REQUEST FOR PROPOSAL Claims EDI Service Provider Authorization Solicitation # PR12028

Transcription

1 REQUEST FOR PROPOSAL Claims EDI Service Provider Authorization Solicitation # PR12028 PURPOSE OF REQUEST FOR PROPOSAL (RFP) The purpose of this request for proposal is to enter into an authorization contract with qualified firms to provide services to Utah Labor Commission Industrial Accidents Division (IAD) trading partners in submission of IAIABC EDI electronic data transfers of Utah workers compensation claim information by employers and insurance carriers. It is anticipated that this RFP may result in authorization of multiple vendors. This RFP is designed to provide interested offerors with sufficient basic information to submit proposals meeting minimum requirements, but is not intended to limit a proposal's content or exclude any relevant or essential data. Offerors are at liberty and are encouraged to expand upon the specifications to evidence service capability under any agreement. BACKGROUND In 1996 Utah privatized its workers compensation system, permitting employers to obtain workers compensation coverage through qualified private insurance carriers. Additionally, qualified employers can self-insure their workers compensation risk. Utah Labor Commission Industrial Accidents Division plans to implement an EDI data transfer requirement effective the first quarter of Self-insured employers and private carriers will be required to report Utah workers compensation claims data in IAIABC-EDI Release 3 Format. The IAD is seeking qualified vendors to provide services to aid and assist the IAD in assuring that EDI data transfers are completed timely and accurately. ISSUING OFFICE AND RFP REFERENCE NUMBER The State of Utah Division of Purchasing is the issuing office for this document and all subsequent addenda relating to it, on behalf of Industrial Accidents Division. The reference number for the transaction is Solicitation # PR This number must be referred to on all proposals, correspondence, and documentation relating to the RFP. SUBMITTING YOUR PROPOSAL Proposals must be received by the posted due date and time. Proposals received after the deadline will be late and ineligible for consideration. Proposals should be prepared simply and economically, providing a straightforward, concise description of bidder s abilities to satisfy the requirements of the RFP. Emphasis should be placed on completeness and clarity of content. The preferred method of submitting your proposal is electronically through BidSync (formerly RFP Depot.) However, if you choose to submit hard copies, one original and three identical copies of your proposal must be received at the State of Utah Division of Purchasing, 3150 State Office Building, Capitol Hill, PO Box , Salt Lake City, Utah

2 When submitting a proposal electronically through BidSync, please allow sufficient time to complete the online forms and upload documents. The solicitation will end at the closing time listed in the RFP. If you are in the middle of uploading your proposal at the closing time, the system will stop the process and your proposal will not be received by the system. Electronic proposals may require uploading of electronic attachments. BidSync s site will accept a wide variety of document types as attachments. However, the submission of documents containing embedded documents (zip files), mov, wmp, and mp3 files are prohibited. All documents should be attached as separate files. LENGTH OF CONTRACT The Authorization Contract resulting from this RFP will be open ended subject to the Terms & Conditions of this contract. Vendor contract time periods with Utah trading partners will be at the discretion of both parties. PRICE GUARANTEE PERIOD Although the IAD will not be charged for the services outlined, we understand our trading partners using your service may incur costs for the service provided. All pricing must be guaranteed for the entire term of the contract. Following the guarantee period, any request for price adjustment must be made at least 30 days prior to the effective date to the contracted trading partner. Requests for price adjustment must include sufficient documentation supporting the request. STANDARD CONTRACT TERMS AND CONDITIONS Any contract resulting from this RFP will include, but not be limited to, the State of Utah and Department of Technology Services (DTS) standard terms and conditions. Bidding on this RFP constitutes acceptance of and agreement to all State of Utah Terms and Conditions attached to this RFP. QUESTIONS All questions must be submitted through BIDSYNC (formerly RFP Depot.) Answers will be given via the BIDSYNC site. Additional information inquiries must be submitted via BIDSYNC no later than 6:00 p.m. (MDT), Friday, August 19, Answers and/or clarifications regarding any inquires will be communicated via BIDSYNC by Wednesday, August 24, 2011 for consideration prior to bid submission. This RFP will close Friday, August 26, 2011 no later than 6:00p.m. (MDT).

3 DISCUSSIONS WITH OFFERORS (ORAL PRESENTATION) An oral presentation by an offeror to clarify a proposal may be required at the sole discretion of the State. However, the State may award a contract based on the initial proposals received without discussion with the offeror. If oral presentations are required, they will be scheduled after the submission of proposals. Oral presentations will be made at the offerors expense. PROTECTED INFORMATION The Government Records Access and Management Act (GRAMA), Utah Code Ann., Subsection 63G-2-305, provides in part that: the following records are protected if properly classified by a government entity: (1) trade secrets as defined in Section if the person submitting the trade secret has provided the governmental entity with the information specified in Section 63G (Business Confidentiality Claims); (2) commercial information or non-individual financial information obtained from a person if: (a) disclosure of the information could reasonably be expected to result in unfair competitive injury to the person submitting the information or would impair the ability of the governmental entity to obtain necessary information in the future; (b) the person submitting the information has a greater interest in prohibiting access than the public in obtaining access; and (c) the person submitting the information has provided the governmental entity with the information specified in Section 63G-2-309; * * * * * (6) records the disclosure of which would impair governmental procurement proceedings or give an unfair advantage to any person proposing to enter into a contract or agreement with a governmental entity, except that this Subsection (6) does not restrict the right of a person to see bids submitted to or by a governmental entity after bidding has closed;... GRAMA provides that trade secrets, commercial information or non-individual financial information may be protected by submitting a Claim of Business Confidentiality. To protect information under a Claim of Business Confidentiality, the offeror must: 1. provide a written Claim of Business Confidentiality at the time the information (proposal) is provided to the state, and 2. include a concise statement of reasons supporting the claim of business confidentiality (Subsection 63G-2-309(1)). 3. submit an electronic redacted (excluding protected information) copy of your proposal response. Copy must clearly be marked Redacted Version.

4 A Claim of Business Confidentiality may be appropriate for information such as client lists and non-public financial statements. Pricing and service elements may not be protected. An entire proposal may not be protected under a Claim of Business Confidentiality. The claim of business confidentiality must be submitted with your proposal on the form which may be accessed at: To ensure the information is protected, the Division of Purchasing asks the offeror to clearly identify in the Executive Summary and in the body of the proposal any specific information for which an offeror claims business confidentiality protection as "PROTECTED". All materials submitted become the property of the state of Utah. Materials may be evaluated by anyone designated by the state as part of the proposal evaluation committee. Materials submitted may be returned only at the State's option. DETAILED SCOPE OF WORK Technical Service Requirements and Deliverables: 1. Technical A. Communications and File Transfers with Trading Partners i. 128 encrypted FTP preferred methodology ii. Offeror should specify if they are XML capable for possible migration in the future. B. Data Formats i. Release 3 FROI (148 & R21), SROI (A49 & R22), AKC (AK1) ii. Creation of flat file format for FROI and SROI to be used by state for system migration. C. IAIABC Edits i. Technical Edits ii. Business Edits iii. Sequencing of transactions D. Trading Partner Acknowledgment Processing i. Transmit AKC for FROI and SROI to trading partner within 24 hours of receipt E. EDI User Interface i. Provide user interface with appropriate edits for entry by IAD trading partners of FROI and SROI. This interface is to be free to the user. F. State File Updates i. Provide daily transfer of error free FROI and SROI ii. Acknowledgements (Transactions Accepted: TA, Transaction Accepted With Errors: TE and Transaction Rejected: TR) G. Maintenance i. Perform necessary technical enhancements for changes to the IAIABC standards or state data requirements

5 ii. Conduct additional trading partner testing as required iii. Conduct additional trading partner training as required 1. Designate if training will be provided in person or via web based platform (i.e. WebEx) 2. Data Ownership Upon completion of each testing period and assembly of the data into a report(s), the Offeror agrees that the content of the report, all working documents, raw and statistic data become the property of the IAD. The offeror further agrees that they shall not release verbally, written or electronically any of the data reported and compiled to fulfill the requirements of this contract. Specific reports requested by the IAD are owned by the IAD and shall not be released to anyone other than the IAD or an entity to whom IAD authorizes the release. Administrative Tasks and Requirements 1. Facilitate Trading Partner Set Up (Transmission Profile Processing) 2. The successful vendor must be able to work with up to an estimated 200 trading partners with file set up and transmission of data, estimated volumes are: i. Overall trading partner claim reporting average is 25 per year; except for ii. Single carrier whose average is 21, Provide Trading Partner Testing A. Develop, coordinate, execute and validate scenario creation and documentation B. Testing procedures creation, execution and documentation i. Coordinate with trading partners 4. Provide Technical Support for state and state trading partners 5. Required timelines: i. FROI to roll out first quarter of 2012 through second quarter ii. SROI to roll out first quarter of 2013 through second quarter PROPOSAL REQUIREMENTS AND COMPANY QUALIFICATIONS The following requirements are considered mandatory. If, in the evaluation process, it is determined that any of the following requirements have not been met, the offer will be rejected. Your response to this RFP should include a response to the following items, in this order and using the following numbering system: 1. Offeror Qualifications A. All offerors must be authorized to do business in the State of Utah. The offeror cannot be under suspension or debarment by the State or any other governmental authority. The offeror must disclose in their response: any convictions of the offeror, its affiliates and all directors, officers and employees and its affiliates for violation of any violation of State or federal law involving fraud, bribery, collusion, conspiracy or

6 misrepresentation with respect to insurance; commission of fraud or criminal offense in connection with any offer or service. The offeror must not have been issued a Cease and Desist Order (or any similar order) in the State of Utah for any reason within the past five years. Provide an affirmative statement that the offeror complies with this requirement B. The successful offeror ideally will have at least 5 years experience in IAIABC Claims EDI and should be an active member of IAIABC. 2. Service Level Agreements (SLA) A. Propose Guidelines for Industry Standard SLA i. Acceptable turnaround of incoming and outgoing file transfers and conversions ii. Acceptable transaction error ratio iii. Acceptable user support response parameters B. Failure to address service level agreement requirements will result in disqualification of the bid. Proposal Evaluation Factors 3. Provide background information about the offeror s qualifications in the form of a brief history and description of services in this field. Indicate the number of employees (total as well as those who are located in Utah, if any). Provide information about the physical location of offices in Utah, if any. Include the number of years the offeror has been providing these services. 4. Describe any important features that distinguish the offeror s qualifications and expertise from those of other offerors. 5. Describe your experience providing similar services to other governmental entities. Provide at least two references if applicable. Service Fee Prospoal 6. Respond to this item on the attached Service Fee Proposal form. PROPOSAL RESPONSE FORMAT All proposals must include: 1. RFP Form. The State s Request for Proposal form completed and signed. 2. Executive Summary. The one or two page executive summary is to briefly describe the offeror's proposal. This summary should highlight the major features of the proposal. It must indicate any requirements that cannot be met by the offeror. The reader should be able to determine the essence of the proposal by reading the executive summary. Protected information requests should be identified in this section. 3. Detailed Response. Provide one response to each item listed above. Where possible, please be brief and concise. This section should constitute the

7 major portion of the proposal and must contain a specific point-by-point response, in the order listed, to each requirement in the sections above titled: A. Offeror Qualifications and Proposal Requirements, items 1-2. B. Proposal Evaluation Factors, items Service Fees Proposal. Service fees will be evaluated independently from the technical proposal. Please enumerate all fees our trading partners will incur for the specified services on the attached Service Fee Proposal Form. PROPOSAL EVALUATION CRITERIA A committee will evaluate proposals against the following weighted criteria. Each area of the evaluation criteria must be addressed in detail in proposal. WEIGHT EVALUATION CRITERIA 50 % Offeror s qualifications, experience and offered service level agreement as specified herein. 25 % Service Fees charged to Utah trading partners 15 % Years of IAIABC EDI experience 10 % Number and/or quality of performance references for similar work.

8 Claims EDI Service Provider Solicitation # PR12028 RFP Evaluation Scoresheet Offeror Name: Evaluator: Date: Experience score will be assigned as follows: 0 = Failure, no response 1 = Poor, inadaquete, fails to meet requirement (>1 year experience) 2 = Fair, only partially responsive (2 years experience) 3 = Average, meets minimum preferred requirement (3 years experience) 4 = Above average, exceeds minimum requirement (4 years experience) 5 = Superior (5+ years experience) Qualifications, experience 50 points and SLA terms offered possible Service Fee evaluation 25 points possible Years of IAIABC Claims 20 points EDI Experience possible Number of performance 5 points References for similar work possible TOTAL EVALUATION POINTS 100 points possible Score 0-5 Weight X 10 *see below X 4 X 1 Points *Service Fee points will use the following formula: The points assigned to each offeror s Service Fee proposal will be based on the lowest proposed fee schedule. The offeror with the lowest Proposed Service Fee will receive 100% of the Service Fee points. All other offerors will receive a portion of the total Service Fee points based on what percentage higher their Proposed Service Fee is than the Lowest Proposed Service Fee. An offeror whose Proposed Service Fee is more than double (200%) the Lowest Proposed Service Fee will receive no points. The formula to compute the points is: Service Fee Points x (2- Proposed Service Fee/Lowest Service Fee)