Health Care Policy and Financing

Department of Health Care Policy and Financing RFP # HCPFJC0606MMIS#2 Colorado Department of Health Care Policy and Financing Questions and Responses RFP # HCPFJC0606MMIS#2 MMIS Takeover and Fiscal Agent Services July 21, 2006 1

Department of Health Care Policy and Financing RFP # HCPFJC0606MMIS#2 General and Questions Covering Multiple Sections 1. What is the status of the Department s National Provider Identifier (NPI) implementation, and are there any NPI-implementation-related requirements associated with the new contract? Response: NPI is scheduled to be completed by May 23, 2007. This Federally-mandated implementation is currently on schedule. Final system code, which will include this enhancement, will be turned over at that time to the new vendor. 2. Between July 1, 2007 and November 30, 2007 (within the Operations phase as specified on page 29 of the RFP), does the state desire that the new Fiscal Agent perform activities related to the Enhancements phase parallel to the Operations phase (e.g., requirements gathering and system design)? Response: No, activities related to the Enhancements Phase in the full transition, if the Department accepts any of the enhancements, will start December 1 as identified in the table in Section 2.7.4. The focus of the first six (6) months following transition by a new vendor will be on CMS Certification. 3. The overview of Section 7 - Evaluation Methodology states that the Department will conduct comprehensive, complete, thorough, and fair and impartial evaluations of each proposal received. Please explain how the proposal evaluation plan addresses at least some of the following items and facilitates a fair and level playing field for non-incumbent entities: Response: The Department recognizes that transition costs will vary according to whichever company is awarded the contract. The Department is focusing more on ongoing operations cost as a major part of the contract. Parallel costs of operations have also been planned for. The Proposal Evaluation Plan is confidential until a Notice of Intent to Make an Award letter is issued. The information provided below in response to these questions is intended to provide general information that can be of use to all bidders responding to this RFP, and should not be interpreted as being the evaluation criteria. While the specific Proposal Evaluation Plan is confidential as described above we are, by this response, notifying prospective Offerors that the variance in transition cost impacts on nonincumbent vs. incumbent entities will be considered in the Evaluation Plan. Additional information relating to the specific issues #7a.-j. is presented below. The Department has planned for the costs identified in #7a.-j., below. a. The cost of state resources involved in the transition activities (e.g., planning, testing, training, provider communications, and provider and client education); Response: The Department has planned for transition cost to facilitate transition activities. 1

b. The cost of new software and/or software licenses (versus ongoing maintenance fees to the incumbent), for the pharmacy POS, drug rebate, document imaging, EDI translator, and all other software components that must be replaced; Response: Whoever is awarded the contract, incumbent or new vendor, will be required to provide new software, and therefore new software licenses, for the subsystems and software utility pieces named above (see 1.1.3. and 3.1.). See also the second paragraph under Response: in # 7 above. c. The cost of hardware, system software, et al, to accommodate the new software and/or software licenses that must be replaced when a new Fiscal Agent is awarded the contract; Response: See the Responses under #7 and #7a., above. d. The provision in paragraph 13 of Appendix K Draft Contract, that all hardware and warranties shall become the property of the State, on or before termination of this contract, which apparently is not a clause in the current contract; Response: See 2.8.3. and Appendix J for equipment and software ownership and configuration. Besides the MMIS software, the Department also owns the hardware and software for the DSS. This subsystem will be transferred to the Department upon completion or termination of the contract. Any new equipment purchased on the Department s behalf in this contract period returns to the Department upon completion or termination of the contract. See also the second paragraph under Response: in # 7 above. e. The cost of replacing telecommunication lines as a result of the transition; Response: See the second paragraph under Response: in # 7 above. f. The cost of other entities affected by the transition (e.g., managed care broker, eligibility system); Response: See the second paragraph under Response: in # 7 above. g. The updating and redistribution of systems and user documentation to reflect resultant changes of transitioning to a new Fiscal Agent; Response: Because this is a takeover, most of the system and user documentation has already been created and is resident on the Department s LAN. See also the second paragraph under Response: in # 7 above. h. Initiation and testing of disaster recovery and business continuity sites, procedures, etc.; 2

Response: This would be included in the Operational Phase. i. Establishing the local operations facility, including the hiring of local personnel; Response: See the second paragraph under Response: in # 7 above. j. The enhancement phase schedules are significantly different should the contract be awarded to a new Fiscal Agent. Response: The new Fiscal Agent will have increased Transition activities and new operations to focus on so the Enhancement Phase is adjusted to take that into account. See also the second paragraph under Response: in # 7 above. 4. If the contractor wants to recommend improvements to the MMIS that are not currently required in any of the three phases under the RFP, what is the proper format within the proposal to discuss and price the improvements? (General) Response: Once operational, contractor-recommended improvements should be handled through the approved change management process. Within the RFP proposal, the contractor is welcome to suggest their recommended additional subsystem improvements. Any additional suggestions provided by the Offeror in their proposal will not be evaluated as part of this proposal evaluation. 5. Is it the Department s intent that the contractor provide Training, Document Management, Quality Assurance, and Inventory Management plans in their entirety in the proposal, or is an outline of each sufficient? If the full plans are required, can they be placed in the appendices? (2.6 para. 3; 4.4.2.1 para. 2; 4.4.25.1 para. 2; 6.2.6 para. 19.7) Response: All plans should be comprehensive enough so that the Department may appreciate that the vendor understands the needs and requirements for training Department staff, the Department s agents and its providers, and for document management, quality assurance and inventory management. More detailed versions should be available by the appropriate phase. 6. Please confirm that the Department will not require a performance bond to be procured by a non-incumbent entity. Response: The RFP does not require a performance bond to be procured by a non-incumbent entity. 3

Section 1 7. On what date will the Department be releasing the list of entities that submitted Letters of Intent to Bid? Response: The list of entities that submitted Letters of Intent to Submit a Proposal will not be available until after the Notice of Intent to Make an Award letter is issued. 8. In section 1.1.3, the Transition Phase paragraph refers to implementation of various subsystem improvements. Please specify the exact scope of the subsystem improvements being referred to. Response: Improvements in the Transition Phase are defined as developing and/or replacing software that is currently contractor owned or licensed to the Department (see Section 2.8.3). The subsystems targeted, and the section containing the scope of change, include: Electronic Transactions (4.4.10), Pharmacy Claims Services (4.4.14), Drug Rebate Program (4.4.15), and Document Management (4.4.25). Other software systems that will require new solutions are the (HIPAA) Electronic Data Transmissions Clearinghouse, the Call Center Customer Relations Management (CRM) software, the change management tracking system and the report management software. 9. In section 1.1.3, the Transition Phase paragraph refers to clearinghouse translator services and other licensed software. Please specify the other licensed software being referred to. Response: See Response to Question 8 above. 10. Will the Department provide a list of vendors who have submitted letters of intent? (1.2.7) Response: The list of entities that submitted Letters of Intent to Submit a Proposal will not be available until after the Notice of Intent to Make an Award letter is issued. 4

Section 2 11. Requiring a non-incumbent Fiscal Agent to license and install the software components listed in the Systems Overview table of 2.8.3 seems to create an advantage to the incumbent Fiscal Agent. Per section VI.D Contract Terms and Conditions Rights to System, of the 1995 RFP which the current Fiscal Agent contract is based, the Department retains ownership of the listed software components, or at the least retains the nonexclusive, royalty-free, and irrevocable license to reproduce or otherwise use and authorize others to use all software comprising the Colorado MMIS at any time during the period of the Contract and thereafter. The section goes on to state that The provisions of this clause shall be incorporated in any subcontract which relates to the development, operation, or maintenance of any component part of the Colorado MMIS (e.g., the Pharmacy Claims Services System, Drug Rebate Analysis and Management System). Federal regulations (i.e., 45 CFR 95.617), specify ownership rights of the state or local government to software or modifications thereof designed, developed or installed with Federal financial participation under this subpart. The regulation also specifies royaltyfree, nonexclusive, and irrevocable license specifications that are very similar to those specified in section VI.D of the 1995 RFP. If the Department decided not to exercise its rights to the software components at issue, please explain the rationale. Otherwise, please amend the RFP with an attachment that includes the documentation necessary to confirm that the software at issue has not been designed, developed, installed or modified with Federal financial participation, including the initial installation and integration of the Department-specific requirements, modifications for HIPAA compliance, or modified using enhancement pool hours, and that the Department does not have rights to the software at issue. Response: The Department has not relinquished rights to the MMIS software. Software that is licensed in the Department s name does not necessarily belong to the Department; for example, Oracle database software. Tools to support operations are the bidder s responsibility. For example, the document imaging system, the call center customer relations management (CRM) software, and the change management tracking system are tools for operations. 12. Section 2.6 indicates that a Quality Assurance / Quality Management plan is to be created as part of this proposal, yet section 6.2.6, items 10 and 11 mention only a global perspective in regards to quality and ask for a discussion of quality tools. Can the Department clarify what is expected in Section 2.6 as opposed to Section 6.2.6 regarding Quality Assurance? Response: The Quality Assurance/Quality Management Plan should be comprehensive enough so that the Department may appreciate that the vendor understands the needs and requirements of the Department, its staff, and the Department s agents and providers. A more detailed version should be available by the appropriate phase. 5

13. Is it the Department s expectation that the future requirements of HIPAA be included in the cost of the contract and not be priced as a contract amendment when rules and changes are mandated, e.g., the upgrade to version 5010 and NPI Remediation? (2.7.1.1) Response: No. 14. The RFP states that an independent auditor must perform SAS 70 audits annually at fiscal agent and data center sites. Is it the Department's intention to have contractor conduct separate audits for each data center site or is one comprehensive SAS 70 audit at the fiscal agent location sufficient, as it is in the current contract? (2.7.2.3 para. 3) Response: Separate audits for the data center site are required. 15. Based on our analysis, implementing the requested enhancements in seven months may not be feasible for all the requested enhancements. Given the magnitude of some of the enhancements and the concurrent implementation schedule, would the Department consider extending the development cycle into the Operations Phase? (2.7.4) Response: The Department may or may not accept any or all of the enhancements. Acceptance is based on cost, time to implement, etc. While these factors weigh in on the consideration, the Department does not intend on extending the Enhancement Phase. 16. Does the phrase multiple versions of data refer to eligibility spans? If not, please clarify meaning of multiple versions of data. (2.8.10 para. 4) Response: Multiple versions of data refer to the start and stop dates on a claim. For example, a claim needs to reference rates that exist within a span of time, even if there are several spans of time with different rates. Multiple versions of data ensures that those start and stop dates are interrogated for that claim. This is part of the base system currently. 17. The current MMIS and Pharmacy system does not provide functionality for table-driven edits. Is it the Department s intent to modify the MMIS and Pharmacy system to allow for this functionality? If so, could the Department provide clarification on the requirement? (2.8.10 para. 6) Response: Table-driven edits refers to the table of edit statuses, such as pay, deny, or suspend by media type. This is part of the base system currently. 18. Throughout this section there is a reference to the Systems Development Manager. Is this the Key Personnel position, Systems Manager? 2.8.12 (para. 11, 12, 13, 14) Response: Yes. 6

Section 3 19. In sections 3.3.2.1, 3.3.2.2 and 3.3.2.3 the terms "project work plan", "work plan and schedule", and "MMIS Transition Plan" are used. In 3.3.2.3 the MMIS Transition Plan and Project Work Plan are then listed as two separate deliverables. Please clarify the difference between the three planning items? Response: Change 3.3.2.2.6. to read Final MMIS Transition Plan and Schedule. 20. In section 3.3.3.1, items 9 and 10 discuss a "system test" and then an "integration test", respectively. Item 11 in that same section refers to the integration test as a "unit test". In section 3.3.3.3, items 1 through 4 indicate that Integration and Interface Test Plans and Test Results are deliverables, yet interface testing is not discussed in the contractor responsibilities. Section 3.3.3.2 indicates that the system test results are a milestone and does not mention any of the other testing. Since these testing terms are sometimes used inconsistently by other organizations, please clarify the use of these terms within the RFP and the Department. Response: Item 11 does not refer to the integration test as a unit test. The testing stream is unit testing, system testing and integrated system testing, including interface testing and user acceptance testing. Also, on occasion, the Department may require Beta or pilot testing. 21. Throughout the RFP and specifically in the Operations Phase, the Department has provided for multiple subsystems improvements to the base CO MMIS. Will the costs for these improvements be incorporated into the Transition Phase or the Operations Phase? (3.1) Response: Transition Phase (see Section 3). 7

Section 4 22. Section 4.2 indicates that key staff for the Operations phase must have at least two years experience in a Medicaid Fiscal Agent contract, or a Bachelor s degree. However, in subsequent subsections many of the key personnel named are required to have a Bachelor s degree and previous experience with Medicaid or with MMIS systems / components. These include Account Manager, Claims Processing Manager, Provider/Client Relations Manager, and MMIS Systems Manager. Please clarify this possible inconsistency. Response: The definitions in 4.2.1. take precedence. 23. Item 2 of section 4.4.2.1 indicates that training plans should be included in the response to this RFP. The item states that the plans must address the implementation of training curricula for the Department, its agents and providers. The item requests a format for the training materials and methodologies. Yet, section 6.2, item 12 requests an approach and section 4.4.2.1, item 7 indicates that a comprehensive Training Plan is to be submitted during the Transition phase. Please clarify this possible inconsistency. Response: All plans, charts, schedules, etc., should be comprehensive enough so that the Department may appreciate that the vendor understands the needs and requirements of the Department, its staff, and the Department s agents and providers. The detailed versions should be available by the appropriate phase. 24. Section 4.3 Location of Contract Functions states that MMIS computer processing functions may be performed outside of Colorado, but within the continental United States. Multiple items listed as Operations Phase activities that must be performed at the Fiscal Agent s Denver facility are typically computer processing functions integrated with the rest of the MMIS (e.g., #3 data capture, #10 Checkwrite-related activities). Will the Department allow additional MMIS processing functions to be located outside of Colorado, and integrated with the rest of the MMIS? Response: While MMIS computer processing functions may be performed outside of Colorado, but within the continental United States, operations and systems staff must be located in a Denver vendor facility. An example is the CheckWrite interface file generation which is part of computer processing; data entry is part of Denver facility operations. Also, print/mail functions can be provided at less cost when integrated into a high-volume operation versus a stand-alone local operation. Will the Department allow print/mail functions to be located outside of Colorado? Response: Yes, however those functions must be performed within the continental United States and are the responsibility of the vendor. 8

25. If the Department moves during the contract period, will the Department require the contractor to relocate from its pre-approved location based on a Department change of address? If so, will the contractor be expected to pay for its required move in order to be compliant with the five mile rule? (4.3) Response: The Department has no plans to move at this time. This requirement will not be waived, however, should the Department move sometime in the future. This requirement will be reviewed with the vendor. 26. This requirement states Data capture, including, but not limited to, hard-copy and electronic claims transactions and encounter records is to be performed at the Denver facility. Can electronic claims capture be considered another form of computer processing as outlined in the paragraph below the bullet list on page 63, and therefore be performed in some place other than Denver? Currently, this function is not performed in Denver. (4.3 para. 3) Response: Yes. 27. Clearinghouses and billing agents do not have an assigned provider type in the MMIS, only the providers linked to them. Is it the Department s intent to add the functionality of having the clearinghouses and billing agents test every time a provider receives a new provider type, as this function does not exist under the current contract? (4.4.4 para. 28) Response: In 4.4.4.1 para 28, this line should read, Certify clearinghouses and billing agents prior to acceptance and submission of billings. Run a test submission prior to certification or when adding a new transaction type to ensure that the submission format is accepted by the Colorado MMIS. 28. Is it the Department s intent to add the functionality of including PAR units and claim status to the AVRS? (4.4.4 para. 5) Response: See AVRS defined in 4.4.5. 29. Current operations require that all submitters (clearinghouses and billing agents) test through the system. Does the Department intend to add functionality requiring that all individual providers submit test data through the system before being allowed to submit claims? This is not current functionality. (4.4.4 para. 62) Response: If submitting interactive claims, the web portal is certified and testing is not necessary. However, if submitting through batch, the process must be certified and tested. 30. Is it the Department s intent to increase the amount of time provider communications/relations phone lines are staffed by an additional two hours, from 7am to 6pm mountain time? The current hours of operation are from 8am to 5pm. (4.4.4.2 para. 6) 9

Response: Yes. 31. Currently, the Department monitors ASA (Average Speed of Answer) as the time for a live person to answer the call. Is the new requirement intended to change the interpretation of ASA to be average time for the system to answer the call? (4.4.4.2 para. 7) Response: No, the Department has only changed ASA from number of rings to number of seconds. The time is still calculated from the time a call is put in queue until the call is answered by a call center agent. 32. Although not part of the operation today, does the Department expect providers or other callers to the AVRS to have access to voicemail to leave messages during the hours that the call center is not covered? (4.4.4.2 para. 7) Response: Yes. 33. The RFP requires that downtime for routine maintenance be limited to the hours of 4am to 5am daily. (4.4.5.2 para. 5; 4.4.13.2 para. 6) a. Will the Department consider negotiating a different window of time for routine maintenance based on traffic volume? Response: Yes. b. IPL is an industry standard database maintenance that must be performed weekly in order to maintain efficient response times. Is the Department willing to allow time for this maintenance in addition to the allowed daily maintenance time? Response: Yes, to a max of 2 hours weekly. 34. Can Periodic be interpreted as meaning monthly as referenced in 4.4.6.1 (10)? (4.4.6.2 para. 5) Response: Yes. 35. Will the Department explain what they are referring to when they list 94 as a claim type? (4.4.8 para. 1) Response: Correction UB-04. 36. Is the Department requesting a major system change to the base CO MMIS to track any and all changes to a record as it is processed and add this information to the claim record for research purposes? Current functionality provides audit information that is updated to reflect 10

only the most current stage of processing. In addition, this information is not currently available online. (4.4.8.1 para. 29) Response: No, this was intended to be an accurate reflection of the system as it currently is today. 37. The RFP states that Special reconsideration claims types are documented in the Claims Section (see Section 4.4.8) along with suspense criteria. These references cannot be found in Section 4.4.8. (4.4.9.1 para. 9) Response: Strike this item. 38. Is it the Department s intention to allow the reports of unsuccessful transactions by the following Claim Types: Professional, Dental, and Institutional? If not, please define claim type. (4.4.10.1 para. 13) Response: Professional, Dental and Institutional are not claim types, they are transaction types. Unsuccessful transactions must be reported by transaction type: Professional, Dental and Institutional. Claim errors must be reported by claim type after MMIS adjudication. See Systems Documentation section 9.6.1. for claim types. 39. The tracking and reporting of reconsiderations is not a part of the base MMIS functionality. Is it the Department s intention that the contractor build and maintain new functionality to allow for this function? (4.4.9.1 para. 1) Response: The Contractor must provide for this responsibility. 40. The RFP states "Process clean claims received according to the following standards. By clean claims, is the Department referring to claims without attachments, as is documented in current procedures? (4.4.11.2 para. 6) Response: Yes, clean claims are those without attachments. 41. Is the contractor expected to take calls from clients with regard to PARs? Since the incumbent contractor does not currently receive client calls, will the Department provide the volume of calls taken? (4.4.13.1 para. 15) Response: No, the contractor will not take calls from clients regarding PARs. The responsibility for communications with clients is for written correspondence only. 42. Is it the intent of the Department to have the contractor staff a phone line 24 hours a day, 7 days a week for pharmacy and/or MMIS in order to receive, document, evaluate, approve, or deny telephone requests for authorization to provide urgent/emergency services? The incumbent contractor does not currently perform this function. (4.4.13.1 para. 16) 11

Response: No. See 4.4.13.2.6. and 4.4.14.2.3. 43. The current base CO MMIS does not contain Tickler Files. Is it the Department s intent that the contractor build and maintain Tickler File functionality within the MMIS? (4.4.13.1 para. 27) Response: Prior Authorization or Aged Pending files serve as tickler files. 44. Would a nightly update of information from the Pharmacy database into MMIS be acceptable to meet the requirement to integrate with the MMIS to synchronize necessary data in realtime and batch modes? The incumbent contractor does not currently synchronize data in real time. (4.4.14.1 para. 3) Response: A nightly update of information into the MMIS would be acceptable to meet the requirement. 45. Is it the Department s intent to have the contractor build and implement a redundant failover system so that downtime does not exceed thirty minutes? Such a redundant system does not exist at this time. (4.4.14.1 para. 5) Response: No. Strike this requirement. 46. Can the Department verify that it wants the contractor to identify duplicate claim transactions based on both medical and pharmacy claims, per user-configurable criteria, for the POS component of the contractor s solution? (4.4.14.1 para. 9.13) Response: Yes, medical claims, such as those which carry J procedure codes, will need to be edited for duplicate payments against pharmacy NDC codes. 47. The current system provides messaging for manually entered claims and claim adjustments, but not for mass adjustments. Is it the intent of the Department to include interactive messaging for mass adjustments? (4.4.14.1 para. 9.29) Response: Messaging is required. Strike the word interactive from the requirement.. 48. Is the Department referring to multiple reversals for a single claim? If so, could the Department provide an example of when there would be multiple reversals for a single claim? (4.4.14.1 para. 10.8) Response: No, this requirement is referring to a single chain of several adjustments or reversals. 12

49. Is it the Department s intent that the contractor provide electronic prescribing (e-prescribing), which would require major enhancement to the Provider Web Portal or the development of an additional portal? (4.4.14.1 para. 11) Response: No, strike 4.4.14.1.11. as a requirement. 50. Is it the Department s intent that the Contractor provide 100% dedicated Pharmacy PAR Call Center staff and Pharmacy PAR review staff dedicated to Colorado? If so, would it need to be located in Denver as required by RFP Section 4.3, bullet #7 on page 63? (4.4.14.1 para. 13.2) Response: The Department is requiring dedicated PARs staff. Staff do not need to be located in Denver.. 51. Is it the Department s intent that the contractor build and maintain functionality to allow for free form text for pharmacy claims? If so, could the Department elaborate on the requirement? (4.4.14.1 para. 18) Response: Free form text should be available on Prior Authorization Requests in order to show justification for the drug usage. Text needs to be available on Pharmacy claims responses only for those claims being returned to the pharmacy, in order to provide reasons for claim edits. 52. Is it the Department s intent to build and implement the capability to link participants to other participants? If so, can the Department provide examples? (4.4.14.1 para. 30.5) Response: No, strike this requirement. 53. Is it the intent of the Department to have the contractor staff a Pharmacy Call Center 24 hours a day, 7 days a week? The incumbent contractor does not currently perform this function. (4.4.14.2 para. 2) Response: Yes. 54. Is it the Department s intent to implement supplemental rebates in the pricing of the Operations Phase? Currently this service is not included within the scope of what the incumbent contractor provides to the Department. Is it the intent of the Department to implement this major enhancement, which will incur considerable cost? (4.4.15.1.2) Response: As stated in the introduction, the Department does not currently participate in supplemental rebates but expects the capability to be there. 55. Is it the Department s intention that we run a report after Capitation, but prior to financials on a monthly basis, then run the monthly R0360 Capitation Report following financials every month? (4.4.18.2 para. 5) 13

Response: The R0360 Capitation Report should run during financials, as it does currently. 56. Is it the intent of the Department to have the contractor build and implement the following SURS functionalities within the Operations Phase? Currently these functionalities don t exist. (4.4.20.1 para. 10, 16, 21) Response: These features would be implemented during the Transition Phase #10 Add encounters when they were previously left out. Response: Yes. #16 Add new criteria for SURS to include an on-review indicator and case managed indicator. Response: Yes. On-review indicator is a lock in and case managed indicator is a PCP flag. # 21 Report based on case/household, whereas it is currently reported by client. Response: Yes. 57. Is it the Department s intent to have the contractor provide industry standard software to monitor code-creep and up-coding? Incumbent does not currently provide this service. (4.4.20.1 para. 24) Response: The requirement is that code creep and up coding be monitored. The Department is not prescribing a solution but asking the vendor to determine the need and then propose a solution. 58. There are currently two test regions, System and Unit. Is it the Department s intent to build and implement a third testing region for this purpose? (4.4.23.1 para. 13) Response: The third test region is not intended as a full-time requirement. The third testing region is a user acceptance testing region that is intended for the testing of major enhancements (such as the one used for HIPAA implementation). The use of the UAT would allow testing of other changes to continue unabated in the other test regions. 59. Is it the Department s intent to use a central document repository to store and provide access to systems and operations documentation, rather than the current method of accessing the documents through the share drive? (4.4.25.1 para. 3) Response: Yes. The share drive meets the requirement of a central document repository. 14

60. The RFP states that 1800 billable programming modification hours worth of work are to be conducted each month. Is it the Department s intent to increase the existing contract billable hours from 1275 to 1800? (4.6.2.1.1) Response: Yes. 15

Section 5 61. The requirement states that the "enrollment process should allow for multiple service locations with email, regular mail and phone numbers for each location." Currently, the MMIS maintains one location address, one billing address, one mail-to address and one email address. Is this statement requesting that the MMIS be enhanced to store more than one physical location address and more than one email address for a single provider? (5.6.1 para. 1.3) Response: Yes. 62. Does the Department expect the new contractor to create and maintain a separate web portal to meet this requirement of real time updating to the MMIS for providers to enroll, or is the expectation that this be performed on the existing State Web portal? (5.6.1 para. 1.2.2) Response: This requirement should be met through integration with the provider service area on the public web site. 63. Is the intent of the Department to have the MMIS store all provider information that is contained in various databases? If so, is a daily refresh of the MMIS acceptable? (5.6.2) Response: Yes. However, the MMIS will provide refresh to other databases on a daily basis. (see 5.6.2.1.3.) 64. Current policy and functionality of the base CO MMIS does not require the enrollment of submitters (clearinghouses, software vendors, or billing agents). Is it the intent of the Department to have the fiscal agent enroll these submitters and assign provider numbers? (5.6.2 para. 1.2) Response: Yes, it is the Department s intent to enroll the submitters. Assigning provider numbers is a design approach not addressed in the requirement. 65. Is it the intention of the Department to electronically generate HIPAA (X12) standard transactions (bills)? Is it also the intent of the Department to create standard paper claims for use by attorneys and other entities? (5.6.4 para. 5) Response: Yes. 16

Section 6 66. The subsection references in section 6.2.5, items 7, 9, 10, 12 and 13 appear to be incorrect. The correct references appear to be 3.3.2, 3.3.3, 3.3.4, 3.3.5 and 3.3.6, respectively. Please clarify these subsection references. Response: That is correct, the reference in 6.2.5.7. should be 3.3.2.; in 6.2.5.9. it should be 3.3.3.; in 6.2.5.10. it should be 3.3.4.; in 6.2.5.12. it should be 3.3.5.; and, in 6.2.5.13. it should be 3.3.6. 67. The instructions for the Approach to the Transition Phase in section 6.2.5 indicate that the page count must not exceed thirty-five (35) pages including charts, tables and explanatory graphics. Item 2 requests a work plan and then a GANTT schedule showing detail for installing the Colorado MMIS. In our experience, the detail in the schedule required to show the major tasks and sub-tasks needed for a project of this size can be lengthy. Would the Department consider allowing the GANTT schedule to be included as a separate addendum not included in the page count? Also, Item 1 requires a work plan. Could the State clarify whether this is a narrative work plan (discussion type) or a work breakdown structure (WBS) in a table format? If this is a WBS, would the Department consider allowing the WBS to be included as a separate addendum not included in the page count? Response: Additional page counts and addendums will not be permitted. All plans, charts, schedules, etc., should be comprehensive enough so that the Department may appreciate that the vendor understands the needs and requirements of the Department, its staff, and the Department s agents and providers. The detailed version should be available by the appropriate phase. 68. Are the Work Plans/Gantt Charts required in Sections 6.2.5 and 6.2.7 included in the page limits or can they be added as appendices? (6.2.5; 6.2.7) Response: Additional page counts and addendums will not be permitted. All plans, charts, schedules, etc., should be comprehensive enough so that the Department may appreciate that the vendor understands the needs and requirements of the Department, its staff, and the Department s agents and providers. The detailed version should be available by the appropriate phase. 69. The RFP references the MMIS Business Analyst Manager. Should this be MMIS DSS Business Analyst Manager? (6.2.6 para. 2.6) Response: 17

The MMIS-DSS Business Analyst Manager has been changed to MMIS Business Analyst Manager (see 4.2.1.). The following is included as the responsibilities for this position: The responsibility of the Business Analyst Manager is to assure that all business functions are tested, implemented, and processed correctly in the system for all maintenance as well as enhancements and modification activities. The manager is responsible for assuring that all systems changes are developed according to the Systems Development Life Cycle (SDLC) processes described in section 2.8.12. and stages described in section 4.6.2.1.2.2. The business analyst manager role will be to manage a team of full-time business analysts (see section 4.6.2.1.1.) who are required during the Operations Phase, unless otherwise directed by the Department, to provide on-site business analysis and serving under the direction of the MMIS Business Analyst Manager. Minimum qualifications for the Business Analyst Manager include: a. Minimum of at least four (4) years supervisory experience in health care claims processing systems business analysis, development, and testing in a system environment similar to Colorado s OMNICAID system. b. Bachelor s degree from an accredited college or university. c. Previous, recent, and successful experience with MMIS or major MMIS components is required. This change will also affect the Operations Phase Key Personnel listing in Appendix I. In this appendix, MMIS-DSS Business Analyst Manager has been replaced with MMIS Business Analyst Manager. The following is the General Responsibilities of this position: Assure that all business functions are tested, implemented, and processed correctly for all maintenance, enhancements, and modification activities. Assure that all systems changes are developed according to SDLC processed described in section 2.8.12. and stages described in section 4.6.2.1.2.2. Manage a team of full-time business analysts to provide on-site business analysis. Minimum qualifications are listed above, and replace the minimum qualifications listed in Appendix I for the MMIS-DSS Business Analyst Manager. In 2.8.12.1., Fiscal Agent Business Analyst Manager is replaced with MMIS Business Analyst Manager. 70. Examples of proposed quality assurance and inventory management plans are to be included with our response. Can these examples be an appendix? Will tables of contents of these plans suffice as examples? (6.2.6 para. 19.7) Response: All plans, charts, schedules, etc., should be comprehensive enough so that the Department may appreciate that the vendor understands the needs and requirements of the Department, its staff, and the Department s agents and providers. Additional page count will not be permitted, nor should these plans or charts be added as appendices. 18

71. In the current contract, postage is a pass through expense. The RFP states All costs for operations, systems maintenance, postage, and modification support at the level defined in Section Four of the RFP are to be presented in these schedules. Does the Department intend to make postage a part of the firm fixed price? If postage is the responsibility of the contractor, will the Department consider putting an annual cap on the postage expense? (6.3.3 para. 2) Response: Postage is a pass through. This paragraph should read All costs for operations, systems maintenance and modification support at the level defined in Section Four of this RFP are to be presented in these schedules. 72. The Offeror needs to include, based on the Offeror s proposed schedule and the payment schedule below, which fiscal years would include which payments or portion of payments. Pricing Schedule D only provides an area for bidders to present one number for each of the nine enhancements. Please clarify how Offerors are to include the required payment information, referenced above, on Schedule D. (6.3.4) Response: Strike this sentence. 19

Section 7 73. Please detail the composition of the proposal evaluators, including the total number, their organization (e.g., a team of evaluators for each RFP section), their roles within the Department and if their day-to-day activities include interaction with the incumbent Fiscal Agent, and whether outside entities are involved (e.g., Solutions Consulting/Public Knowledge, other state agencies). Response: The composition of the evaluation committee is not disclosed prior to the issuance of the notice of award. Per Section 7.1 of the RFP: Committee members will be selected who do not have a conflict of interest in this procurement. 74. Please detail the points system used to score proposals and award the contract. Please specify the total number of points available, the breakdown between technical and cost proposals, and any additional categories that points can or will be awarded. Response: The details of the system used to evaluate proposals and make an award is not disclosed prior to the issuance of the notice of award. 20

Appendix C 75. Question 35 references the Fiscal Operations section, specifically RFP Sections 5.2, 5.3, 5.4, 5.5, and 5.6. Are the correct references RFP Sections 4.2, 4.3, 4.4, 4.5, and 4.6? (Appendix C C-4 para. 35) Response: Yes. 21

Appendix G 76. In the costing sheets, reference is made to basing the bid on a volume of 35-40 million claims per year. In Appendix G, the Department has provided claim volume for SFY 2005-2006 at 2.1 million claims per month. Please confirm that the Department s expectation is that the bid be based on 35-40 million claims per year. If so, please explain the increase. (Appendix G Statistics Table; Appendix H Pricing Schedule C.1-C.3) Response: Encounters claims are currently not included in the MMIS Statistics, but will be added going forward. Estimated claim volumes were determined using Department caseload projections. 77. Will the Department consider removing postage costs from the fixed price of the contract, making postage costs pass-through-reimbursement, instead? Response: See Question 71. 78. Appendix G Current MMIS Statistics specifies monthly averages for postage costs. Are there any requirements in this RFP that will increase the volume or type of mail from the volume or type that produced the stated monthly averages? If so, please provide reference(s) to those requirements. Response: There are no requirements in the RFP that are expected to increase the volume or type of mail in the stated monthly averages. 22

Appendix K 79. Paragraph 6 of Appendix K - Draft Contract does not specify the holdback percentage. Please indicate the percentage required by the Department for any and all applicable phase(s). Response: The Draft Contract does not duplicate the requirements of the RFP; the RFP is included by reference in the contract. Any provisions for holdback percentages that have been identified in the RFP and its attachments will apply to the resulting contract. 80. Paragraph 24 of Appendix K - Draft Contract does not specify the minimum limits of liability insurance required of the Fiscal Agent. Please provide the required limits. Response: Paragraph 24.A.4. in Appendix K Draft Contract, should be changed to read: Professional liability insurance with minimum limits of liability of not less than $5,000,000. 81. Paragraph 13 of the Draft Contract states that On or before termination of this contract, all hardware and warranties in place to support development and production work to fully meet the performance obligations in this contract shall become the property of the State. According to Appendix J, much of the current hardware and some of the software are owned by the current Fiscal Agent contractor. Is it the State s intention that ownership of all hardware and software IT assets (i) currently used in the performance of this contract as described in Appendix J (mainframe, servers, etc.), and (ii) to be implemented in the contract resulting from this RFP, must be transferred to the State at the end of the contract resulting from this RFP? (Appendix K page 4 para. 13) Response: See 2.8.3. and Appendix J for equipment and software ownership and configuration. Besides the MMIS software, the Department also owns the hardware and software for the DSS. This subsystem will be transferred to the Department upon completion or termination of the contract. Any new equipment purchased on the Department s behalf in this contract period goes back to the Department upon completion or termination of the contract. 23