ATTACHMENT A
DENTAL QUESTIONAIRE
VENDOR QUESTIONS
Organization Information
1. Describe your organization:
a. Name of firm ______
b. Address ______
c. Contact person ______
d. Telephone number ______
e. FAX number ______
Year founded ______
g. If Applicable
Current AM Best’s and Standard & Poor’s ratings for your company
AM Best’s financial size classification
2. Describe your client book of business in Texas:
a. Number of clients
b. Number of public entity clients
c. Number of covered lives
3. Please provide a brief history of your organization:
Is your company engaged in any discussions that might change its fundamental ownership structure within the next 24 months?
Is your company owned or controlled by another organization? If so, please describe this relationship.
4. Please describe any past (within the last 5 years) or pending litigation in which your company is currently involved.
5. Describe your business insurance coverage.
6. Please detail your disaster recovery plans.
Administrative/Account Services/Member Services
7. Describe your Administration Services Contract:
Will you duplicate the current scope and level of benefits of the current contract?
Will you provide alternative options to the DHMO product?
Note: The City prefers a 3 year quote with opportunities to renew in one year increments.
Please provide a specimen copy of the group policy provided to clients.
8. State the location where administrative services will be provided for the City of Mesquite (customer service, claims processing, issuing and distribution of ID cards, etc.). What are the telephone hours for the customer service unit that will handle the City of Mesquite’ account?
9. Will there be an individual account manager dedicated to the City of Mesquite?
10. Will an implementation manager and support team be assigned to lead and coordinate the implementation activities with the City of Mesquite?
11. What is your implementation time line?
12. Do you conduct educational and/or feedback forums for Benefit Managers of your major accounts? If yes, please give frequency and list of past topics.
13. Will you be willing to have representatives available at initial employee educational and enrollment meetings as well as future open enrollments, health fairs, and other special requirements?
14. Are eligibility/billing/reports available online to Human Resources staff?
15. Attach samples of your standard reporting package that is included in your quote.
16. Attach sample reports that are available but not included in standard package. How are these requested and what is cost if any?
17. What is the average hold time for customer service calls? Please supply a sample phone unit report.
18. City of Mesquite requires the right to approve any correspondence sent to our employees. Do you agree to the prior approval agreement?
19. Do you have the ability to accept electronic transfer for eligibility?
20. Explain your data conversion process.
21. Describe any state, federal or statutory reserve, filing or reporting requirements to which the plan adheres. Is the plan in compliance with these requirements? Please describe any noncompliance issues.
22. How are administrative expenses billed and accounted for? What percentage of the quoted rate is allocated for administrative expenses?
23. Will you accept an enrollment form created specifically for the City of Mesquite?
24. Please provide samples of all forms, communications, reports, and statements that your company would use in administering the Plan.
25. What is the average turnaround time for supplying ID cards directly to participants? How does an employee replace an ID card?
26. What is your claim audit accuracy percentage for the last year?
27. Please discuss your procedure and process for transferring existing claims/services.
28. Describe how benefits will be handled for members who are traveling temporarily out of their service area or have covered, dependent children away at college, or dependent children who live outside of the state? (If, applicable.)
29. What percent turnover have you had in your Claims Department in the last year? In the last 2 years?
30. What is the minimum amount of experience your organization requires to process and release claims for payment with little to no supervision of the adjuster?
31. Does your company auto-adjudicate any dental claims? (If yes, what percentage is currently being electronically paid?)
32. What is the minimum acceptable processing and financial accuracy that is acceptable to you for all claims adjusters?
33. What is your claims turnaround time goal? What percentage of your business is currently being processed within goal time? What is your organization doing to increase the percentage paid within goal time?
34. Please describe your procedure(s) for Co-ordination of Benefits when your plan(s) are considered as the secondary carrier.
35. State your current actual measurements for the following:
Length of time for a call to be answered -
Abandonment rate -
Length of time a caller is placed on hold -
Maximum time length for a call to be returned -
36. What is the ratio of customer service representatives to 1,000 members?
37. Do you record any calls? What percentage?
38. Identify the specific services and information a City of Mesquite employee should expect to be able to access via your toll-free number, including but not limited to: benefits, eligibility, pre-determination, claims status, network information, pending requirements, complaints, etc.? Is the same number used for provider calls or do providers and their staffs have a separate phone number for benefit information?
39. Describe the telephone system, computer, and software packages your company uses to handle your in-bound customer service calls and call tracking?
40. Does your customer service phone system have the means of receiving “after hours” calls? (If yes, how soon are these calls returned on average?)
41. What is your initial call resolution rate?
42. If a member requests to speak with a Customer Service Supervisor, will that request be honored? Under what circumstances would a Customer Service Representative do this?
43. What is the Supervisor to Phone Rep ratio in your Customer Service toll-free phone unit?
44. Will your phone unit provide support to the initial and on-going future enrollments by answering member’s phone calls about benefits and networks, etc? (If yes, keep in mind that calls could start coming in 4-6 weeks prior to the City of Mesquite’ eligibility data being loaded so CSR’s would have to be working from specimen policies, summary plan documents, and early schedules of benefits to answer member questions since neither the plan nor the member will be loaded into your system prior to the initial enrollment).
45. Will a dedicated service member be available to accept and answer calls from the City of Mesquite’ administrative staff that deal with one-on-one member calls?
46. Describe your online tools and resources available to members.
Network/Providers and Discounts
47. Indicate the database that you utilize to determine reasonable and customary (R&C) allowances, including how often the data is updated. How are fees in excess of R&C handled? What percentile is used as your R&C?
48. Please provide a copy of all network directories for the proposed service area (passive only).
49. Describe how participants select network providers. Do you provide member support services for selecting and/or locating network providers?
50. Do you have on-line access to network provider listings and locations to assist members with provider selection?
51. Who maintains the provider network? Does the number of providers remain relatively stable?
52. Will any of your services be sub-contracted with outside vendors? (If yes, please describe the services and with whom you sub-contract –i.e. ABC Company for ID card printing.)
53. What percentage of membership utilizes your designated network? Explain how your designated network is promoted to members.
54. How do providers qualify for your designated network?
55. Are you anticipating any material changes in network size in the network area serving City of Mesquite during the next 12 months? _____YES _____NO
56. What is your standard process and advance notification timeframe to notify City of Mesquite and its subscribers of network changes?
57. Is your designated network separate or a subset of your larger network?
58. How active is your organization in recruiting new network providers and seeking nominations from your client organizations to add to your network?