REQUEST FOR INFORMATION (RFI) FOR ADMINISTRATION OF CLAIMS AND PROGRAMS OF RISK MANAGEMENT BY THE STATE OF TENNESSEE Treasury Department

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1 A. STATEMENT OF INTENT REQUEST FOR INFORMATION (RFI) FOR ADMINISTRATION OF CLAIMS AND PROGRAMS OF RISK MANAGEMENT BY THE STATE OF TENNESSEE Treasury Department RFI # A.1. The State of Tennessee Treasury Department (the State) issues this Request for Information (RFI) for the purpose of soliciting information from the vendor community which will assist the State in performing an analysis of various alternative software and infrastructure systems solutions available to potentially meet the State s need for updating technology and enhancing its management of the State s risk management programs. The information obtained from responses to this request will be used by the State to improve the quality of any future Request for Proposal (RFP) developed for the acquisition of such services. This request is strictly a mechanism for gathering information, and will not constitute a procurement process. This RFI is not a competition, and the information submitted in writing will be used only to improve the State s knowledge of a vendor s capability to provide the services sought. No evaluation of participating vendors will occur and your participation is not a promise of future business with the State. Responding or not responding to this RFI does not preclude the vendor from bidding on any future solicitations. Please do not include any information regarding costs of services or costs of services rendered in other projects. The State appreciates your cooperation and looks forward to a meaningful and productive research effort. B. BACKGROUND B.1. The Divisions of Risk Management and of Claims Administration, oversees a variety of risk management areas, including oversight management of insurance and safety programs which are designed to 1

2 protect and maintain the financial integrity of all state-owned assets, and provide a safe working environment for state employees and the general public. The Division of Risk Management oversees the administration of the State's workers' compensation and property insurance programs, while the Division of Claims Administration processes claims filed with the State for tort liability (filed against the State), Interlock Assistance Fund, Criminal Injuries Compensation ( victims' compensation) and Sexual Assault Forensic Examination (SAFE) Reimbursement. The objectives of the RFI process are to solicit information from the vendor community which will assist the State in performing an analysis of various alternative software solutions which can effectively and aggressively aid in administration of the State's risk management programs and initiatives, and facilitate oversight specific to workers' compensation, property management, tort liability, employee property damage, interlock reimbursement, Criminal Injuries and SAFE claims. B.2 Description of Divisions of Risk Management and of Claims Administration processes: a. Workers' Compensation The State's current Worker's Compensation program is administered by contracted third party administrator (TPA). Claims are submitted electronically and telephonically from injured employees in the various State agencies, in addition to the Tennessee Board of Regents, and the University of Tennessee. Approximately 3,300 claims are administered each year, with approximately 75% of these claims being medical only. System functionality includes the following: intake and administration of claims; acceptance of claim specific documentation; tracking of decision; claimant notification and compensation. In its primary oversight function, the Division of Risk Management utilizes the TPA query capabilities for monthly, quarterly and annual reports, designed to track state-wide activity for claim administration initiatives, payment reconciliation and to support returning injured workers to work at the earliest reasonable point in time. b. Property Management 2

3 The Division of Risk Management administers the State s property insurance program, including the procurement of all-risk replacement cost property insurance for all State-owned buildings and contents, fine arts coverage, coverage for all State-owned boiler objects, and aviation insurance for the State s aircraft. The State procures its insurance with the aid of a qualified property and/or casualty insurance broker. As of January 1, 2013, the State s total insured property values were approximately $19 billion. The Division of Risk Management currently manages claims for property damage and destruction valued in excess of $25,000 with a maximum value of $750 million. Reported incidents valued at under $25,000 are managed within the reporting agency with the Division of Risk Management tracking the reported incidents for future risk mitigation and facility management training opportunities. c. Tort Liability: Individuals who have been allegedly harmed or have suffered a loss as a result of negligent actions by a State of Tennessee employee or agency can submit a Tort Liability claim to the Division of Claims Administration. The Division of Claims Administration objectively determines the state's liability for claimed injuries and compensates claimants for damages when liability is supported by evidence or denies claims when liability is unsupported. The Division of Claims Administration recognizes its stewardship role in protecting state resources by striving for efficient and timely service to citizens. Approved claims are paid out of the Risk Management Fund. The Division of Claims Administration renders decisions on claims within 90 days, during the 2012 fiscal year, payment allocation were made for 1,683 tort claimants totaling $7,069,114. Currently, the tort liability claim process includes applying State statutory requirements, claims management oversight and a State designed database to track claims and claim activities, including the age of each claim and claim payments. d. Criminal Injury Compensation Program: The State s Criminal Injuries Compensation Program is intended to defray the costs of medical services, loss of earnings, burial costs and 3

4 other pecuniary losses to either an innocent victim of a crime or to the dependents of a deceased victim. Eligible crimes generally include, but are not limited to, homicide, aggravated assault, sexual assault, robbery by force, and drunk driving. The funding for the programs includes privilege taxes assessed in courts against criminal defendants and other offenders upon conviction, fees levied against parolees and probationers, the proceeds of bond forfeitures in felony cases and a federal grant. Jurors may also elect to donate their jury service reimbursement to the Fund. The Division of Claims Administration staff reviews criminal injury claim applications and supporting information provided by the claimant, in addition to communicating with the appropriate District Attorney s Office in order to determine eligibility for payment from the Criminal Injuries Compensation Fund. The claims process includes applying State statutory requirements and claims management techniques for the timely rendering of decisions and payments, with an average claim decision being rendered within 52 days. During the 2012fiscal year, the Division of Claims Administration made payments to victims of crime totaling $11.5million. The reporting claimant must file a claim within 1 year of the date of the incident, which may be waived if good cause is shown. The statute of limitations for a minor victim or minor dependent claimant is 19 years of age. The claimant (or claimant s attorney) may file the Criminal Injuries Compensation claim form. Currently Criminal Injury claim payments calculations are tracked using a variety of manually designed Excel spreadsheets while claim supportive data, deadlines, claimant letters and all claim decision information are managed with the Gemini system. Payment(s) on approved claims are managed in the Edison accounting application. e. SAFE: In 2007, the General Assembly amended the Criminal Injuries Compensation Act to provide payment for services related to sexual assault forensic examinations. Requirements and reimbursement are guided by statutory requirements. The Sexual Assault Forensic Examination (SAFE) Fund Reimbursement process provides reimbursement to a facility that performs sexual assault forensic exams on victims of certain sexually-oriented crimes. Facilities must bill the Fund (not the victim) and cannot seek any additional payment from the victim after payment by the Fund. Payment is up to $750 for such services for crimes occurring on or after July 1, In accordance 4

5 with Tennessee Code Annotated, Section , the amount reimbursed by the Division of Claims Administration under SAFE must be accepted as payment in full. The facility cannot bill the patient a balance, for any reason. In the fiscal year 2012, the SAFE program approved 2,204 claims for payments totaling $1.4million. Although the person may elect to report the crime, a report to law enforcement or cooperation with the prosecution is not required for payment of the exam. The documents must be submitted to the Division of Claims Administration within one (1) year of the date of the exam. Payment shall be rendered within ninety (90) days of receipt of request. Medical treatment for injury may be billed separately and directly to a patient/victim, who then may file a claim for Criminal Injuries Compensation. Currently SAFE claim payment calculations are tracked using a variety of manually designed Excel spreadsheets while claim supportive data, deadlines and deadline alerts, claimant letters, and all claim decision acknowledgement are managed with the Gemini system. Payments on approved claims are managed in the Edison accounting application. f. Employee Property Damage: The Employee Property Damage (EPD) program is designed to provide liability protection for the personal property of state employees in situations where the damage occurs while they are in the course and scope of employment. In order to be compensable the property must be a requirement of employment or the damage/loss must be the result of an assault/battery or special hazard. This does not include situations in which the damage or loss was the result of an intentional or negligent act by the employee. Generally, the Division of Claims Administration reimburses the State employee for the repair or replacement value of the personal property. Typical claims for EPD include eyeglasses, clothing and the insurance deductible for an employee s personal vehicle that was damaged while being used for state business. Payments are made out of the Risk Management Fund and in accordance with the EPD statute (T.C.A ). Over the past fiscal year, claimant support information and payments for Employee Property Damage totaling $ 18,827 have been managed in Gemini, with payments being made in the State's Accounting application Edison. g. Interlock Assistance Fund: 5

6 Established in 2010, the Interlock Assistance Fund was created by the Department of Safety and Homeland Security as a means of advocating stronger D.U.I enforcement and highway safety. The function of the Interlock Assistance Fund is the management of costs associated with the lease, purchase, installation, removal and maintenance of such device or with any other cost or fee associated with a functioning ignition interlock device required by this part, of persons deemed by the court to be indigent. Whenever a person is ordered to install an interlock device pursuant to state statutes and he asserts he is indigent, a judge reviews and determines whether he meets the requirements. If so, the judge signs the participant s Affidavit of Indigency. Once the person is determined eligible to receive the installation of an interlock device and does so per statutory requirements, the provider of the device may file a claim with the Division of Claims Administration for reimbursement under the law. If the request is found to be eligible, the reimbursement is made per statutory guidelines from the Interlock Assistance Fund (IAF). The Division of Claims Administration can only consider payment to an approved interlock provider. All submitted claims and supporting documents are reviewed pursuant to TCA , namely the Affidavit of Indigence, the Restricted License Order from the sentencing judge, and proof that device was installed on or after January The monetary limits on installation, maintenance, and other related eligible costs are established annually by the Department of Safety and Homeland Security in the Rules for the Interlock program. Currently, IAF claims are tracked manually on Excel spreadsheets, including all requests, date of receipt, names of participant and interlock providers, payments, vehicle information and dates of device install and removal or any required maintenance information. All correspondence including invoices and s are currently scanned for electronic access and storage. There are approximately 30 approved providers in the state with fewer than 10 filing IAF claims. In FY 2013, there were 148 reimbursement requests. While there is no required processing timeframe the Division of Claims Administration currently averages days for reimbursement. C. GENERAL INSTRUCTIONS 6

7 C.1. The State is requesting the following specific information from all interested parties. Provide a detailed description, including diagrams where applicable, of how your solution addresses the following: C.1.1 Functionality and Features a. Describe the ability capability for your solution to accept new claims and manage existing claims. Include discussion on capabilities for capturing incident specific information and the ability to view real-time claim data. b. Describe your capability in archiving historical claims. Include in this discussion, the archiving process, the timeframe for online access or stored claim data. c. Describe how you would address the tracking of claim and payment ' value as of ' limits. Include in this discussion the process of deriving realtime statistical payment data for weekly, monthly, quarterly, annual, and ad-hoc reports required for managing the Return to Work and other State programs. d. Describe your features and methods available for notifying claimants in the following circumstances; Pending, Approved, Denied, Appealed or Transferred status, and Settlement explanation, Medical Release / Return to Work and applicable statuses of claims. e. Describe the ability to manage claims submitted by various claimants/ customers and State agencies (example -: Property Damage, TORT, Employee Personal Damage, Auto Liability & Interlock Program claims). Describe any features available to enhance claim management, including duplicate claim prevention options and the linking of companion or related claims. f. Describe your online processing capabilities. Can claimants/customers and administrators submit and review claims and supporting documents, query claim account balances, maintain contact information, and print statements over the Web? g. Describe your ability to accept and manage property inventory. Include discussion on the ability to capture individual property locations with primary and secondary Construction, Occupancy, Protection, Exposures (COPE) level details and import historic property inventory in diverse formats. h. Describe your ability to capture and retrieve data elements specific to property inventory, including but not limited to property documents, images and video. 7

8 i. Describe your ability to allow users in various locations access to input property inventory. Include in this discussion the ability for end-users in various locations to view real-time property inventory data. C.1.2 Reporting a. Describe your capabilities for producing real-time reports to capture monthly, quarterly, annual, and ad-hoc status of existing claims of all status types. Include discussion on capabilities for program-specific customization of reports. b. Describe your ability to design or customize transaction audit-logs related to claim updates. c. Describe your query functionality available for inquiring on claim administration, including claim data and decision activity. Also include how individual security roles can be customized for querying. d. Describe how you report claim events based on type and severity of reported injury, including any additional/unique reporting features that you can offer. e. Describe your ability to produce real-time reports to track historic and contemporary property inventory. Include in this discussion the ability to generate periodic or ad-hoc agency-specific reports including but not limited to COPE levels, and specifics on property location, content and tenant type. f. Describe how you report claim events based on type and severity of reported property damage and or destruction, including any additional/unique reporting features. g. Describe your ability to design or customize transaction audit-logs related to all property inventory updates. h. Describe your ability to design or customize transaction audit-logs related to claim updates. i. Describe your query functionality available for property inventory management. Include discussion on how individual security roles can be customized for querying property inventory. j. Describe your query functionality available for claim administration, including claim data updates and uploads and decision activity regarding 8

9 vendor payments. Also, include how individual security roles can be customized for querying. C.1.3 Application Security and Interfaces a. Describe the types of bi-directional interfaces that you offer. b. Describe the type of security that you incorporate into your interfaces. c. Describe your security capabilities to define role-based user functions. C.2. Please feel free to contact the State Point of Contact with any questions regarding this RFI. All vendor communications regarding the RFI should be in writing or by only and reference RFI: The State Point of Contact is: Dawn Rochelle State of Tennessee Treasury Department 14th Floor, Andrew Jackson State Office Building 502 Deaderick Street Nashville, TN Phone: Fax: C.3. Potential proposers must ensure that the State receives all written comments, including questions and requests for clarification, no later than the Vendor Questions Due Deadline detailed in the RFI Section D.8, Schedule of Events. All questions should be submitted in writing via to the point of contact listed in C.2. D. INSTRUCTIONS FOR RESPONDING D.1. D.2. The State has assigned the following RFI identification number that must be referenced in all communications regarding this RFI: Please feel free to contact the State Point of Contact with any questions regarding this RFI. All vendor communications regarding the RFI should be in writing or by only and reference RFI: The State Point of Contact is: Dawn Rochelle State of Tennessee Treasury Department 14th Floor, Andrew Jackson State Office Building 9

10 502 Deaderick Street Nashville, TN Phone: Fax: D.3. D.4. D.5. D.6. D.7. Submit your response to this RFI to the State Point of Contact on or before 2:00 p.m. CST on January 31, Please submit at least one bound hard copy and one copy via in PDF format. Responses should be in the form of a well-organized document and include the original question/request number along with each associated answer. Please indicate not applicable to any question that does not apply. Under no circumstances shall the State of Tennessee be liable for, or reimburse any costs incurred by any vendor in the preparation and submission of its RFI response or for other costs incurred by participating in this process. Furthermore, there is no guarantee that a procurement of software and/or implementation services described in this RFI will ever take place as a result of this RFI. All responses submitted in response to this RFI are public record and shall be open for inspection by a member of the public pursuant to Tenn. Code Ann By submitting a response, you acknowledge and accept that the full contents of the response and associated documents shall become a public record except such information made confidential by statute. Participation in this RFI process does not guarantee inclusion in a future Request for Proposal (RFP) procurement process for such services, nor does failure to submit a response to this RFI result in exclusion to participate in a future RFP. Any individual, company, and/or entity involved in assisting the State in development, formulation, or drafting of this RFI may not submit a response to this RFI. D.8. The RFI schedule of events is as follows: RFI Release January 10, 2014 Vendor Questions Due 2:00 p.m. CST January 21, 2014 Responses to Vendor Questions 2:00 p.m. CST January 24,

11 Vendor Responses Due 2:00 p.m. CST January 31, 2014 Vendor Demonstrations (If determined necessary by the State) March 3, 2014 March 11, 2014 D.9. If the State determines it necessary, the State Point of Contact will contact entities that have submitted responses to this RFI in order to schedule demonstrations relative to software functionality. Demonstrations may be conducted in person at the State of TN Treasury Department's office or via a standard online web conferencing site hosted by the vendor. Included in your response should be an estimate of the time required for your onsite or web demonstration, for scheduling purposes. 11