PROPOSAL EXHIBIT B Questionnaire

Transcription

1 PROPOSAL EXHIBIT B Questionnaire Please respond to each requirement below. The responses will be used to determine the finalists who will be invited to present their services in a formal interview. Items will be scored up to the maximum point value of 155 points. Please respond to all questions and requests contained in this questionnaire in a separate document. Precede answers with both the section name and question number, i.e. Claims Conversion #1, and a restatement of the question. Respondents should fully answer each question, giving complete information regarding current and relevant references. Consultants may submit any additional materials relating to their ability to perform the assignment. Company Overview, Experience and Qualifications (20 points) 1. Provide a brief statement of your company s third party administrator experience and qualifications to meet the requirements of Lane County. Include a brief description of your company, number of years in business providing TPA services, number of employees (full and part-time), number of claim adjusters and claim support personnel, corporate headquarter location and location of the claim office that would be assigned to service Lane County. Include a statement acknowledging proposer s acceptance of the contract terms and conditions included in the RFP. This submittal is required though it will not be scored. 2. Describe your organization s experience working with entities similar to Lane County. 3. Identify any service(s) you intend to subcontract to others and identify the proposed subcontractors, including names, phone numbers and the qualifications of the subcontractors company. 1

2 Claims Administration and Management (35 points) 1. Please identify proposed staff members who would be assigned to Lane County and submit statements or résumés detailing their qualifications and experience with local government. 2. Please describe the caseloads of the proposed medical only and indemnity claims adjusters that would be assigned to Lane County claims. How are claim assignments made? What is your staffing back up plan in cases when the team is not available? 3. If workloads increase over the life of the service agreement, propose how your company would meet the increased staffing needs. 4. What is your claims management philosophy? 5. Please describe your company s reserving practice, including timeliness in establishing initial and subsequent reserves as well as the supervisory review and approval process. 6. Please describe your index bureau process. What are the adjuster s requirements to follow up on index bureau hits? 7. How would your firm address conflict of interest issues involving other public entity clients? 8. Please disclose the turnover ratio in the last three years of your management team and claims adjusters. 9. Please describe ongoing training for claims adjusters, support personnel and management team regarding legislative changes and current industry trends. 10. Does your TPA employ Board Certified physicians or vocational rehabilitation specialists? If so, how do they support the claim adjusters? 11. How often do your adjusters maintain contact with the claimants throughout the duration of the claim? What are the adjusters standard methods of communication to clients and claimants? 2

3 12. What percentage of claims (separated by medical only and indemnity) do your adjusters close within one year, two years and beyond two years? 13. Describe your company s quality control program and the frequency of internal operational audits. 14. Please provide a copy of your company s best claim practices and a sample special handling instruction agreement. 15. Indicate your willingness to agree to a performance guarantee, subject to mutual agreement between your company and Lane County. Include your suggestions regarding the performance areas to be measured, how they would be measured and at what intervals. Include a sample of your standard performance guarantee. Claim Management Information System (15 points) 1. Provide a description of your company s claims management information system. Describe the access Lane County will have to review claim notes and run reports. 2. When was the last release/update to your claim management information system? Describe what upgrades were made. Do you have any planned enhancements to your system? If so, describe. 3. Describe your disaster recovery plan regarding the continuation of your claims management and risk management information system. 4. Provide a list of data elements you capture and indicate which data elements are available in reportable form. 5. What standard reports are provided within your service fee? Describe them in detail and provide a few sample reports. Please also state whether or not your software program is able to prepare OSHA reports. 6. Describe your ability to provide customized reports and the fees associated with providing these reports. 3

4 Claims Conversion (5 points) 1. What experience do you have converting claims data from other third party administrators? Please outline the timeline and process for converting the County s claim files if you are the awarded Proposer. 2. Describe your process for data transmittal at the end of service agreement period including format for data to be provided to Lane County and conversion assistance when converting data to a new TPA. Include any fees charged for this service. 3. Provide a proposed transition plan and implementation timetable. Audits, Reporting, Financial Controls and Security Procedures (15 points) 1. Describe your claim audit program, including areas that are audited, frequency of the audit, and corrective action on areas in need of improvement. Areas to include: internal audit process, internal financial controls, security procedures, medical bill auditing and hospital/specialty review services. 2. Summarize the results of your Claims Reserve/Report of Losses Field Audit, Compliance Audits, Quarterly Claims Processing Performance, and any other WCD field audits for the last three calendar years for your Oregon clients. Provide information on the circumstances and status of any disciplinary action taken or pending against your company during the last three years by any state regulatory bodies or professional organizations. 3. Describe your customer satisfaction program and how concerns are addressed and resolved. Please describe the procedure you have in place to audit the effectiveness of legal counsel on the outcome of claims. 4. Please describe the procedure you have in place to audit the effectiveness of legal counsel on the outcome of claims. 5. How does your company propose to report Lane County claims per the Medicare, Medicaid, and 4

5 SCHIP Extension Act ( MMSEA )? Billing Procedures and Related Services (5 points) 1. Describe your billing procedures, wire transfer capabilities and supporting documentation used to reconcile the transfer of funds between your company and your client. 2. Provide a copy of your company s standard Quality Service Plan or other similar document describing your standardized internal processing expectations and indicate your organization s willingness to customize the document to meet the requirements of the individual client. Additional Services (10 bonus points) 1. Please describe any other services your organization would provide with the potential to lower the cost, improve the level of service or reduce risk to Lane County. 2. Please describe how your organization assists with FMLA administration. 5