WTCHP HPS RFI Questions Completed.docx

Questions : HEALTH PLAN SUPPORT

RFI: WTCHP-HPS-RFI_2020

Question: Where does reporting and FWA analytics fit into this?

It should be part of the solutions the vendor will propose.

We are beginning to plan for the cloud migration as a separate effort from this solicitation.

The data will include member information and benefit eligibility data.

Question: What is the current infrastructure and how does access to claims currently operate (e.g. SQL database)?

Plexis

Question 2: Are data use agreements with all primary payers currently in place? If so, how regularly is updated data provided?

1. Our CCEs and NPN vendors are responsible for coordination of benefits and work in conjunction with the HPS and the Comprehensive Cost Avoidance, Coordination of Benefit and Recovery (CCA) contractor.

2. The Provider is required to submit claims to the member’s private and/or public insurance before submitting the claim to the Program. The Provider must also send the insurer’s Explanation of Benefits to the Program along with the claim. Data are updated daily. Please visit the Program Administrative Manual at https://www.cdc.gov/wtc/ppm.html for more information about Program member eligibility and coordination of benefits.

Question 2: Are data use agreements with all primary payers currently in place? If so, how regularly is updated data provided?

Duplicate with 4.

Question 2: Are there any final/definitive mechanisms or outcomes other than eligibility determination to build models upon?

1. Data will be provided upon an award

2. Yes, the desired outcomes are a comprehensive approach to loss prevention, FWA management approach, efficiency, access to quality of care, and cost control. The vendor should provide innovative and comprehensive approaches, such as Artificial Intelligence (AI) if any.

Question: How frequently does the HPS currently provide claims data updates from WTC?

Daily

We intend to split the contract into appropriate manageable sizes. Announcement may include both set aside and full an open.

It is unclear where the government would prefer to see the administrative information as it indicates “Section 1 of the White Paper” but has this listed under the general corporate capabilities statement that is in addition to the white paper.

Please state it in the general corporate capabilities statement using 1.5 line spacing, and 12-point san serif fonts.

It is unclear which functions are being referred to.

See #9.

· If this private managed network does exist for the CDC, who is CDC’s preferred cloud exchange service provider?

Currently there is no MPLS in place.

See #2

· What are the benchmarks that are currently being measured/monitored?

· Are there any new areas where CDC needs more insight and would like to add new measures?

Please reference the current and prospect industry standard and best practices.

Please clarify, reference Section Chapter 10 - Governmental Affairs, Subsection 5. Payment Item b, in the WTC HP Administrative Manual, the circumstances where reimbursement would be below FECA rates for the NPN i.e., other than when the billed amount is lower than the established FECA reimbursement rate.

The NPN contractor maintains contracts with their providers, including compensation rates for services with FECA as the ceiling. There are services for which there is no FECA rate and for these the Medicare rate is used as the standard.

· Please clarify who NYCA providers have an agreement with. Is it CMS or CDC?

· Does the WTC HPSC staff reference information in PECOS or is the provider’s information entered into PECOS?

· Can a provider be enrolled in NYCA network without being entered into PECOS?

No.

· CDC

· Our current HPS is able to consume information from PECOS. The vendor should describe how you would approach enrolling providers through PECOS if you have the relationship with CMS. What would you do if providers refuse to enroll through PECOS and how would you contract individually with that provider?

· Yes.

Please note access to PECOS is not required if you already have a well-established network where you can assure the providers will meet the program rules or that you have the ability to work with the network of providers established by our program. The most important thing is that this is and will be the WTCHP network.

· If hosted and cloud-based services are permitted, are there any guidelines or limitations on what or how the services can be consumed? Example: only FedRAMP accredited services are permitted.

Whatever is the most efficient, innovative and resilient with reasonable and affordable pricing and cost control.

See #2

In addition, only FedRAMP certified providers and solutions will be permitted if the vendor decides to use the cloud.

What are the programs that are referred to in Item C?

There is a typo with the list alphabet. The second “c” should be “h”. The “programs” refers to measures (i.e., administrative actions, processes, hardware and software, etc.,) to manage FWA program.

See #2

The vendor can provide information on other member services but is not required.

The vendor must be able to reconcile COB claims and work with other contractors to manage Other Health Insurance Information (OHI).

Regarding the request for “claims and payment analytics and meaningful reports with solutions to improve efficiency and financial integrity,” in order to accurately depict current and future member costs, will the bidder be required to integrate data from various sources?

Yes, but it will likely through the cloud.

Regarding the question for “reporting capabilities for claims utilization and cost projections,”

· From a claim’s perspective, does this require the integration of various data sets not all housed by any one vendor? As an example, to accurately depict future costs for a member as well as current costs, data would have to be aggregated from the following types of systems: Claims/Eligibility/RX/Case Management. If this is true can the vendors be listed with a description of the data they would supply to this vendor?

· What is the expectation around managing third party data?

· Is the request to access real-time or near real time data?

· Does WTCHP currently use an actuarial firm to complete a full cost analysis?

We are currently building a cloud-base environment where the vendor will have to operate in.

More details will be available in the RFQ or after the award.

The vendor should clearly describe solutions to maintain cost control.

Yes, the vendor can propose a solution where you can be a fiduciary. However, your providers are required to provide all necessary information including NPI# and Tax ID. The vendor must provide a concrete plan on managing claim payment, including liability and dealing with negative balances and recovery efforts.