REQUEST FOR QUALIFICATIONS

Transcription

1 REQUEST FOR QUALIFICATIONS for CLAIMS ADMINISTRATION SERVICES for CADDO PARISH SCHOOL BOARD 1961 Midway Street Shreveport, Louisiana RFQ NO. RFQ13C-19 Sealed Proposals Will Be Accepted Until THURSDAY, JANUARY 31, :30 am cst Caddo Parish School Board Director Lisa Stringer-Lloyd, MSL, CPPB P O Box Shreveport, Louisiana

2 TIME LINE Schedule of Activities: The following tentative time lines has been established for the benefit of both CPSB and the vendors responding to the RFQ. Dates and times may change as necessary. ACTIVITY Date Time 1. Release of Request For Qualifications to Vendors January 8, 2019 N/A First Public Notice Published (Shreveport Times, ) 2. Second Public Notice Published January 15, 2019 N/A 3. Final date to submit questions. January 24, :30 pm All questions must be submitted in writing via to: Lisa Lloyd: lslloyd@caddoschools.org RFQ-13C-19 must be in the subject line. Any questions submitted after the date and time shown may not be considered or answered. 4. Proposal Opening date January 31, :30 am 5. Evaluation January 31 February 8, Anticipated Board Approval Date February 12, :30 pm 2

3 CADDO PARISH SCHOOL BOARD Shreveport, Louisiana REQUEST FOR STATEMENT OF QUALIFICATIONS for CLAIMS ADMINISTRATION SERVICES PURPOSE The Caddo Parish School Board (CPSB) is soliciting Statements of Qualifications from third party administrators (TPA) for workers compensation claims administration services and leasing of TPA claims system by CPSB to utilize internally for the management of casualty and property claims. The claims administration services will consist of the management of all reported workers compensation claims and all open or re-opened (take-over) claims beginning on the contract start date and continuing thereafter until each claim is closed. BACKGROUND INFORMATION Caddo Parish School Board is self-insured for workers compensation and carries excess workers compensation insurance coverage. The CPSB Risk Manager oversees the TPA administrating the claims. There is an average of 345 claims filed annually (40 indemnity, 230 medical only, 12 report only). Currently there are 100 open claims (58 indemnity, 42 medical only). QUALIFICATIONS TPA must be licensed to do business in the State of Louisiana. TPA may be required before the award of any contract to show to the complete satisfaction of the Caddo Parish School Board that it has the necessary facilities, ability, and financial resources to provide the service specified herein. CPSB requires that the firm selected to provide claims administration services should illustrate a successful record of experience in providing such services to governmental clients. The TPA must be approved by the Caddo Parish School Board s workers compensation excess carrier(s). TPA will be required to sign an E-Verify Affidavit if awarded contract. The TPA is also required to give history and references in order to satisfy the Caddo Parish School Board in regard to TPA s qualifications. By submitting references, the TPA shall authorize the Caddo Parish School Board to contact the references and ask any and all questions the Caddo Parish School 3

4 Board deems appropriate to determine the TPA's performance. For all references provided, the following information will be included: 1. Organization name, address, zip code and telephone number; 2. A specific person to whom reference may be addressed, and 3. The nature of the service provided, length of time coverage has been provided, and any other information which the TPA feels pertinent. The Caddo Parish School Board may make reasonable investigations deemed necessary and proper to determine the ability of the TPA to perform the work and the TPA will furnish all information for this purpose that may be requested. The Caddo Parish School Board reserves the right to reject any and all bids if the evidence submitted by, or investigation of, the TPA fails to satisfy that the TPA is properly qualified to carry out the obligations of the contract and to complete the services described therein. Evaluation of the TPA's qualifications will include, but not limited to the following: The ability, capacity, skill, and financial resources to provide the service required. The ability of the bidder to provide the service promptly or within the time specified, without delay or interference. The character, integrity, reputation, judgement, experience, and efficiency of the TPA. The quality of performance of previous services evaluated from references provided. All TPA s must include the following: Full name and principal address of the firm. Identify main office and the office from which services will be rendered. Identify key personnel who will be providing services to the Caddo Parish School Board. Indicate the level of assistance that can be expected without charge and the additional services available at charge. Indicate rates for services that are subject to additional charge. A financial statement. A.M. Best Rating (if applicable). List of local governmental units served within the State of Louisiana. 4

5 SPECIFICATIONS TPA s personnel shall be located in or in close proximity to Shreveport, Louisiana. Personnel required in Shreveport, Louisiana, or in close proximity to, shall include supervisory, adjusting, medical case management and administrative staff. Trained, competent and, where required, licensed claims adjusters to perform the services outlined in this RFP in a manner commensurate with the highest professional standards, in good faith and in accordance with all applicable laws and regulations. TPA s adjusters shall be familiar with Louisiana General Statutes as well as legal matters and court proceedings. The TPA shall assure that there is adequate staffing to support all claims processing and support services required by the Caddo Parish School Board. It is expected that the contractor will assure that caseloads for recurring and litigated claims will be consistent with industry standards as described in various industry publications. The Caddo Parish School Board will have final approval of all staff assigned. Adjusters or other representatives of the TPA who fail to conduct themselves in a manner deemed appropriate by the Caddo Parish School Board shall be removed from Caddo Parish School Board account. TPA's office shall be open for business, at a minimum, on the days and during the core hours that the Caddo Parish School Board offices are open. TPA must be able to receive claims by mail, fax, , and telephone. TPA shall have procedures to handle all types of submittals. TPA must be able to accept reported claims and other information via , preferably in pdf format. TPA must have 24 hour response capabilities on all accidents involving multiple potential claimants or involving serious injuries. TPA shall report losses to the respective excess carrier in a timely manner pursuant to each carrier s requirements. Adjusters must be able to provide in-depth, comprehensive excess reports. Claim supervisor will be assigned to all claims to ensure claims are handled appropriately. At the Caddo Parish School Board s discretion, TPA shall provide the option to meet at least monthly with the Caddo Parish School Board Risk Manager to review claims, settlements and strategy. TPA staff will be return telephone calls within the same business day. s will be answered no later than the following business day. TPA shall have a comprehensive web-based claim system with the ability to add custom fields specific to Caddo Parish School Board. TPA shall provide Caddo Parish School Board with unlimited real time access to claims information. 5

6 Managed care services shall include but not be limited to state fee scheduling, usual, customary and reasonable bill review, PPO networks, Pharmacy Benefit Manager (including first-fill program), medical case management and vocational rehabilitation network, modified duty/return to work programs, and hospital bill audit services. TPA will assist the Caddo Parish School Board in meeting requirements of Section 111 of the Medicare, Medicaid and State Children s Health Insurance Program Extension Act of 2007 to ensure compliance with Medicare Secondary Payer statute (MSP) and the Mandatory Insurance Reporting (MIR). Federal law requires that all settlements adequately consider Medicare s future interests. TPA and its adjusters will keep abreast of these laws and will protect Caddo Parish School Board interests in settling claimant s Medicare conditional payments and assist the district with other requirements of the law. TPA will develop and maintain adequate claim reserves and provide continuous review of same to reflect changes. TPA will submit monthly claim and expense summary reports in a manner and format mutually agreed upon. TPA s proposal should include an example of their monthly report. Prepare and provide settlement evaluations to the Risk Manager. Adjuster or supervisor shall be available for any hearings, mediations, arbitration or any other legal matters related to the claims/lawsuits TPA is handling. Make recommendations regarding claims processes and procedures. The TPA agrees that all data contained on any type of media and other records pertinent to the TPA s services provided to and on behalf of the Caddo Parish School Board are the property of the Caddo Parish School Board and must be capable of separate retrieval and distribution. The TPA must provide for the physical security of all such records. All data, including medical, financial and personnel information collected in relation to the TPA s services provided to the Caddo Parish School Board shall be held in strict confidence and shall not be released, disclosed or published by the TPA except to others required to provide a service under the contract. The TPA will be responsible for maintaining records in accordance with the Caddo Parish School Board s record retention policy. 6

7 TRANSITION PERIOD AND TRANSFER OF CLAIMS TPA shall assume the responsibility for the handling of all open claims, including open/reopened tail claims, under this contract. The TPA is responsible for conversion of all data necessary to support ongoing operations and preserve existing historical data (including data related to casualty and property claims). The TPA is expected to provide the materials and staffing to conduct initial communication and training for the start-up of the contract. Within 60 calendar days of implementation, all pending claims shall be assigned to adjusters and supervisors with claim reviews conducted and documented in the electronic activity notes. The contractor shall review, assess, and make a plan of action for updating/resolving each transferred claim. The Caddo Parish School Board Risk Manager and the contractor will establish a standard schedule for reviews of claims by adjusters and supervisors. Changes to this schedule must be approved by the Risk Manager. Upon termination, regardless of the reason for or type of termination, the TPA agrees to transfer to the party designated by the Caddo Parish School Board, at no cost, all data, records, computer files, other files, and materials of any sort that were maintained for the Caddo Parish School Board. The TPA shall cooperate with the Caddo Parish School Board and any new contractor during the transition of the contract to a new contractor. Upon request by the Caddo Parish School Board, the TPA shall provide all Caddo Parish School Board information maintained by the Contractor in a time frame approved by the Risk Manager. Information provided via tape or other electronic transfer shall be in a format approved by the Caddo Parish School Board Risk Manager and shall include, but not be limited to file layouts and legends. The TPA shall provide such explanation of the information provided as to facilitate a smooth transition. 7

8 CLAIM REPORTS TPA must be able to generate detailed loss runs and ad hoc claim reports. Examples of claim reports include: Summary and detail level reports of claims data will be required. Users must be able to select and sort by data fields such as claim type, date of loss, location, cause code, adjuster assigned, close date, line of coverage, policy period, subrogation status, litigation status, driver name, job title, etc. Financial reports Summary and detail level reports of financial data will be required. Reports must be able to be sorted by data fields such as reserve amount, change amount, payment type, etc. Reports must be able to summarize data by both accident year and policy/fiscal year. Transaction reports Summary and detail level reports of amounts paid will be required. Users must be able to select and sort by data fields such as payment type, location, period, vendor, etc. Diary reports Summary and detail level reports of claim diary data will be required. These reports include delinquent diary reports and reports of claims with no activity in a specified period. Users must be able to select and sort data by adjuster, diary dates (including future diary dates), etc. Comparison reports Summary and detail level reports which allow comparison of claims information between departments must be provided. Trending Analysis reports Summary and detail level reports which support analysis of loss data for loss prevention purposes must be provided. Users must be able to select and sort by data fields such as loss date, injury status, cause code, etc. The ability to produce charts and graphs from report data. Benchmark Report Annual Stewardship Report IBNR Monthly Report which includes every fiscal year for all claim data which includes the total claim count, total med paid, total indemnity paid, total vocational paid, total expense paid, total legal paid, deductible paid, recoverable total, total paid by line of coverage. Loss Triangle Report Check register documenting all payments issued, voided, recovery/reimbursements. Check register must contain coding fields specific to Caddo Parish School Board. 8

9 Other workers compensation reports related to lost time, transitional duty, penalties paid, adjuster caseload or as deemed necessary by Caddo Parish School Board. The TPA shall submit all periodic reports required by the OWCA. Loss runs shall include the following at a minimum: GENERAL INFORMATION Claim Type (BI, PD, Indemnity, Medical Only, RPO, etc) Claim Opened Date Date of Birth Claim# Claim Closed Date Gender Occurrence # Claim Reopened Date Occupation Related/Legacy Claim# Claim Reclosed Date SUBROGATION/SIF/LEGAL INFORMATION Claimant Name Claim Open - Days Subrogation (Y/N) Date of Loss Adjuster Name Second Injury Fund (Y/N) Time of Accident Location Litigation (Y/N) Day of Week Department Plaintiff Attorney Date Reported to Carrier/TPA Sub-Department Defense Attorney Date Reported by Insured Custom fields TBD by CPSB BENEFIT/DISABILITY INFORMATION Date Reported by Location CLAIMANT INFORMATION Average Weekly Wage Claim Reported Lag Days - Insured Date of Hire Compensation Rate Claim Reported Lag Days - Location Age Benefit Type Claim Status (Open/Re-Opened/Closed) Age at Time of Loss Last Worked Date 9

10 Date of Disability FINANCIAL - OUTSTANDING FINANCIAL - TOTALS Return to Work Date Lost Work Days INJURY Body Part Nature of Injury (Strain, laceration, fracture, etc ) Surgery (Y/N) MMI Date COVERAGE INFORMATION Line of Business (WC, Auto, GL, PL, Property) Line of Coverage Policy# Coverage Effective Date Coverage Expiration Date Deductible/Retention Carrier Name Carrier Claim # Reportable to Carrier (Y/N) Carrier Reported Date Date of Last Carrier Report Policy Year Loss Year ACCIDENT INFORMATION Accident Description Accident Location - Street Accident Location - City Accident Location - Parish Accident Location - State Accident Location - Zip Jurisdiction State Driver Name (Auto accidents) Cause of Loss Cause of Loss Detail Unsafe Act Outstanding Indemnity/Bodily Injury/Damages Outstanding Indemnity/Bodily Injury/Damages - Recoveries Net Outstanding Indemnity/BI/Damages (Outstanding - Recoveries) Outstanding Medical Outstanding Medical Recoveries Net Outstanding Medical (Outstanding - Recoveries) Outstanding Expenses - Legal Outstanding Expenses - All Other Outstanding Expenses Total (Legal & All Other) Outstanding Expenses Recoveries Net Outstanding Expenses (Outstanding Expenses - Recoveries) FINANCIAL - PAID Paid Indemnity/Bodily Injury/Damages Paid Indemnity/Bodily Injury/Damages - Recoveries Net Paid Indemnity/Bodily Injury/Damages (Paid - Recoveries) Paid Medical Paid Medical Recoveries Net Paid Medical (Paid - Recoveries) Paid Expenses - Legal Paid Expenses - All Other Paid Expenses Total (Legal & All Other) Paid Expenses Recoveries Net Paid Expenses (Expenses Paid - Recoveries) FINANCIAL - INCURRED Incurred Indemnity/Bodily Injury/Damages Incurred Indemnity/Bodily Injury/Damages - Recoveries Net Incurred Indemnity/Bodily Injury/Damages (Incurred - Recoveries) Incurred Medical Incurred Medical Recoveries Net Incurred Medical (Incurred - Recoveries) Incurred Expenses - Legal Incurred Expenses - All Other Incurred Expenses Total (Legal & All Other) Incurred Expenses Recoveries Net Incurred Expenses (Incurred - Recoveries) Total Paid (Indemnity/BI/Damages & Medical & Expenses) Total Paid Recoveries (Indemnity/BI/Damages & Medical & Expenses) Net Paid (Indemnity/BI/Damages & Medical & Expenses) Total Outstanding (Indemnity/BI/Damages & Medical & Expenses) Total Outstanding Recoveries (Indemnity/BI/Damages & Medical & Expenses) Net Outstanding (Indemnity/BI/Damages & Medical & Expenses) Total Incurred (Indemnity/BI/Damages & Medical & Expenses) Total Incurred Recoveries (Indemnity/BI/Damages & Medical & Expenses) Net Incurred (Indemnity/BI/Damages & Medical & Expenses) 10

11 CLAIM MANAGEMENT Assignment of claims by the claims supervisor will commensurate with the adjuster s expertise and technical abilities within 24 hours. Written supervisory directives must be documented at the onset of the claim with follow-up directives every 60 days thereafter. The TPA shall review all claims received and process each to conclusion in accordance with applicable statutes, rules and regulations, operating procedures or other instructions including but not limited to client service instructions. The TPA is required to complete three-point contacts with the injured worker, the designated departmental representative and the health care provider within 24 hours of notice of claim. The information obtained from these contacts shall be accurately documented in the claim system. Recorded statements shall be taken on all lost time claims or cases where there is questionable compensability. Written acknowledgement shall be sent to all injured workers, and shall include a claim number, and adjuster s name and phone number, within five (5) business days after receipt of the claim. The adjuster must maintain regular contact with the employee when there is lost time involvement and/or there is ongoing medical care. Medical Only Claims - Investigations shall be initiated by the TPA within one (1) work day of receipt of the Employer s Accident Report using the three pronged contact system (i.e., injured worker, doctor, department representative) to determine if compensability is to be acknowledged or questioned. Physician reports shall be requested immediately. All appropriate documentation shall be made a part of the permanent claim file. Should a medical only claim reach $2,500 in medical expenses, the claim shall be reviewed for possible further investigation and management. All medical only claims will have a compensability analysis, will be reviewed for closing every 60 days; a compensability analysis and closure review will be entered in the claim notes with rationale for closure. At a minimum, within 14 calendar days from receiving the any claim, there shall be a documented claim review by the adjuster including but not limited to compensability assessment, medical summary, subrogation/second injury Fund potential, return to work or transitional employment potential, reserve analysis and action plan. A decision on the compensability of each claim shall be made within 14 business days of the receipt of the claim. Denial decisions shall be immediately communicated in writing to the injured worker. On cases wherein compensability determinations are pending more than 14 business days, the TPA shall contact the injured worker advising them of the reasons as to why a decision cannot be made. Aggressive attempts by the TPA should be continued in order to finalize a decision within 30 business 11

12 days of the receipt of the claim. Notification to the OWC will be made in accordance with the Louisiana Workers compensation statutes. TPA is responsible for obtaining a benefit election form from the claimant and providing a copy to the Caddo Parish School Board Payroll Department. TPA is responsible for obtaining the required documentation from the Caddo Parish School Board in order to calculate benefits. Indemnity payments on compensable claims shall be made within fourteen (14) calendar days after notice of injury. The TPA is required to make all OWCA filings in a timely manner. Penalties and fees incurred as a result of late filings will be the responsibility of the TPA. The TPA is required to obtain medical documentation to justify continuing indemnity payments. The TPA is required to obtain a LWC-WC-1025.EE Employee Certificate of Compliance form from the employee. The TPA is required to obtain LWC-WC-1020 Employee s Monthly Report of Earnings forms on all indemnity claims or questionable claims. The TPA is required to obtain a LWC-WC-1121 Physician Choice Form if the employee elects to seek treatment with a physician of their choice. The TPA shall perform all duties and abide by all rules required of the Caddo Parish School Board under the Louisiana Workers Compensation Act, OWCA, and any other rules formal or otherwise implemented by the Louisiana Office of Workers Compensation Administration in the handling of the claims. This includes timely filing of required OWCA forms and notices. The TPA is required to provide a monthly report of injured workers on receiving indemnity benefits and working in a modified duty capacity to the Risk Manager. The TPA shall assure that all cases are reviewed aggressively for return to work in either a full or modified duty capacity as quickly as possible. All medical bills, prescription reimbursements, and other related expenses shall be re-priced according to the current Louisiana Workers Compensation Medical Fee Schedule. Bills received on compensable claims shall be paid in accordance with the Louisiana Workers Compensation Act. The TPA shall provide an easy to use discount prescription drug program which shall include dispensing medication for a 30-day period pre-claim approval (First Fill). The TPA shall provide medical care and medical cost containment services in accordance with the Louisiana Workers Compensation Act. The TPA shall monitor the treatment programs recommended for injured employees by physicians, specialists and other health care providers in accordance with the OWC Medical Treatment Guidelines. 12

13 Any medical bills received will be approved by the adjuster prior to payment with regard to causal relationship to the accident/work-related injury. The TPA shall request a second medical opinion (SMO) as needed. Pre-certification determinations and utilization reviews shall be done in compliance with the Louisiana Workers Compensation Act. The TPA must respond to all LDOL-WC-1010 requests in a timely manner. Initial medical care, including but not limited to diagnostics and physical therapy, may be authorized by the adjuster foregoing utilization review. A medical case manager, with a relevant clinical background in nursing or medicine (RN), shall be considered for utilization at a minimum in the following situations with approval from the Risk Manager: When an employee is not responding to treatment. When, based upon the diagnosis and initial expected recovery period, return to work has not occurred. When modified duty extends longer than 30 days post-injury with no clear expectation of full duty release by day 40, with follow-up at 30 day intervals until employee is released to return to work full duty. When there is a lack of compliance with the medical regimen. When there is a chemical dependency. When there is a long-term physiotherapy. When there is prescription medication dispensed long-term (over 1 year). When physician visits are more than is typical for the type of injury/illness. When referrals are more than typical for the type of injury/illness. When prescriptions are more than typical for the type of injury/illness. When the case extends substantially beyond the expected resolution date. When the medical situation is a mix of occupational/non-occupational conditions. When the employee and/or their support system are not capable of coordinating services, setting appointments or comprehending medical needs. When an original injury causes a secondary health problem to occur. Medical causation issues are present. Medical case manager or vocational rehabilitation professional shall be assigned with prior approval of the Caddo Parish School Board Risk Manager. Claims will be referred for medical case management as soon as medically feasible, but no later than 45 days after an injury has occurred if an employee has not been returned to work full or modified duty, with prior approval of the Caddo Parish School Board Risk Manager. TPA shall initiate vocational rehabilitation services performed by a licensed Vocational Rehabilitation Counselor if an employee is unable to return to full duty at the job of injury. The Vocational Rehabilitation Counselor will address transitional duty employment. If transitional duty employment is not available, efforts will be made to return employee to work with other employers. 13

14 The Caddo Parish School Board will work with all departments to establish return to work policy, whenever possible. The TPA shall notify the Caddo Parish School Board Risk Manager at least 30 calendar days prior to any scheduled mediation or hearing before the Louisiana OWC Administration, and the TPA s adjuster (or supervisor) shall attend any mediations or hearings. All open claims shall be maintained on a continuous diary for timely payment(s) and conclusion of claims. The TPA is responsible for any penalty or other fee assessed to the Caddo Parish School Board. This includes, but is not limited to assessment of waiting time penalties in workers compensation cases, interest, and attorney fees, and any erroneous payments that are not an obligation of the Caddo Parish School Board. Upon request by the Caddo Parish School Board, the TPA shall also defend the Caddo Parish School Board against claims for such penalties and fees. The Caddo Parish School Board shall reduce the amount of monthly payment to the TPA for any penalties or overpayments paid from Caddo Parish School Board funds. Penalties and erroneous payments are to be reported promptly to the Caddo Parish School Board. The following data is required: (a) Name of the Claimant (b) Claim Number (c) Check Number (d) Date Paid (e) Amount of Penalty/Overpayment (f) Period Penalty Covers, or period of overpayment Penalty assessments or other legal obligations incurred as a result of delay or bad faith handling by the TPA shall be the sole responsibility of the TPA and paid by the TPA and not from Caddo Parish School Board funds. Expenses attributed to errors made by the TPA in the payment or handling of claims will be borne by the contractor. The TPA will insure the Caddo Parish School Board s compliance with Centers for Medicare & Medicaid Services CMS Section 111 Mandatory Insurer Reporting Law. TPA will establish a proactive system of fraud detection and deterrence for all claims, through the use of a fraud checklist or other measures. TPA will notify the Caddo Parish School Board Risk Manager of all claims involving potential fraud. The Caddo Parish School Board Risk Manger will monitor all expenses paid and if it is determined that specific expenses are excessive, will restrict or require prior approval for those categories. TPA shall conduct continuous audits of claim files. Open claims shall be reviewed by a supervisor at regular intervals as indicated by type and severity of claims. Documentation of the review shall include comments in the electronic activity notes on reserve adequacy, verification of financial activity, and 14

15 recommendations for future handling of the claim. At time of closure, all claims shall be reviewed by a supervisor. Documentation of the review shall include comments in the electronic activity notes to confirm the validity of closure and claim coding, and to reconcile financial activity to insure appropriateness of payments. Audit results are to be provided when requested. TPA will report claims to the Caddo Parish School Board excess carriers in accordance with policy provisions. TPA will provide additional information to the Caddo Parish School Board excess carrier(s) as required by the carrier(s). RESERVES Reserves shall be established by the TPA within three (3) business days of receipt of the claim, entered into the TPA s computer system, and shall reflect the expected ultimate cost based upon all information in the file or known at the time the reserve is established. Each claim file shall contain reserve calculation sheets and reserve comments on the computerized narrative log relative to initial and ongoing reserves. Reserves greater than $100,000 and subsequent increases shall require preapproval by the Caddo Parish School Board Risk Manager. TPA will set reserves on approved Second Injury Fund claims in accordance with La R.S. 23:1378 (5)(a)(i). The TPA shall maintain a current estimate of expected total cost of each claim and provide reserves and reserve calculation tracking including initial reserve establishment and all subsequent changes. The TPA shall set reserves for claims assigned for handling as soon as there is sufficient information about the claim available to make a reasonable estimate of the value of the claim. In all cases, a reserve shall be set when the claim file is opened unless there is a documented reason for delaying setting the reserve. In all cases, the reserve shall be set no later than 30 days after receipt of the claim. After reserves have been set, the contractor shall review and adjust reserves whenever new information that would change the evaluation is received. The adequacy of reserves should be reviewed at least every 90 days, and the file shall be documented to reflect this review and substantiate any adjustments in the total reserve within 24 hours of the change. SUBROGATION/RECOVERIES/OFFSETS The TPA shall address subrogation potential early during the investigation and immediately secure any evidence so that subrogation rights are preserved. The TPA shall pursue recovery from all responsible third parties. All cases involving possible third-party liability and second injury fund recoveries shall be fully investigated within 60 days of notice of accident or information indicating possible recovery. The TPA is required to review and monitor all claims which might involve third-party liability and to pursue subrogation against any and all outside parties for which this subrogation may be appropriate. 15

16 The TPA shall document all subrogation standard operating procedures and aggressively communicate verbally and in writing with the appropriate parties. The TPA shall assure that the Caddo Parish School Board is notified 90 days prior to the statute of limitations expiration if a suit has not been filed to protect the district s interest. TPA will identify potential Second Injury Fund claims and submit claims to the Second Injury Board for approval no later than 180 days subsequent to the date of loss. TPA will pursue Second Injury Fund recovery on all approved SIF claims through claim closure. Second Injury Fund reimbursement requests will be submitted to the SIF quarterly. TPA will take all action necessary to maximize SIF recoveries. TPA will pursue recovery through claim closure on all claims with potential excess recovery. LITIGATION The TPA shall transfer complete investigation files to the Caddo Parish School Board Risk Manager and attorney whenever legal action is commenced against the district. The TPA shall coordinate with defense counsel on all litigation including but not limited to, supplying detailed claim documentation, drafting answers to interrogatories, providing medical analysis, and participation as needed in hearings and settlement actions. The services of experts and consultants required to defend a claim will be procured by the TPA, with approval by the Risk Manager, and paid as an expense. Litigated claims shall be maintained on a continuous diary to obtain reports from the defense attorney defining the status of the litigation and the plan for resolution of the litigation. SETTLEMENTS TPA will submit a detailed settlement evaluation and compensability analysis to the Risk Manager in a timely manner. Settlement evaluation must be made based on information included in the file, as well as other criteria by which a value may be based. Once settlement authority is granted, the adjuster will handle settlement negotiations. The TPA must demonstrate timely effort to settle claims voluntarily and reduce litigation. 16

17 CASH MANAGEMENT The TPA shall maintain financial policies and procedures including, but not limited to, financial reporting, bank reconciliations, segregation of duties and check processing. The TPA is responsible for ensuring that their internal operating procedures establish and maintain appropriate internal controls. All records (including all paid bills and invoices) shall be maintained in a secured environment and retained for the entire contract period. Cancelled checks, check copies, or document images, are to be securely stored, placed in numeric (check number) order, and are the property of the Caddo Parish School Board. All records, images, and documents shall be made available to the Caddo Parish School Board upon request and access to such records shall be within twenty-four hours. The TPA shall be responsible for complying with 1099 regulation issued by the Internal Revenue Service. The TPA shall be liable for any penalties assessed on 1099 established by the Internal Revenue Service. The Contractor shall provide the Caddo Parish School Board with an electronic version of the 1099 file it submits to the Internal Revenue Service within 30 days of filing. The Contractor is responsible for researching and resolving any errors as identified by the IRS. The TPA shall utilize a Trust Checking Account. The Caddo Parish School Board will fund the Contractor s Trust Account on a monthly basis for the amount of checks presented for payment. Bank account reconciliations, including the bank statement, are to be complete and copies delivered to the Caddo Parish School Board by the end of the subsequent month (example: January reconciliation by the end of February). The TPA shall, for each payment made, maintain for on-line access by the Caddo Parish School Board, the check number, check date, amount of check, payee, federal employer identification number or social security number, claim number associated with the payment, and the date the check cleared the bank. Any check issued to an injured worker shall have an informational stub section that will include check number, check date, check amount, payee, claim number, date of service and name and telephone number of the benefit coordinator. 17

18 TPA INSURANCE REQUIREMENTS Insurance shall be placed with insurers with an A.M. Best s rating of no less than A-VI. requirement shall be waived for Workers Compensation coverage only. This rating Certificate of Insurance The Contractor shall not commence work under this contract until he has obtained all insurance required herein. Certificates of Insurance must be filed with the Caddo Parish School Board for approval. The Contractor shall not allow any subcontractor to commence work on his subcontract until all similar insurance required for the subcontractor has been obtained and approved. If so requested, the Contractor shall also submit copies of insurance policies for inspection and approval of the Caddo Parish School Board before work is commenced. Notice of cancellation is required in accordance with policy provisions. Said policies shall not hereafter be permitted to expire, or be changed without thirty (30) days' notice in advance by the Contractor. Workers Compensation Insurance Before any work is commenced, the Contractor shall maintain during the life of the contract, Workers Compensation Insurance with statutory limits and Employer s Liability Coverage of $1,000,000 for all of the Contractor s employees. In case any work is sublet, the Contractor shall require any and all subcontractor(s) similarly to provide Workers Compensation Insurance with statutory limits and Employer s Liability Coverage of $1,000,000 for all the latter s employees, unless such employees are covered by the protection afforded by the Contractor. Contractor agrees any employees exempt from Workers Compensation and/or Employer s Liability insurance coverage will not be allowed to work under the Contract. Waiver of subrogation in favor of Caddo Parish School Board is required. Commercial General Liability Insurance The Contractor and any and all sub-contractor(s) shall maintain during the life of the contract such Commercial General Liability Insurance which shall protect him, the Caddo Parish School Board during the performance of work covered by the contract from claims or damages, damages for personal injury, including accidental death, as well as for claims for property damages, which may arise from operations under the contract, whether such operations be by himself or by anyone directly or indirectly employed by either of them, or in such a manner as to impose liability to the Caddo Parish School Board. The Contractor and any sub-contractor(s) Commercial General Liability insurance shall name the Caddo Parish School Board as additional insured for claims arising from or as the result of the ongoing and completed operations of the contractor/sub-contractor providing coverage at least as broad as CG and or equivalent; waiver of subrogation in favor of Caddo Parish School Board; and the contractor and sub-contractor s insurance will be primary and noncontributory with the Caddo Parish School Board's coverage. I In the absence of specific regulations, the amount of coverage shall be as follows: Commercial General Liability Insurance, including bodily injury, property damage and contractual liability, with combined single limits of $2,000,

19 Insurance Covering Special Hazards Special hazards as determined by the Caddo Parish School Board shall be covered by rider or riders in the Commercial General Liability Insurance Policy or policies herein elsewhere required to be furnished by the Contractor, or by separate policies of insurance in the amounts as defined in any Special Conditions of the contract included therewith. Commercial Automobile The Contractor and any and all sub-contractor(s) shall maintain during the life of the contract, Commercial Automobile Liability Insurance for all owned, hired and non-owned vehicles in an amount not less than combined single limits of $5,000,000 per occurrence for bodily injury/property damage. The Contractor and any sub-contractor(s) Commercial Automobile Liability Insurance shall name the Caddo Parish School Board as additional insured for claims arising from or as the result of the operations of the contractor/sub-contractor; waiver of subrogation in favor of Caddo Parish School Board and the contractor and sub-contractor s insurance will be primary and noncontributory with the Caddo Parish School Board's coverage. Professional Liability Insurance The Contractor and any and all sub-contractor(s) shall maintain Professional Liability Insurance with a minimum limit of $2,000,000. Claims-made coverage is acceptable. Subcontractor s Insurance The Contractor shall require that any and all subcontractors, which are not protected under the Contractor s own insurance policies, take and maintain insurance of the same nature and in the same amounts as required of the Contractor. HOLD HARMLESS AGREEMENT The Contractor and any and all sub-contractor(s) will be required to indemnify, defend, and hold harmless Caddo Parish School Board for all claims arising out of the contractor's work under the project. 19

20 PRICING All pricing should be presented on a life-of-claim basis. Please provide cost estimates based on both a quoted per claim fee and on an annual flat fee basis. Per indemnity claim (new) Per medical only claim (new) Per reporting only claim (new) Per indemnity claim (takeover) Per medical only claim (takeover) Identify with specificity the type and natures of services being provided for the charge. If additional or supplement charges are to be assessed for any service required by the scope of service, list them. Refer to TPA Cost Proposal Worksheet. Evaluation and Selection NO PROPOSAL WILL BE CONSIDERED IF DEEMED NON-RESPONSIVE. It is the respondent s responsibility to comply with the instructions in the Completion of the Qualification Response section which follows this section. The responses will be scored by the Chief Financial Officer and Risk Manager on behalf of the Board. The attached scoring sheet will be used. Staff will consider the evaluation scores, interview results and other factors considered important to make a recommendation to the Board. The School Board reserves the right to require additional information before the final acceptance of a proposal. Completion of the Qualification Response CPSB requires the firm selected to illustrate a successful record of experience in providing claims administration services. The attached proposal form is provided to ascertain the qualifications of each firm. Your response MUST include all text contained on pages 7-9 of this package. Your response MUST follow after the appropriate text of the item to which it pertains. The response may refer to an attached Appendix that provides the required information. ALL ITEMS requiring responses MUST be addressed. ALL ITEMS requiring signatures MUST be signed by the appropriate person(s). You MUST provide at least two (2) copies of the proposal. If you include supplementary brochures or other documentation not required, you MUST provide at least two (2) copies. 20

21 Proposal Evaluation Worksheet Criteria Maximum Points Awarded Local Service Proximity (required) 15 General Impression of Proposal 10 Completeness Clarity and relevance of detail Organization of firm, relationship to affiliated parties Compliance with required format Client Agreement 10 Scope and Approach 15 Claim Staff Qualifications 10 Client Service and Support 10 Claim System 10 Unique Attributes 10 References 10 Grand Total 100 TPA SUMMARY QUOTE SHEET Bidder s Company Name and Address: Please answer all questions completely. 21

22 Caddo Parish School Board P.O. Box Shreveport, LA STATEMENT OF QUALIFICATIONS RESPONSE REQUIREMENTS Please submit your response in accordance with the following format. A. GENERAL INFORMATION 1. Name of Firm 2. Address: (Local) 3. Address: (National) (Include Web Address) 4. Describe the organization of your firm and its ownership. List all principals, or shareholders of over 5%, in the firm and their roles. Describe your firm s relationship to other financial institutions, brokers, or other entities, if any. 5. Primary Account Representative(s): Name/Title/Phone/ Address. 6. Has the account executive(s) listed in (5) above been given clearance by the firm to be its representative to CPSB? (yes or no). By whom? 7. Identify those individuals who would perform services for this engagement. Describe how their work would be managed and their responsibilities assigned. 8. Which of these people will be available to meet with Staff personnel? How often? 9. If this person is unavailable, who else in your organization can be contacted in the event of operations problems? 10. Enclose a copy of your firm s proposed client agreement. B. EXPERIENCE AND HISTORY 11. Add anything to this section. 12. Provide biographies of the personnel described in A-5 and A-6 above with primary emphasis on their professional qualifications and experience relative to managing investments for governmental clients. 13. Describe the reports that are provided as part of your standard package. How frequently are they produced and how quickly are they distributed? Provide a sample of each report. 14. Provide information on any attributes or characteristics of your organization or staff that would provide unique benefits to CPSB. 15. Provide information on any claims management systems (along with annual maintenance costs) that could be utilized by CPSB. 22

23 C. REFERENCES 16. Provide the names, addresses, telephone numbers and contact names for at least four government clients for whom you actively manage individual fixed income, and/or cash management accounts (do not include clients whose accounts consist primarily of mutual funds or other co-mingled funds). Louisiana Government clients are required. Make sure to include governmental clients with whom your primary representative has an established business relationship. NOTE TO PROPOSER: If submitting a hardcopy proposal, please include an electronic copy of your submission on flash drive or CD. Failure to do so may result in rejection. 23

24 THIRD PARTY ADMINISTRATOR (TPA) COST PROPOSAL WORKSHEET Option 1: Flat Fee (Preferred Option) Year 1 Fee Year 2 Fee Explanation/Comments Claims Administration and Bill Review (Medical Provider/Pharmacy/Hospital) $ $ Option 2: Fixed Per Claim Cost with Medical Bill Repricing Year 1 Fee Year 2 Fee Explanation/Comments Indemnity (new) $ $ Medical only (new) $ $ Reporting only (new) $ $ Indemnity (takeover) $ N/A Medical only (takeover) $ N/A Bill Review (Medical Provider/Pharmacy/Hospital) $ Flat rate per bill (Preferred Option) Bill Review (Medical Provider/Pharmacy/Hospital) $ Per Line, identify maximum PPO Savings $ % of PPO Savings - Below fee schedule Data Management Year 1 Fee Year 2 Fee Explanation/Comments Data Management/System Access/Reporting (including training) - WC Claims $ $ Data Management/System Access/Reporting (including training) - Casualty & Property Claims $ $ Other Services Hourly Per Service Explanation/Comments* Utilization Review $ $ Field Nurse Case Manager $ $ Telephonic Nurse Case Management $ $ Field Investigation/Accident Investigation $ $ Special Investigation Unit/Surveillance $ $ Vocational Rehab $ $ Indexing Fee $ $ Medicare, Medicaid, SCHIP Extension Act of 2007 (MMSEA) $ $ Other: (All Program Expenses Must Be Disclosed): 24

25 *Explanation/Comments - If service is provided by a vendor, please identify firm(s). If service is provided internally, please note. Please use separate sheet to provide any additional details for each option. REQUEST FOR QUALIFICATIONS January 8, 2019 RFQ-13C-19 CADDO PARISH SCHOOL BOARD Lisa Stringer-Lloyd, Director PO BOX PH: MIDWAY STREET SHREVEPORT, LA lslloyd@caddoschools.org 25

26 PROPOSAL TITLE: CLAIMS ADMINISTRATION SERVICES LEGAL NAME OF BIDDER: MAILING ADDRESS: CITY, STATE, ZIP CODE: TELEPHONE NO: ( ) FAX NO: ( ) SUPPLEMENTARY STATEMENTS. I/We understand that supplementary statements dealing with the price quotation as attached to the proposal forms will be ignored. PROPOSER CERTIFICATION AND IDENTIFICATION. I/We certify service(s) submitted for proposal pursuant to these specifications and proposal invitations do in fact comply fully with all of the specification details and requirements and with all Federal and State regulations governing service(s) of the type contained herein. I/We certify that this proposal is made without prior understanding, agreement or connection with any corporation, firm or person submitting a proposal for the services, and is in all respects fair and without collusion or fraud. I/We further certify that none of the principals or majority owners of the firm or business submitting this proposal are at the same time connected with or employed by the Caddo Parish School Board. AUTHORIZED SIGNATURE: NAME (PRINTED/TYPED): DATE SIGNED: TITLE: PROPOSER QUALIFICATION: The form of business organization under which this bid is submitted is as follows: A CORPORATION incorporated under the laws of the State of and (is) (is not) authorized to do business in the State of Louisiana. A PARTNERSHIP. Names of Partners: AN INDIVIDUAL trading and doing business under a name and style other than his own. The Owner s Name is: PROPOSAL SECURITY: None Required. PERFORMANCE BOND: None Required. ACKNOWLEDGEMENT OF ADDENDA RECEIVED: Addendum No. 1 Dated: Addendum No. 2 Dated: Addendum No. 3 Dated: Addendum No. 4 Dated: 26

27 FROM: Proposal NUMBER: Proposal TITLE: RFQ-13C-19 CLAIMS ADMINISTRATION Services Caddo Parish School Board OPENING DATE: THURSDAY, JANUARY 31, 2019 SEND TO: CADDO PARISH SCHOOL BOARD Purchasing Department 1961 Midway Street P.O. Box Shreveport, LA Attn Bidders: Use this print format on the outside of your envelope when responding to any formal bids, RFPs or RFQs. Electronic submissions are acceptable on the official electronic bid site: No other electronic bid responses will be deemed valid.