our insured.

109 Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor.

146 Diagnosis was invalid for the date(s) of service reported

Question 5- Can you provide your Current Accounts Receivable (AR) split by aging between insurance and patient?

Answer:

• OSPHL does not bill patients directly, only private and public payers and the facilities that submit specimens to the laboratory (often called submitters).

• Below is a table showing total current outstanding aging by billed date for Submitters, Medicaid, and Commercial (includes Medicare) payers:

Total Aging by Billed Date (Data as of 09/17/2025) Insurance Current 31–60 61–90 91–120 >120 Total Submitter $17,610.46 $15,782.31 $6,234.61 $2,924.22 $18,773.76 $61,325.36 Medicaid $20,435.11 $2,818.97 $2,053.26 $2,229.78 $55,195.48 $82,732.60 Commercial $4,546.24 $1,449.17 $1,215.20 $1,140.37 $20,495.31 $28,846.29 Total $42,591.81 $20,050.45 $9,503.07 $6,294.37 $94,464.55 $172,904.25

Question 6- Can you provide your in-Network Percentages?

• This question is being answered assuming that the Proposer is inquiring about the health plans’ share of payment versus the patient’s share (e.g., co-pay or coinsurance).

• OSPHL’s most frequent payers are Medicaid plans for which there is no patient cost sharing permitted.

• A smaller percentage of claims are billed to Medicare and Commercial payers. Because OSPHL does not bill patients directly, our laboratory does not track in-network percentages.

Question 7- What is your average Monthly in-bound call volume?

OSPHL does not have data on the volume of inquiries received by our contracted billing vendor.

Question 7.1- What is the expectation in-bound and out-bound?

Answer:

• OSPHL does not have data on the volume of inquiries received or responded to by our contracted billing vendor.

• The selected proposer can likely anticipate that the volume of client services activities would be greater during the Stabilization Phase and early Ongoing Services, and following any substantive changes.

Question 8- What is the expectation of work for the unbillable claims and what is the expectation for reimbursement to the vendor for the work on these claims?

Answer:

• Using the OSPHL billing rules, claims determined to be non-billable are to be reported on OSPHL reports. This is described primarily in RFP section 2.4.1.6.a.x.

• Attachment L, Example OSPHL Billing Rules, also details situations when a claim would not be billable and therefore reported to OSPHL.

• Reimbursement to a vendor for this activity is to be included in the Proposers’ price proposal.

Question 9- Are you expecting any delays in the go-live due to government shutdown?

Answer:

OSPHL does not currently foresee delays to go-live due to the Federal government shutdown.

Question 9.1- Has there been an impact to revenue due to government shutdown? Do you anticipate revenue impact?

Answer:

• At this time, the Federal government shutdown has not affected OSPHL programming or revenue.

• Foreseen impacts are more likely to affect non-billable services than those that are billable and generate revenue through the billing vendor’s activities. Unforeseen impacts are always possible.

Question 10- How many Full-Time Equivalent (FTE) support billing today?

What are your costs associated with these FTEs?

Answer:

It is unclear to OSPHL whether the Proposer is inquiring about FTE and costs supporting the activities within the laboratory or with the current vendor.

If within the laboratory:

• OSPHL’s Contract Administrator on the project routinely spends an approximate average 0.05 FTE supporting billing and OSPHL-level client services billing-related activities. This FTE flexes significantly based on project needs.

• Additional OSPHL staff enter insurance data at the time of specimen receipt, are cross-trained to support some contract administration and OSPHL-level client service activities, and Oregon Health Authority Office of Financial Services liaison tasks.

• OSPHL does not specifically track staffing costs related to billing activities.

If with the current vendor:

• OSPHL does not have data on how many total FTE are assigned to the project with the current billing vendor.

• The current vendor contract has a not-to-exceed amount of $165,000 per year.