ADDENDUM #1 RP Provide Workers Compensation Claims Administration Services on an Annual Contract

Transcription

1 April 21, 2017 ADDENDUM #1 RP Provide Workers Compensation Claims Administration Services on an Annual Contract The proposal due date has changed. Proposals will be received until 2:50 P.M. local time on May 10, 2017 at the Gwinnett County Financial Services - Purchasing Division 2nd Floor, 75 Langley Drive, Lawrenceville, Georgia Any proposal received after this date and time will not be accepted. Proposals will be publicly opened and only names of submitting firms will be read at 3:00 P.M. Q1. Can companies from Outside USA can apply for this? A1. Yes, they can. Q2. Do we need to come over there for meetings? A2. Yes, we require an onsite claims adjuster. Q3. Can we perform the tasks (related to RFP) outside USA (from India, Canada, etc.)? A3. No. Q4. Can we submit the proposals via ? A4. No. Per the proposal, No faxed or copies of the proposal will be accepted. Q5. Do we have to have a physical office in Georgia? A5. Having a physical office in Georgia is a requirement for award of this contract. Q6. We would like to have your detailed loss runs, in an excel format. A6. See attached file: Detailed loss run Gwinnett County without names Q7. The Estimated medical bill volume of $2,398, average from shown underneath the loss data, on the bottom of page 3, is that the annual average medical billed charges or paid charges? A7. See attached file: Workers Comp info Q8. Please provide total open claims by LT and MO. A8. See attached file: Gwinnett County Open Claims LT and MO without names Q9. Pages 7-8 Section V. Third Party Administrator Information Form, please advise where this should go in the Proposal Submission Format (provided on bottom of pg. 4) A9. This should be included as part of the proposal, not the financial submission. Q10. Under Georgia Open records Act, please provide a copy of the in-force contract with Gwinnett County's Board of Commissioners' current third party administrator, ASC. A10. See attached file: RP Contract

2 Q11. Please advise how your current program is currently set up (Life of Claim or Life of Contract)? Which do you prefer? A11. Life of Partnership Q12. Is the program set up on a Per Claim or Flat Fee? Which do you prefer? A12. Per claim. Q13. Given the level of detail needed to respond to the County's RFP, would the County consider extending the submission due date? A13. Yes. See above note. Q14. Page 2 states the County requires an adjuster positioned in the County s Human Resources Department on a full-time basis. Is the current WC adjuster dedicated and reside on-site at the County on a full-time basis? What is the current adjuster s caseload? (is he/she managing both Indemnity and Medical Only?) If onsite currently, is the adjuster on the County s payroll or the TPA s? A14. The current WC adjuster is dedicated to Gwinnett County and is onsite on a full-time basis. The caseload is the number of claims that the County has. The adjuster handles all claims for the County. The adjuster is on the TPA s payroll. Q15. Page 9, VI Claim Service Questionnaire, A. Staffing/Administration item 9., asks Which office(s) will handle Gwinnett County claims? Please clarify if this is in addition to a fulltime adjuster onsite at the County and/or if the County is open to other options regarding the location of the adjuster(s). What is the County s current claims adjusting staffing model? A15. Payments are made from current TPA s office. This is the information we are asking for. How will you handle the payment of claims and where will the payments originate. Q16. The County has experienced an average of 439 claims a year for the years ; Averaging 94 Indemnity, 277 Medical Only, and 68 Report Only. Please provide detailed loss runs for the years so we can review the detail of the losses/departments where the losses are occurring. A16. See attached file: Copy of Gwinnett Co 5 year status without names Q17. Page 2 indicates, Should the County make a TPA change the new TPA will assume and manage any existing claims. Please provide detailed loss information on Open claims, by year, by coverage type (Indemnity/Medical Only). A17. See attached file: Gwinnett County Open Claims LT and MO without names Q18. Per requirement of the RFP, Costs will be provided in a separate envelope from the response. Page 16 asks for proposed pricing for services, a.1. Workers Compensation Administrative Services (per claim), 1.1 New Lost Time Claim; 1.2. New Medical Only Claim Does the County desire a per claim rate on a Life of Claim or Life of Contract basis? Please clarify that the County would also require pricing on Takeover claims as well? A18. A.l. Life of Contract basis. Yes we would like pricing on Takeover claims. Q19. What is the pricing structure of the County s current services agreement? Per Claim or Annual? Does the County currently have some type of Performance Guarantee included? Please provide a copy of the current services contract for review. A19. We would like to add a performance guarantee. We pay an annual admin fee and a per claim fee.

3 Q20. The RFP states the County s medical bill volume as $2,398, from Can the County provide the following information: a. Total number of bills processed in 2016 b. Total number of lines processed in 2016 c. Total bill charges by year (supporting the $2,398, from ) d. Total fee schedule reductions e. Total PPO network reductions f. Total Specialty Network reductions g. Total Other reductions h. PPO penetration percentage i. Total Bill Review fees paid for bills processed j. Total PPO network fees paid for bills processed A20. a. Total number of bills process in 2016: 4,499 b. Total number of lines processed in 2016: 12,471 For answers to questions c j, please see attached file: Gwinnett County Claims info Q21. What is the County s current loss fund arrangement? Please clarify if the TPA will use a bank account owned by the TPA and if an escrow is set up. A21. The TPA pays the claims and sends an invoice to the County on a bi-monthly basis. An escrow of $200,000 is provided. If claims are excessive, an interim reimbursement is made. The TPA uses a bank account owned by the TPA. Q22. Who does the County utilize for workers compensation legal services? Do you have a preferred or use in-house? A22. We have used legal services provided by the TPA. We do not use in house legal. Q23. Does the County require the TPA to assist in OSHA recordkeeping and/or reporting? A23. The County is not subject to OSHA recordkeeping and/or reporting. Q24. How many online accesses does the County require? A24. We will need 4 online accesses. Q25. Who does the County currently have attending hearings? A25. TPA representative, legal counsel (if appropriate), Benefits personnel Q26. Would the County consider an extension of the submission deadline to allow respondents to fully evaluate and prepare proposals after receiving necessary information needed to provide comprehensive and thoughtful offers? A26. Yes. Q27. If necessary, will proposers be allowed to ask for clarification to answers provided by the County? A27. Not after the submission deadline. Q28. What are the days and hours required of the onsite adjuster? A28. Monday Friday, 8:00am-5:00pm Q29. What are the current open claims? How many are there? A29. See attached file: Detailed loss run Gwinnett County without names Q30. How is the onsite person paid? A30. By the awarded vendor as part of the administrative cost of the contract. Gwinnett County will provide an office space.

4 Q31. Are bonds required? A31. No. Bonds are not required. Q32. Are the values on page 11 current? A32. No. There was an error in the initial information. Please see corrected page 11R. Submit page 11R as part of your proposal. Q33. How do we currently interface with the STARS system? A33. Monthly download and ability to excess data on the system. HR uses SAP to interface. Claims are ed to a designated address. Q34. Who is on the evaluation committee? A34. Sheryl Dallas, Debbi Davidson, Raechell Dickinson, Bill Swiger Clarifications: C1. Please see attached revised example calculation page. The CPT code and cost values have been updated. Return the attached as part of your proposal. See attached preproposal conference sign in sheet. If you are accessing this addendum via the Gwinnett County website, contact dana.garland@gwinnettcounty.com for attachments. Thank you for your interest in Gwinnett County. This addendum should be signed in the space provided below and returned with your proposal. Failure to do so may result in your proposal being deemed non-responsive. Thank you Dana Garland Purchasing Associate II Company Name Authorized Representative

5 Page 11R For comparative purposes, and in consideration of your proposed fees, Proposer must include example calculations showing the amount of the discount to be applied, plus the administrative fee for the item, for typical ORTHOPAEDIC injury charges for the Current Procedural Terminology (CPT) codes shown: A. CPT Code OFFICE CONSULTATION 40 MIN Typical charge for CPT Code $ B CPT Code X-RAY WRIST COMPLETE MINIMUM 3 VIEWS Typical charge for CPT Code $ C CPT Code THERAPY 1+ AREAS EA 15 MIN Typical charge for CPT Code $ D CPT Code MANUAL THERAPY 1+ REGIONS EA 15 MIN. Typical charge for CPT Code $87.00 E CPT Code OFFICE OUTPATIENT EST. 15 MIN. Typical charge for CPT Code $ Total cost to county for the above example charges

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