Responses_to_Questions_9-30-2014.pdf

RESPONSES TO QUESTIONS 9-30-2014

Section Question Responses I Statement of Work, This section states, "The Contractor shall page 15, describe how it would implement its services and Implementation and train BOP staff in the use ofthe bill adjudication Training system. The Contractor will provide a firm fixed per claim price, inclusive of any and all training and one-time start-up costs." Is the cost for training to be combined with all other start up costs and included in CLIN 0006 (One time start up costs)?

Training should be combined with all other start-up costs.

2 Attachment II, In Attachment II, page II the BOP states, ""The

Statement of Work, contractor shall describe their customer support page II , Customer service program for institutions with questions Service about specific EOBs as well as for healthcare providers regarding incorrect claims (i.e., EDI rejections, HIPAA critical issues)." Can the BOP clarifY that the contractor will not provide a full service customer service call center for providers and that questions from providers are to be limited to technical questions related to the electronic submission of their claims (i .e. , technical edits from the EDI submission process, HIP AA coding edits from the EDI submission process)? Questions from providers should be limited to technical questions related to the submission of claims.

3 Attachment II , In Attachment II, page II the BOP states, Statement of Work, "Customer support must be provided during page I I, Customer normal business hours (Monday-Friday, 7:30 am Service Eastern Time to 4:00 pm Hawaii-Aleutian

Standard Time) for all institutions." Can the BOP confirm that the contractor shall operate within the time zones where the BOP has implemented institutions? For example, until such time that institutions in Hawaii are "live" there is no need for the call center to be available Contractor customer service availability is expected only until 4:00pm Hawaii Aleutian Standard Time. for institutions that are (and, will be in the future) !

participating in the adjudication process.

4 Attachment II, In Attachment II, page I, the BOP indicates it Statement of Work, "currently provides healthcare to more than page I, Background; 220,000 inmates in more than 119 prisons page 15, (institutions) geographically dispersed

Implementation of the service at each institution is Implementation and throughout the contiguous United States, Hawaii, Training and Puerto Rico." On page 15, the BOP states, mandated by when the comprehensive medical service

"An implementation schedule will be setup at the contract is awarded and all necessary requirements are met.

beginning of each option period." Could the BOP A timeline or schedule cannot be provided by option period provide a timeline or schedule by option period at this time, since we do not know when the institution's outlining when all I 19 institutions dispersed pending contract will be awarded. Once the medical claim throughout the contiguous United States, Hawaii, adjudication contract is awarded, we can provide a and Puerto Rico will transition under this schedule for the base year to include the present institutions contract? receiving the service and may include institutions that had a comprehensive medical contract awarded. As the option years are renewed, we can provide a schedule of institutions with awarded contracts and pending contracts.

5 Attachment II , Can you provide more detail on the Good Faith Statement of Work, Estimate Process for the Bureau of Prisons?

page 12, Quality The authorization process is explained in detail in the SOW

Assurance 3-5 .

6 Attachment II , Statement of Work, Please provide more detail on pre-authorizations, All episodes of care require an authorization of service, page 3, which procedures require them and more detail including Medicare-based services performed on-site at a

Preauthorization on the process for BOP? BOP institution.

8 General Do you have any workflow diagrams or more details on the current process? See attached.

9 General If a prisoner is pre-approved for a surgical procedure, does each claim for the episode of care (inpatient, surgeon, anesthesia, assistant, etc.) constitute a separate claim for contractor Each claim for an episode of care constitutes a separate n"iml- · numo<;P.<;? claim for reimbursement purposes.

10 General How many phone calls for assistance is the DOJ estimating per month? This is highly variable as it is impossible to foresee at this time the number of future calls. However, based on the current number of institutions (22) participating in the adjudication process, there are approximately !50 call per month.

II General What percentage of pre-authorizations is the DOJ estimating will not be approved? This is The BOP will only send authorizations for services that are important since the contractor will not be pre-approved by the institution Utilization Review reimbursed for pre-authorization requests, only Committee; the percentage of non-approved authorizations for processed claims. should be zero.

12 General Is the DOJ expecting the contractor to work with each provider to submit EDI claims, or will the DOJ provide a bridge or clearinghouse function to forward EDI claims to the contractor? The BOP expects the contractor to work directly with each

[provider regarding the submission ofEDI claims.

13 General Is the DOJ expecting the contractor to receive and data enter paper claims? Is a portal where There will be instances in which paper claims are the provider can data enter the claim acceptable? submitted and the contractor will be expected to accept those paper claims; however, this will be the exception.

15 General Will the new contractor be responsible for As per the SOW, the out-going contractor shall complete honoring the outgoing contractor' s good faith all good faith estimates within three working days prior to estimates and pre-authorizations? the end of the contract.

18 General What is the expected/anticipated go-live date for the new system? The RFP gives the impression that immediately after the transition-out of the incumbent --30 days after the award. It is highly unlikely that the setup, configuration, customization, data mapping, data cleansing and load, testing, implementing security control, performing IV&V, and then going live all within 30 days period.

60-90 is acceptable to the BOP.

20 General What external, independent assessments must be performed in support of DOJ FISMA accreditation process? Are the accreditation requirements for new DOJ systems and contractors solely identified in DOJ Order DOJ Order 2640.2F is the current order. All new systems 2640.2F or is there a newer order? must meet its requirements.

21 General Will the proposed solution reside within DOJ It is BOP's preference to house the system in its Central Office facilities and on government furnished equipment data center. However, an external facility is an option dependent (GFE)? upon the proposed solution.

General Can you provide the historical volume for claim 1 In the last 24 months, there have been approximately 46UU data and call center (pre-authorization) ? claim processed per month; this is based on 22 actively

22 !participating institutions.

General The RFP calls for BPO users, administrators, and technical staff training and access to the system.

Will BPO staff be running the system or the The contractor is responsible for running the claim system;

23 contractor? however, BOP staff will have access to the system.

General Are the adjudication services to be provided to the BOP facilities currently directly contracted with healthcare providers, BOP facilities under comprehensive healthcare contracts, or both? The adjudication services are only for BOP facilities under

25 comprehensive medical contracts.

General It seems to me that you are looking for a company to process you BOP health insurance The BOP is not looking for a billing company. The BOP is claims, but it also seems that you are looking for soliciting a third-party contractor to provide objective criteria that falls under what an insurance payment recommendations, ensuring compliance with company does, not a billing company. Would applicable Medicare guidelines, NCCI edits, and/or fee

26 you mind to clarify? schedules, and the avoid duplicate or erroneous billing.

27 Background Attachment A is referenced but missing.

Billing of Adjudication Should denied or improperly submitted claims be counted as a claim in terms of billing under this Yes, denied claims should be counted as a claim in terms of

Services contract? billing under the contract.

On page 2, the SOW references that "claim forms

- are specified by the individual medical services

Claims Submission contract". How many BOP institutions utilize The comprehensive medical contracts awarded for each claims forms other than the CMS-1450 or CMS- institution require claims to be submitted on CMS-1450 or

29 1500? CMS-1500.

r--- For those comprehensive medical contractors or network providers not able to submit a claim electronically via the X 12 83 7 transaction, will

Claims Submission they be mailing the claims to the Medical Claims Adjudication contractor or to the individual BOP facility? Will the contractor be responsible for performing data entry of the claim into the Comprehensive medical contracts require providers to

30 svstem? submit claims electronically via X 12 837 transactions.

Does the BOP currently have an EDI

Claims Submission implementation guide for the 837 and 835 transactions that it can share and that the

31 contractor should follow? The BOP does not have an EDI implementation guide.

Will claims be submitted only by the comprehensive medical contractors or could they

Claims Submission be received directly from the comprehensive medical contractor's "network ofhealthcare All claims should be received from the comprehensive

32 providers"? medical contractor.

On page 6, It states "AdditiOnally, the claim submission summary (or similar report) with notification of acceptance/rejection sent to the health care provider shall also be copied to the

Claims Submission appropriate institution." Would the Xl2 997 Functional Acknowledgement response to an 837 sent by a provider be sufficient documentation of receipt date/time for electronically submitted The statement in the SOW refers to the Xl2 997 Functional claims or does this statement refer to the 835 Acknowledgement response to an 837 submitted by a

33 (F.OR)? contractor.

Implementation and Can the BOP provide an estimate of the total On average, approximately five people at each institution

Training number of BOP users needing to have access to will require access to the system, along with another I 0 the system? Central Office and/or ancillary staff.

In order to help us estimate the amount of Implementation and training effort required, how many of the 119 Training BOP facilities are currently submitting claims to The BOP currently has 22 institutions receiving the

35 the incumbent? medical claims adjudication services.

In order to help us estimate the amount of

Implementation and training and implementation effort required, how

Training many of the 119 BOP facilities are currently submitting claims to the incumbent electronically The BOP has 22 institutions submitting claims to the

36 via EDI? incumbent electronically.

Given the need to perform annual refresher training for all BOP users as well as other fixed costs to be experienced each option year, would the BOP consider additional CLINS for each option year for bidders to bid fixed costs (similar to CLIN 0006 for the base year)? If not, would

Implementation and BOP be willing to guarantee a minimum number

Training of claims for each year on the contract in the event that fewer claims are received for Annual refresher training may not be required every year.

processing than anticipated in an Option Year? The training is required when there is a change that will Without the ability to quote fixed costs affect the process. The BOP will consider additional fixed separately or having claims volumes guaranteed costs for training. The BOP will not guarantee a minimum each option year, bidders could assume number of claims as this is dependent upon the need for significant financial risks for factors outside of community-based medical care and cannot be predicted in

37 their control. advance.

Should bidders plan on site visits to each facility Bidders should anticipate on-site visits to each facility to

Implementation and or each region to conduct training for provide training on their program and process. Annual

Training implementation? What about the annual refresher training may not be required every year. Only refresher training each option year? when there is a change that will affect the process.

However, the BOP is open to other options for annual

38 refresher training, i.e., video conference, teleleaming.

The SOW states that "Primary care is provided by BOP staff physicians and mid-level practitioners". Is it correct to assume that BOP

Preauthorization staff physicians and mid-level practitioners would be generating the referrals to the The BOP staff physicians and the mid-level practitioners comprehensive medical contractors requiring would generate the referrals to the comprehensive medical

39 [greauthorization? contractors requiring preauthoriztion.

Do the BOP staff physicians utilize a common EHR or referral system and is there the BOP staff health care practitioners do not utilize a

Preauthorization possibility to obtain copies of referrals/orders common referral system. BOP cannot provide copies of from this system in an electronic format to referrals from the incumbent system. All information from facilitate verification of a preauthorization the incumbent system is licensed information and cannot be

40 request? distributed.

Would each comprehensive medical contractor's "network ofhealthcare providers" be responsible

?reauthorization for obtaining preauthorization individually or will the preauthorization requests be aggregated through each comprehensive medical contractor? Information for the authorization will be sent directly from

41 the institution to the medical claims adjudicator.

Is the EDI X 12 278 Healthcare Services Review ?reauthorization Information transaction currently being used for The EDI Xl2 278 Healthcare Services Review Information

42 preauthorizations? is not used for preauthorizations.

Is there a dollar threshold for what outpatient procedures must be preauthorized? Based upon the SOW, there is a broad statement regarding preauthorization of outpatient procedures. Since multiple procedures are typically billed under a single outpatient claim, this could create

?reauthorization significant data entry effort for the comprehensive medical contractors and/or their network of providers. This could also generate 2 5 times the number of preauthorizations that have to be processed for each outpatient claim There is no dollar threshold for procedures that must be

· d ·f h r · · 1 · receiVe 1 eac I~e Item on an outpatient c atm authorized. An authorization should only be generated for

43 must be preauthonzed. an episode of care, i.e., one authorization

Can the BOP provide more details on the "typical outpatient procedure costs for a given

P h . . category/group of procedures" . What are the reaut onzatJOn . .

outpatient categones/groups of procedures that a contractor will be expected to provide a GFE

44 for? All procedures/encounters will have an authorization.

Is it possible for BOP to provide access to BOP Th d f: · h · h ld b b d h . . . . . e goo att estimates s ou e ase on t e . . h1stoncal claims m electromc format so that

PreauthonzatJOn h h h . . b mformatton sent to the contractor from the mstttutJOn. A contractors e p s ape t etr GFE estimates ased GFE .11 b b d th h

. WI e ase on e contract structure at t e upon previous experience at BOP?

45 mstitution, I.e., current Medicare rates. ___ ..... _________________ ..... ~...- _____ _;__.:...._ _______________ _J

- It appears that the primary role of the preauthorization process is for the contractor to prepare GFEs for each BOP facility so that adequate funding may be committed or obligated

Preauthorization for the resulting claim. Will the contractor be expected to perform any medical necessity reviews? If so, what medical utilization review guidelines and processes will be used and what BOP staff will be involved in this utilization No, in the event medical review is required, the contractor

46 ·~··=· nrnrP<:<:? shall contact the institution for direction.

Based upon the technical requirement on page 7 to use my FX for "secure automated file transfers of inmate information from the Bureau's mainframe system", will there be a requirement for the contractor to maintain a master inmate index or will the inmate location be taken from

Preauthorization the preauthorizations submitted by the "network ofproviders"? lfthe inmate location should be derived from the preauthorizations and claims, Inmate location and demographic information utilized to should the preauthorization request formally ensure appropriate billing will be sent from the DOJ system route to a BOP facility staff member for review to the contractor via secure automated file transfers from and approval and to verity the inmate's the BOP mainframe system. The contractor will be

47 information? expected to maintain this information.

If there is a requirement for the contractor to maintain a master inmate index, how often will

Preauthorization updates be received from BOP and in what format (please share a file layout/format if

48 possible)? Yes, the information will be updated daily.

Will the contractor be required to maintain information on the "network of providers" used by each of the 119 comprehensive medical contractors in order to validate that the provider submitting a claim is at least a valid subcontractor to a comprehensive medical

?reauthorization contractor or will the comprehensive medical contractors be the only parties submitting Yes, the adjudication contractor will be expected to preauthorization requests and claims? If maintain the information on practitioners providing care to information must be maintained on the "network inmates, ensuring the claim is from a "valid subcontractor."

of providers" supporting each of the 119 Comprehensive medical contracts require the contractor to comprehensive medical contractors, how will this send the provider data information initially and updates as

49 data be obtained and updated? appropriate to the third-party adjudication service.

The BOP solicits pricing for comprehensive medical

How many of the BoP's 119 facilities utilize services contracts at Medicare-based rates. A large majority of comprehensive medical services contracts are

Medicare rates with premiums or discounts awarded on that basis. However, there are situations where instead of base Medicare rates for their BOP is unable to negotiate Medicare-based rates. In Rates comprehensive medical contractors? This will addition, offerors are advised that comprehensive medical impact our bid for one-time set up and services contracts are awarded for a one-year base period maintenance of provider fee schedules. and four, one-year option periods. Accordingly, individual comprehensive medical services contracts will be at varying stages of expiration at any given time and are subject to new/different rate structures as they are

50 resolictited.

The BOP solicits pricing for comprehensive medical services contracts at Medicare-based rates. A large

How many of the BoP's 119 facilities utilize majority of comprehensive medical services contracts are percent of charges rates or other reimbursement awarded on that basis. However, there are situations where mechanisms instead of base Medicare rates for BOP is unable to negotiate Medicare-based rates. In Rates their comprehensive medical contractors? This addition, offerors are advised that comprehensive medical will impact our bid for one-time set up and services contracts are awarded for a one-year base period maintenance of provider fee schedules. and four, one-year option periods. Accordingly, individual comprehensive medical services contracts will be at varying stages of expiration at any given time and are subject to new/different rate structures as they are

51 resolictited.

Should bidders submit the Past Performance Provide three (3) Past Performance Questionnaires along

Questionnaires to their references and then with your proposal. Please follow Submission of Proposals

RFP Instructions compile the responses as part of the proposal or for date, time, location and contact as specified in simply complete sections I and II of the Attachment I - Instruction for Offerors.

52 questionnaire so that BOP may send them out?

Technical and Can the BOP please confirm that if the system should be housed in the BOP Central Office

Interoperability Information Systems Data Center or can it be

Requirements hosted at an external facility. The system can be hosted at an external facility.

In Attachment III, the BOP provided a template for a Past Performance Questionnaire but there

Attachment Ill, Past are no instructions guiding submitters on how many questionnaires should be completed by our Provide three (3) Past Performance Questionnaires along Performance customers nor to whom the completed with your proposal. Please follow Submission of Proposals Questionnaire questionnaires should be sent nor by what date. for date, time, location and contact as specified in

54 Please clarify. Attachment I - Instruction for Offerors.

In Attachment I, Page 4 the BOP states, "Past

Attachment I, pages 4, performance will be reviewed and rated

Bureau of Prisons according to the Past Performance Information

Medical Claims Retrieval System (PPIRS)." Can the BOP clarify

Adjudication Addenda if the hard copy questionnaires we are asking our customers to complete will be rated according to to Instructions for this system or will information within the system

Offerors be used in addition to the hard copy Information within the system will be used in addition to

55 questionnaires? the hard copy questionnaire.

In Attachment I, page 2, the BOP states, "All Attachment I, page 2, proposals shall be typewritten in 12-point font Content of Proposals, and double spaced ... " Could the BOP clarify if A. General - Applies to the font used in headings, tables, graphics and The Headings, tables, graphics and captions, headers and Entire Proposal captions, headers and footers must be in 12-point footers do not have to be in 12-point font and double

56 font and double spaced? spaced.

"All necessary permits and licenses required by federal, state, and local authorities shall be acquired and maintained by the Contractor and any subcontractors (as applicable) for the life of the contract. Contractor must provide copies."

Attachment I, page 3 Could the BOP clarify whether an offeror should provide these license copies as part of the proposal or upon contract award? If as part of the

All necessary permits and licenses required by federal , proposal, please clarify whether or not it is permissible to submit these license copies as state, and local authorities shall be acquired and maintained attachments to an offeror's proposal. by the Contractor and any subcontractors (as applicable)

57 may be provided upon Award.

In Attachment I, page 2, the BOPindicates, "The maximum number of pages that will be accepted

Attachment I, page 2, for a submitted Tehcnical Proposal is limited to

The Experience and Price Proposal factors are limited to three hundered double-sided pages." Could the Content of Proposals

BOP clarify page limitations for the Experience twenty {20) double-sided pages for each factor . The Past factor as well as the Price Proposal and Past Performance Questionnaire is four {4) pages but will

58 Performance? accept no more than five (5) pages.