Questions from Potential Bidders For Bill Review and UR RFP - Answers follow the questions from potential bidders with their wording in bold italics.
1.
· Under Attachment VI Fee Proposal Form why is “negotiating of hospital and surgical bills” removed? What will happen to those bills? Those bills will be sent through the standard bill review and PPO process.
· Is the pre proposal conference mandatory? No. Are there any points given or taken away? No.
· Must scanning be done on site at SF offices or can paper bills be sent to other locations? Paper bills can be sent to other locations.
· Does MBE have any points associated? No.
· What fee is SF paying now for bill review and PPO network access? $9.05 per bill for bill review and 25% of savings for PPO. UR? $133 per UR and $338 for peer review.
2.
· Under RFP Attachment V; Proposal Template #5. “Prior Contracts.” Is the City referring to terminated or ex-clients? (Note: this question was e-mailed and also asked in the pre proposal conference.) Yes.
· Where can the contract language be found? In Attachment 4 that has been posted.
3. From GSG Associates and Definiti Healthcare:
· On page 1 (of 9) of the RFP background document, in section 1.2, you state “There are no HRC Local Business Enterprise Goals and outreach requirements for the RFP.” But in your Proposal requirements, section 3.2, you state that the Proposal Package must include “RFP Attachment II (2 copies) of theHRC LBE Forms. If there is no LBE requirement, are the forms still necessary? Yes, they are still required..
· Also in 3.2 you state the Proposal package is to include:
RFP Attachement I – Acknowledgement of RFP Terms and Conditions (Word) – not included in the files for download. We don’t see your T and Cs document. It should be there now.
RFP Attachment III – City’s Administrative Requirements (Word with links) – not included in the files for download It should be there now.
RFP Attachement IV – City’s Agreement Terms and Conditions (Word) – as stated above, we don’t see this document for download. Again, it should be there now.
Are there MBE, WBE provisions within the CCSF contracting/RFP process? No.
· The RFP is for Bill Review and Utilization Review, if two companies partner to provide the services, will CCSF all two contracts for services or mandate a prime/sub arrangement? We would like to enter into one contract for the services.
4.
BILL REVIEW
Current pricing structure? Per bill. Rate? $9.05
Medical Billed Charges for 09/10? $58,978,211
Medical Charges allowed for 09/10? $21,337,139
BR Savings for 09/10? $37,641,072
Fee for PPO access fee? $372,778
PPO penetration rate? 24.8% PPO Savings? $1,602,191
# Pharmacy bills? UNKNOWN
Do you have a managed pharmacy program? No
UTILIZATION REVIEW
Pricing for UR & Peer Review? Per review and type of review. Is CCSF paying a flat rate per referral, or hour rate, if so what is rate? $133 per UR and $338 for Peer Review.
For 2009 what percentage of review were nurses only? 70% What percentage were Peer reviews? 30%
Total paid for UR, RN review only? $251,503
Total paid for UR MD review? $282,177
Total spent on UR? $533,685
Preferred pricing model? See RFP
Miscellaneous
Who is currently being used for LBE? N/A
Confirming the LBE participation is “waived for this RFP”? Correct? Yes. Or is outreach recommended?
5.
° Is the Valley Oak claim system used by the City also used by your TPA? Yes
Currently in MPN?
° Describe the City’s position on provider networks? Is the intent of the RFP for the vendor to provide a network strategy inclusive of MPN or does the City have network contracts in place that the selected vendor will need to enable? No, the City has its own boutique MPN administered by Intermed.
° The timeline reflects 30 days from the time the contract is awarded until the time services are to begin. Is there any flexibility to this date and for making a decision sooner given if the City changes partners, additional time may be needed to support EDI development? No.
° Who is the TPA that administers 30% of the City’s claims? Intermed.
° What is the logic for which claims will be administered internally by the City vs outsourced to TPA? Not applicable to this RFP.
° How much has the City spent for bill review services for the last 12 months? $1,076,671 Prior 12 months? Information not available.
° How much as the City spent for UR services for the last 12 months? $533,685 Prior 12 months? Information not available.
° Who is your current bill review and utilization partner(s) and how long has the City had a contract with this partner? Allied Managed Care since September 2005.
6.
· Section 2.1,1.k., of the Scope of Work discusses assisting with services on medical liens. Can you provide your yearly experience with these services including the number of court appearances per year? Minimal – less than 5
· How do you control the cost of medical care in addition to UR? With our MPN.
· Do you have a return to work plan? Yes. Disability manager? No Early intervention program? Yes.
· Do you have best practices for UR? Yes.
· If a Treating physician requests MRI, PT, wheel chair in one PR-2, is it treated as one review by your current vendor or 3 reviews? This would not be referred for UR. It would be handled in-house.
· What % of bills are duplicates?
· How is the CCSF currently charged for their MPN. We have our own and it is administered through our TPA.
· How does your bill review integrate with utilization review determinations? Treatment that is not authorized under UR is not processed through for payment on the bill review side.
· What were the total medical charges billed for 2009/10? $58,978,211
· What was the total allowed for 2009/10? $21,337,139
· What was the CCSF’s total cost for Medical Bill Review in 2009/10? $1,076,671
· Do you have customized rules for bill payment and processing that you want employed? Yes.
· What is your current % of savings for PPO? 24.81%
· For the EDI processing of bills and attachments, do you have a standard or protocol that you already have in place? No.
7. From the pre proposal conference:
· When will the conversion to iVOS be completed? By the end of November.
· The same (iVOS conversion) would apply to the TPA? Yes
· When are changes or updates made to the providers on the MPN? Monthly.