TECHNICAL QUESTIONNAIRE - DENTAL PROPOSAL FORM TD1

Transcription

1 Responses should be concise and brief. OVERVIEW 1. Identify any recent or anticipated changes in ownership, including but not limited to, acquisitions, mergers, acquisition of new venture capital, etc. Describe the potential impact if any of these events have occurred within the last year or are planned within the upcoming year. 2. Please provide the key differentiators for your organization in providing group dental coverage to employers similar in size to CCPS. 3. Provide information about your group dental coverage and number of lives covered in your current book of business. Group Segment/ Market <= ,500 > 2,500 DPPO Accounts Members 4. Provide references of three (3) current (preferably school system) clients of similar size for whom you provide administration for the benefit plans you are quoting. Include plan effective date, benefit plans administered, number of covered employees, name of entity/contact person and phone number. Client/Entity Name: Contact Name: Contact Phone: Contact Original Effective Date: Dental Plans Administered: Covered Employees: 5. Provide references of three (3) former clients who have terminated your services in the past two years. Provide the same information as noted above. Client/Entity Name: Contact Name: Contact Phone: Contact Calvert County Public Schools Page 1 of 12

2 Original Effective Date: Dental Plans Administered: Covered Employees: 6. If any subcontractors will be utilized for any of the services you intend to provide to CCPS, please furnish the following information: a. Name of each contractor and length of time you have utilized them. b. Describe the services or products the Contractor will provide and the number of years in operation. c. Describe the terms of your arrangement with each subcontractor listed above, including duration of contract, quality controls, liability insurance, and termination provisions. d. Confirm that you are accountable for the performance of all subcontractors. e. Do you have any plans for future subcontractors? If so, please detail. f. How are any subcontractors paid? 7. Will any services performed to support the CCPS plan be provided offshore? If yes, please describe. 8. Do you agree to the Performance Guarantees noted in the RFP specifications? If no, describe deviations, enhancements or conditions. 9. Are you able to administer the current plans as described in the summary of benefits provided? If no, indicate deviations or conditions on Technical Proposal Form TD Please confirm that all communication to employees of CCPS will be provided to the employer and not released without prior employer approval. 11. Describe your strategy around using social media and other new technologies to communicate dental benefits to members. 12. Has your company, or any of its officers or directors, been subject to any complaint, investigation, probe, or formal inquires, or, are sanctions current or pending from any federal or state regulatory body including, but not limited to, the Department of Insurance, Calvert County Public Schools Page 2 of 12

3 Department of Health, and/or the Center for Medicare and Medicaid Services (CMS)? If yes, please explain. 13. Detail your general and professional liability coverage currently in place to protect CCPS from losses or negligence. 14. Describe the audit rights available to CCPS. CCPS reserves the right to select independent auditors at any time with 90-day advanced notice. Net overpayments discovered during any audit must be refunded to CCPS on behalf of any of the participating entities regardless of whether the administrator can recoup payments from the employees and providers. Is this acceptable to you? 15. How often do you audit the accuracy of plan program pricing and overall adjudication accuracy? Describe how this will be shared with CCPS. 16. Regarding CCPS data, describe how your company uses this data. Is any CCPS data shared with outside entities? Do you receive fees from anyone for use of this data? 17. Describe any services you provide that are located in Calvert County. ACCOUNT MANAGEMENT 18. Identify all the Account Management and Service team members that will be assigned to CCPS. Include name, address, phone, title and role, as well as line of business if necessary. Name: Title: Address: Phone: Primary Role: Manager s Name: Manager s Title: Resumes must be included for the Account Manager (AM) and Service team members. 19. What has been the incidence of account management turnover for the unit/department which will service CCPS over the last two years? 20. How many accounts is the proposed AM responsible for and how many covered lives do they support? Calvert County Public Schools Page 3 of 12

4 21. What level of support do you provide clients regarding changes in Federal and State legislative events that require communication to their benefit plan participants? 22. Do you survey client benefits staff on their satisfaction with your organization and the account team? If yes, please provide a sample report. IMPLEMENTATION 23. Confirm you have included a sample implementation timetable and project plan assuming a July 1, 2018 Effective Date. 24. What type of training will you provide to CCPS during implementation on your systems and reporting tools? Will the training be provided on-site at CCPS? 25. What level of support are you willing to commit to Annual Open Enrollment meetings, new hire benefit orientation sessions and other employer benefits events? 26. Describe the process for employees that have treatment in process or have recently received pre-approval for dental services when the new vendor takes over the contract. COMPLIANCE/SECURITY 27. Please provide a general description of your system s infrastructure, including security measures for protecting members personal data and information. 28. Are you planning any major technological changes (electronic or administrative) that you anticipate will provide significant value to CCPS? 29. Is your organization in full compliance with all HIPAA regulations? 30. In lieu of using employee s Social Security Number, can the client use an employee ID number or an assigned number issued by the vendor for eligibility transmission? 31. What procedures/systems do you have in place to protect the personal information of participants from security breaches? 32. Has your organization experienced a security breach of members personal information? If yes, please provide: Calvert County Public Schools Page 4 of 12

5 a. When breach occurred. b. Number of members impacted c. Steps taken to correct breach 33. Is the data your plan receives, transmits and stores encrypted in transit and at rest? 34. Provide a copy of your most recent SOC2/SOC3 report. If not available, please indicate when the report(s) will be ready. 35. Describe your Disaster Recovery Plan for data backup. Has the disaster recovery plan been tested? If so, when was your disaster recovery plan last tested? What is the normal frequency of your testing? 36. If you work with vendor partners, how is your disaster recovery plan integrated with your partner? REPORTING/SYSTEMS 37. List the standard reports included in your offer and include samples. Indicate how often each report is provided. 38. List any additional reports that are available and identify any associated cost in your financial proposal. 39. Can employers access all reports electronically? 40. Confirm you will provide benchmark data on dental costs and utilization. Do these reports include benchmarking against groups similar in size, plan design, utilization and risk? 41. What analytical tools, reports and resources will be provided to CCPS to enable future strategic decision making about benefits, plan designs, contribution strategy, products, wellness and health management initiatives? 42. Which of the following services are currently available through your website? Member Services Can members: Access provider information Access Provider Directories Access Provider Directories with Driving Directions Participate in community forums Calvert County Public Schools Page 5 of 12

6 Access benefit summaries Enroll online Check eligibility Order replacement ID cards File a claim Obtain costs for dental procedures for specific providers Download printable versions of claims forms Look up claim status in real time Submit appeals Submit inquiries to customer service via Access educational material Provider Support Employer HR Staff Can providers: Verify in real time the eligibility status of members Submit claims Access member benefit summaries Can employer staff: Add/delete/edit eligibility in real time Obtain reports specific to their members Submit retroactive termination requests Correspond with account management and customer service for problem resolution View detailed Member enrollment and eligibility record View of member claim status/eobs Order ID Cards on behalf of members /chat with Customer Service/Claims Representatives 43. Identify your employee and employer website location(s). Can you provide demo access to your website for authorized representatives of CCPS or Bolton Partners during the bid evaluation phase? If yes, please provide the login credentials here. 44. Is a customized pre-enrollment website available to members prior to the effective date to receive CCPS specific information about your organization, finding providers, reviewing products and health & wellness program information, etc.? If yes, please provide sample screen shots of sites you have established. 45. Can CCPS provide a link from their website to yours through a secure single sign-on? 46. What mobile apps are available to members? Calvert County Public Schools Page 6 of 12

7 ELIGIBILITY 47. Please provide a detailed description and copy of the data elements required for the initial eligibility file upload 48. What cycle do you recommend for eligibility file exchanges following initial upload (daily, weekly, monthly)? 49. Can you accept full-file eligibility transfers or do you require changes-only files for eligibility maintenance? 50. Identify the average number of business days required to update your eligibility system following receipt of clean data file from CCPS. 51. How quickly is eligibility information available in the system once you receive it? 52. Can you provide real-time online eligibility access for CCPS or their designated administrator? 53. As part of your proposal, will you provide a third-party enrollment vendor to CCPS or do you provide that service yourself? Please provide a list of such vendors your organization has worked with in support of other large clients (e.g., Benefit Focus, Benelogic, ADP, etc.). CUSTOMER SERVICE/MEMBER SATISFACTION 54. Where is the location of your customer service operation that will be used for CCPS members? 55. Is your customer service operation combined with the claims unit or handled separately? 56. Are Customer Service Representatives (CSRs) authorized to make real time claim payment adjustments? If so, what is the criteria/limitation of adjustments they can perform? 57. How many full-time CSRs are employed at the location that will be used for CCPS members? 58. What are the hours available to speak with a live representative? 59. Is there a toll-free number to your customer service center? Calvert County Public Schools Page 7 of 12

8 60. Will a designated customer service team be assigned to CCPS? If yes, how many individuals will be assigned to the designated team? 61. What has been the ratio of client service representatives to members over the past three years? 62. Provide the following member services statistics for the most recent four quarters: Quarter Quarter Quarter Quarter Quarter Avg. Telephone Answer Time Abandonment Rate Average Waiting Time Average Call Time 63. Can you provide a designated toll-free Customer Service number prior to the Plan Effective Date to answer questions from potential members? 64. How are hearing impaired non-english speaking member calls facilitated? 65. Do you currently perform membership satisfaction surveys? If yes, what percent of members indicated that they were satisfied or very satisfied with the overall program? Provide a copy of the latest results of the survey. CLAIMS ADMINISTRATION 66. Briefly describe your claims processing system (including the handling of network and nonnetwork claims). Confirm that your claims system is fully compliant with HITECH requirements to the HIPAA regulations. 67. Where will your organization process dental claims? How many claims did this office adjudicate in 2016? 68. How long has the claim system been operational? 69. Describe your systems capabilities for the following: Electronic claim payments Multiple fee schedules Interface with Member service system System edits Ability to pend and bundle claims from the same EOB In and out-of-network claims paid on same system Calvert County Public Schools Page 8 of 12

9 70. Describe the claim payment expected performance and actual recent results (for 2016 and 2017 YTD), for the claim office(s) which will administer your plan(s): Metric Payment Accuracy Coding Accuracy Financial Accuracy Claim Turnaround Time - Clean claim - Claim requiring add l info Percentage of dental claims submitted electronically Percentage of auto adjudicated claims 71. Please provide sample copies of the EOB forms which will be used for the dental programs you are proposing. 72. Approximately what percentage of such claim inquiries can you completely resolve at first contact? Within 48 hours of first contact? 73. Describe the appeal process on denied claims. What are the different levels of review and your timing standards? What is your expectation regarding client involvement for selffunded plans? Are you compliant with the claims review and appeal process as required by PPACA? 74. How do you determine the reasonable and customary expense allowances you will use for non-network claims? 75. Can you provide claims data to integrate with CCPS medical plan data for Disease Management programs? Calvert County Public Schools Page 9 of 12

10 ADMINISTRATIVE SERVICES 76. Provide a list of all services provided under a self-insured arrangement. 77. Provide a specific list identifying services that would not be provided as part of a selfinsured quote. PROVIDER NETWORKS 78. List the different dental networks you offer and indicate what network(s) your offer assumes. You must complete the Proposal Forms for each Dental Network included in your offer. 79. Do you own the Dental Networks you are proposing? If not, please provide detailed information about any entity that your sub-contract with for network services, 80. Is your dentist credentialing program certified by NCQA? If so, please provide a copy of the credentialing certificate. 81. Indicate any significant changes you anticipate between the submission of this proposal and July 1, 2018 (e.g., provider contracting efforts, provider termination, network reductions, etc.). 82. How many provider relations staff do you have assigned to the Maryland market? 83. How often does your team conduct visits with dental providers? How many visits are conducted each month? 84. How do you manage your network and evaluate provider performance? How do you deal with providers who are not meeting these standards? 85. What was your network provider turnover rate in 2016? First two quarters of 2017? 86. Will you accept nominations for individual providers to be added to your network? If so, please describe how this process works. 87. What member-to-provider ratios currently exist in your dental networks that would service CCPS plan members? 88. What percentage of participating dentists have limited their practice to current enrollment? Calvert County Public Schools Page 10 of 12

11 89. Describe your criteria and process for network provider selection. 90. How do you determine network fees for dental claims? How often do you update your fee schedule? 91. How do you determine fees for Out-of-Network Claims? Confirm this is the OON reimbursement schedule your offer assumes. 92. How often do you update your OON schedules? 93. Do your contracts with participating dentists include an annual cost increase in reimbursement levels? If yes, what was the average increase in provider reimbursements for the last two years? 94. Describe the terms or your Provider contracts specifically: Length of term of standard contract Notice required from Providers to terminate Vendors required notice of intent to terminate provider Provider s required continuation of care to existing network Participants following provider s termination from the network, if applicable? 95. Confirm the claim amount paid will be the negotiated amount and that none of the savings will be retained by your organization or shared with any other organization. 96. Verify that you have a hold harmless agreement that prohibits providers from billing more than the plan s designated coinsurance or copayment. 97. What percent of dentists are Board Certified? Endodontists Oral surgeons Periodontists Prosthodontists Orthodontists Total % of Providers Board Certified Calvert Co. Maryland National Calvert County Public Schools Page 11 of 12

12 98. Do you employ licensed dentists to review complex claims? If so, how many full-time dental consultants do you have on staff? 99. Provide your minimum requirements for malpractice and liability insurance Provide the percentage of providers rejected out of total applicants for the past three years Do you have a process for excluding or penalizing providers who do not meet performance standards? 102. Does your offer include claims fiduciary responsibilities, including appeals, under ERISA for claims adjudication and defense of "utilization review" decisions? 103. Describe any wellness programs included in your offer Does your proposal include a Dental Care Cost Estimator? If yes, does your Dental Care Cost Estimator calculate the member s cost taking into account her/his applicable benefits, including any maximums and remaining deductible? Can members compare fees from multiple dental offices at the same time? 105. Are you able to provide a plan structure using multiple networks? The current plan uses two networks (Traditional and PPO) and if a member accesses a dentist that participates in both, the claim is automatically adjudicated at the PPO allowance level. Describe how this would work in your proposal. Calvert County Public Schools Page 12 of 12