COMMUNITY FIRST HEALTH PLANS (CFHP)

Transcription

1 COMMUNITY FIRST HEALTH PLANS (CFHP) REQUEST FOR INFORMATION NCQA Certified Credentialing Software Request for Information Credentialing Software Page 1

2 Section 1: Company Overview 1.1 Company Information CFHP is a local non-profit organization based in San Antonio that offers access to health insurance for the uninsured and under-served in Bexar and surrounding counties. With a member population of approximately 130,000, CFHP administers Medicaid and CHIP programs to provide health coverage for children in low-income families, as well as, commercial and affordable health insurance plans in the Health Insurance Marketplace. 1.2 Scope of Requested Services Support CFHP in all aspects concerning Credentialing according to NCQA specifications. Provider Demographics Provider Address Group Practices Licenses Education Insurance Affiliation/Employment Specialty/Boards Health Status Credentialing Group Types Credentialing/Verification Credentialing Groups ABMS Direct Connect Select Products/Contracts Site/Medical Record Reviews Member Complaints/Sanctions Peer Review Malpractice Claims NPDB/HIPDB Manager OIG Manager Contact Log Provider Areas of Interest Alternate Providers CME Events Provider Summary Questions Institutions Potential vendor maintains an appeal process that gives you the opportunity to file a complaint or appeal an audit result within 10 business days of receipt. Vendor shall assign an independent CHCA to investigate and respond in a timely manner (not to exceed 10 business days from filing). Vendor will inform NCQA of the investigation s progress, the outcome and the nature of any corrective action. Please note that any changes in rates resulting from an appeal may not be eligible for resubmission to NCQA for inclusion in NCQA s reporting products or accreditation, due to publication timelines and other submission deadlines set by third-party stakeholders including CMS. Request for Information Credentialing Software Page 2

3 1.3 Selection Process CFHP shall conduct a fair, impartial and comprehensive evaluation of all submissions. The information will be evaluated independently by members of a CFHP selection committee whereby the top three vendors will be identified. The Vendor s submission should include all information that is pertinent to its ability to service the requirements of CFHP. Factors that will be evaluated include, but are not limited to, the following: Competitive Price Service components Member experience Geographic coverage Implementation process Quality Assurance process Reporting and Technical capabilities RFI responses submitted to CFHP will be kept confidential. Section 2: Vendor Instructions 2.1 Response Format In order to facilitate a prompt evaluation of the submissions, please provide your response to the vendor questions and pricing for services required by the specified due date shown in the Response Timeline below. Please send an electronic version of response to: Vida M. Frausto, BS, CPCS Manager, Credentialing Community First Health Plans Silicon Drive, Suite 100 San Antonio, Texas [email protected] Telephone number: (210) Response Timeline RFI Milestones Due Date Release of RFI to vendors Clarifying questions due from vendors Request for Information Credentialing Software Page 3

4 Questions and answers provided to all vendors RFI Response Due Finalist Presentations Intended Award Decision Project Start Date 2.3 Clarifying Questions Questions pertaining to the RFI must be ed to Vida M. Frausto by. All questions are to be submitted in writing and must specifically reference the section of the RFI in question in order to be considered. CFHP will not respond to questions submitted after this date. Responses to the questions will be sent to all vendors included in this submission process. This process will ensure that all vendors receive the same information regarding this RFI. Section 3: Vendor Questions Executive Summary 1. Summarize your business. 2. Is your company a Texas Historically Underutilized Business? 3. Describe the features and benefits of your product/service. 4. Describe how your proposed product/service will meet CFHP s Credentialing needs. 5. Is your service accredited? If so, by what organization and when was the accreditation awarded? 6. Please provide an overview of your credentialing program. 7. Provide an overview of the implementation process. 8. Provide a summary of the proposed pricing. 9. What key attributes distinguish your organization from the competition? 10. What standard reports are available and how frequently? Are there additional costs associated with any of these reports? Request for Information Credentialing Software Page 4

5 11. Does your software have an audit function? If so, please describe. 12. Describe your company s security protocols for system access, ID, password controls including information on encryption, forced change/expiration of passwords and ID elimination when access is to be terminated and data recovery. 13. Describe your customer service: Hours of operation Location(s) Representative training Average tenure Number of customer service representatives employed by your organization 14. References: a. Provide the name and contact information of three customers with similar configuration and/or applications (preferably two Medicaid managed care plans). b. For each reference, describe the type of services performed and the length of engagement Request for Information Credentialing Software Page 5