REVISED ADDENDUM NO. 1. Third Party Administrator Claims Services (RFP )

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1 August 31, 2015 TO: All Proposers REVISED ADDENDUM NO. 1 Third Party Administrator Claims Services (RFP ) This revised ADDENDUM No. 1 forms part of Durham County s Request for Proposals (RFP ) Third Party Administrator Claims Services for Durham County. All other requirements of the original Specifications remain in effect in their respective order. Receipt of this Addendum must be acknowledged on the Addendum Acknowledgement Form included in the RFP. 1. The Proposals are due by 2:00 P.M., on September 8, The last day for questions regarding this project was August 21, 2015, by 3:00 P.M. 3. Attached are questions received regarding this project along with the responses. 4. Attached are Durham County Workers Compensation Loss Run Open Claims as of and Durham County Workers Comp Loss Run FY2009-FY2015 in Excel Format. Should you have any questions regarding this Addendum, please give us a call. Sincerely, Hilda W. Williams Hilda W. Williams, Senior Procurement Specialist Attachments Durham County Administrative Complex 200 E. Main St., 4th FL, Durham, NC (919) Fax (919) Equal Employment/Affirmative Action Employer 1

2 QUESTIONS AND ANSWERS (RFP ) 1. Question: Who is the current TPA and what is the current pricing structure? (Per claim or flat rate and can you tell me the current rates?) Answer: Compensation Claims Solutions is our current TPA for workers compensation claims and is compensated on a flat rate. Liability claims are currently self-handled. 2. Question: Would you please define the TPA s adjuster staff assigned to the County? (i.e. 1 Indemnity adjuster, 1 MO adjuster, etc.) Answer: Currently, the County is assigned one (1) adjuster for indemnity claims and one (1) adjuster for medical only claims. 3. Question: How many open Indemnity files are there, how many open medical only files are there and how many open casualty files are there? Answer: See attached Workers Compensation Open Loss Run (Attachment). Currently, there are no open casualty files that will be handled by the TPA. 4. Question: How many ID s will the County need to access the claim system? Answer: Three (3). 5. Question: What is the anticipated start date of the contract? Answer: Anticipated contract award date is October 16 th. We anticipate that the TPA will begin handling claims December 1 st. 6. Question: The selected TPA is to take over the handling of open claims. How many open claims are there at this time? Please provide the open claims volume broken down by claim type. Please provide loss runs as well. Answer: See attached Workers Compensation Open Loss Run (Attachment). 7. Question: Does your current TPA provide all required services for the County (claims, medical bill review, and case management) or are other companies used for any of these various services? Answer: The County s current TPA handles all services required under this Request for Proposal with regards to workers compensation claims. General liability claims are currently self-handled. 8. Question: How many medical bills are processed /paid each year (for the past 3 full years) for workers compensation claims? Answer: The County does not track the number of medical bills processed by the TPA. 9. Question: Please provide a copy of the County s current TPA contract. Answer: A copy of the current TPA Contract is attached. 2

3 10. Question: What are the current annual fees being paid to the TPA (or any of their subcontractors) for all services: claims handling, bill review, PPO network savings fees and any other fees? Answer: See attached copy of the current TPA Contract. 11. Question: Are there any service concerns with the current TPA or areas the County is looking to improve service in? Answer: The County has no service concerns with its current TPA. 12. Question: Is the County of Durham working with a broker on this RFP? If so, which firm and broker? Answer: The County s broker is AJ Gallagher and the point of contact is Peter Luca. Peter Luca Arthur J. Gallagher & Co Homewood Court, Suite 260 Raleigh NC, (919) Question: Please provide a recent 5 year Workers' Compensation loss run with summary in excel which breaks down the following at a minimum: Total Medicals paid per year Total paid on all claims per year Claims categorized as lost time, medical only, record only, etc. Claim status to show # of open Lost Time and Medical only claims currently What percentage of your RX's are paid by the County's Health Services? Answer: See Workers Compensation Loss Run FY2009-FY2015 (Attachment). The County does not have an exact percentage of prescriptions filled by the County s Health Department pharmacy but that share is low. Most prescriptions are filled at CVS, Walgreens, or Walmart. 14. Question: Please provide a breakdown of GL claims (GL/BI, G/PD, Professional, etc.) incurred each year as well as how many open claims there are currently? Answer: The County has historically not kept a loss run for general liability claims and is currently reviewing historic claim files to compile a loss run. Therefore, the County can only provide estimated claim counts. For the past four years the County has experienced approximately fifteen (15) general liability claims per year. 15. Question: Would the County need assistance with handling of Auto and Professional claims handling? Answer: The TPA will not handle auto liability or auto physical damage claims. The TPA may be asked to handle professional liability claims. 16. Question: Your Litigation Management requires review of legal bills. Can we use our Defense Counsel guidelines or will you provide your own? Answer: The County is open to considering the TPA s recommendations to best handle litigation management and bill review. 3

4 17. Question: For litigated matters, will the TPA handle the claim or work with the County Attorney? Answer: For liability claims, the County will handle litigated matters. 18. Question: Please provide us with the current TPA contract(s). Answer: A copy of the current TPA Contract is attached. 19. Would the County be amenable to negotiating portions of the sample contract provided in the RFP (Our TPA contract often includes TPA specific language such as funding, RMIS, etc.)? Answer: Included in the Request for Proposals is a Sample of our standard Service Contract. Any modifications to our standard contracts maybe negotiated with the awarded Contractor prior to executing the contract. 20. Question: Number of open claims, by type, to be assumed. Answer: See attached Workers Compensation Open Loss Run (Attachment). 21. Question: Current TPA for each line of business. Answer: Workers Compensation claims are currently handled by Compensation Claims Solutions. The County self-handles all other lines. 22. Question: Excess carrier for each line business. Answer: The County s Workers Compensation excess carrier is Safety National. The County currently has no coverage for liability lines. 23. Question: Please clarify the selected TPA s expected handling of liability claims. The RFP indicates general liability claims will be handled on an as needed basis. Will the selected TPA handle all the County s general liability claims? Or are some to be handled in house or by another party? Answer: The County is seeking a TPA that can handle general liability claims on an as needed basis. The County currently self-handles general liability claims and would like the flexibility of forwarding some to the TPA during high volume times. The County will not ask the TPA to handle currently open general liability claims. 24. Question: Will the selected TPA handle the County s automobile liability claims? If so, how many of those type of claims are currently open and how many historically have occurred each year? Answer: No. 25. Question: Does the County purchase liability insurance coverage? Answer: The County is considering obtaining excess insurance coverage for general liability and auto liability in

5 26. Question: Can you please tell me if you are self-funded for your health benefits as well? If so, who is the contact person at Durham County for benefits as well? Answer: Yes, the County is self-funded for health benefits. The County contact person for health benefits is Diane Pearson in Human Resources (919) However, should you have insurance products you think the County would be interested in, please contact our insurance broker, John Gasiorowski of Independent Benefits Advisors at Question: Will the County of Durham consider an RFP response solely for the workman compensation TPA services? Answer: The TPA needs to be able to accommodate general liability claims on an as needed basis. 5

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