11162 - FUNCTIONAL REQUIREMENTS
Item # / Item / Vendor Response1.000 / General Company Information and Background
1.100 / Name and Address of Premium Billing Contractor / Electronic Data Systems Corporation
5400 Legacy Drive, Plano, Texas 75024
1.200 / Years in business as a Premium Billing Contractor / 13 years
1.300 / Years of experience providing Premium Billing Services / 13 years
1.400 / Ownership (list all owners of the entity) / EDS is a publicly held corporation.
1.500 / Briefly describe your companies performance standards in terms of volume and accuracy measures; Distinguish between electronic and paper processes. / While we recognize that achieving accuracy
standards on paper transactions is more
difficult, it does not change our focus on
meeting KHPA’s requirements. In reviewing
KHPA’s performance standards, no
differentiation was made between paper and
electronic transactions. EDS’ approach is to
focus on service excellence. For example,
on our Medicaid contract there are more
than 200 RFP requirements but only 14
specific performance requirements with
liquidated damages tied to them. We
monitor all RFP requirements monthly and,
on average, consistently exceed 40 percent
of the requirements every month. Our
processes and staffing for the Premium
Billing and Collections Services project are
designed to support the performance
standards included in this RFP.
1.600 / What is the volume of transactions/policies that were managed last year? / EDS managed more than 4.5 million
premium-related transactions last year. We
support commercial healthcare plans
ranging from 100,000 members to 20 million
members.
1.700 / Is Premium Billing Contractor registered as a TPA with the Kansas Dept of Insurance and in good standing? / Yes. EDS is registered as a TPA in Kansas
under the name of EDS Administrative
Services, LLC.
1.800 / Does the Premium Billing Contractor have experience in working with State, County and Local government entities? / Yes
2.000 / Billing Consolidation Service
2.100 / Can the service support multiple benefit product types? / Yes. Through the configuration process,
different product types can be set up in iC
PB&C.
2.200 / Can the service support multiple carriers? / Yes. Multiple carriers can be set up in iC
PB&C. Currently, Oklahoma supports
multiple carriers for both the employer and
individual plans.
2.300 / Can the service provide an on-line statement or a paper statement? / Yes. Online and paper statements are
available through iC PB&C. Members also
can display and print printable versions of
their online statements.
2.400 / How frequently will the Premium Billing Contractors database be updated with KHPA membership and eligibility information? / iC PB&C supports daily updates of
membership and eligibility information.
2.500 / Can the service be utilized via web access? / Yes. iC PB&C supports member registration,
one-time and recurring scheduled payments,
online delivery of statements, and
automated e-mail generation to registered
members.
2.600 / Can the service integrate with the payroll system? / Yes. iC PB&C currently supports various
interfaces to support clients’ business
needs. EDS will establish the interface
required to send payroll deduction
information to the State of Kansas’ payroll
system.
2.700 / Can the service support multiple pay groups? / Yes. iC PB&C can support premium
statement generation and payment
management for multiple carriers, programs,
and pay groups. The output files generated
by iC PB&C will be modified to include
Kansas-specific pay group values for
KHPA’s financial management.
2.800 / Can the service support multiple locations? / We can support multiple locations as
defined in the answer to Question 28 of RFP
Amendment 2.
2.900 / Can the service support the multiple business rules and services provided by KHPA? / Yes. Rules and services not already
inherent in iC PB&C will be incorporated as
part of the enhancement effort during
implementation.
2.110 / Is the company willing to integrate with the specific IT systems of the KHPA? / Yes. iC PB&C currently supports several
client interfaces. Specific KHPA interfaces
will be established to pass data to the
systems requested by this RFP.
2.120 / Can the service support multiple file formats for import and export of data? / Yes. iC PB&C supports receiving and
sending data. As part of the implementation,
the required input and output formats for the
data exchanges will be developed and
tested.
2.130 / Is the service available 24/7? / Yes, the service is available 24/7 through
the Web. Telephone payments are available
24/7 through the interactive voice response
(IVR) system. EDS will notify Kansas in
advance of scheduled downtime for system
maintenance. Planned downtime is typically
scheduled for late nights on weekends.
2..140 / Is there a specific Premium Billing Contractor customer service representative (or multiple representatives) assigned to the group? / Yes, EDS will assign dedicated customer
service professionals to the group.
2.150 / Are customer service representatives able to provide customer services in multiple languages? What are these languages? / Yes, customer service professionals will
support English and Spanish. Additionally,
through our translation vendor, we can
conference in their staff members, who
support 150 different languages.
2.160 / How many customer service calls are you able to answer at one time? / Based on the number of members listed in
the RFP and our calculation of typical call
volumes per member, our solution provides
KHPA a team of five customer service
agents dedicated to support premium
assistance calls. Additionally, the IVR
system will support the receipt of telephonic
checking and savings account payments.
Our Avaya system supports automated
messaging to answer some of the most
common questions, while also giving callers
the opportunity to speak to an agent. The
aforementioned types of customer service
calls can occur concurrently. At a single
moment in time, each aspect of our
customer service solution can support active
calls as follows:
• Agents: Five concurrent active calls,
average of three minutes per call, with 10
calls in queue waiting on an agent
• IVR: Unlimited
2.170 / Describe cultural and diversity training provide to customer service agents. / EDS has a dedicated diversity manager,
Cindy Davis. Cultural and diversity training
developed by our Global Learning and
Development (GLD) Team is available on
EDS’ myWorkLife Portal. Customer service
staff training will include cultural and
diversity training based on the courses
developed by GLD.
2.180 / Can the Premium Billing Contractor accept one payment each month from the KHPA for all groups and sub groups? / Yes, single payments received from KHPA
can be applied to the outstanding current
balance for all members of the group or
subgroups.
2.190 / Can the Premium Billing Contractor accept multiple payments from the subordinate groups and locations? / Yes, multiple payments are handled in the
same manner as payments received from
individuals.
2.210 / Is there a lock box or unique account established for premium collections and payment to the carriers? / Yes, a lockbox will be established with a
local Kansas bank, Bank of America. Based
on the answer to Question 104 of RFP
Amendment 2, the vendor is not responsible
for carrier payments in the SEHP.
2.220 / Explain the process for collecting funds from the group and remitting to carriers / Based on Question 104 of RFP Amendment
2, the vendor is not responsible for carrier
payments in the SEHP. Our solution is
designed to collect funds from the group by
check or electronic payment. If the groups
remit their payments to KHPA directly,
KHPA will provide the payment information
to EDS for posting to the accounts.
Remittance to carriers other than those
supporting SEHP can be handled through
EFT or by including the payment on the file
transmitted to STARS for other payments
required under this scope of work. We will
finalize our handling of carrier remittances
during the requirements validation process.
2.230 / Can beneficiaries access the system on line? / Yes. iC PB&C supports member registration,
one-time and recurring scheduled payments,
online delivery of statements, and
automated e-mail generation to registered
members.
2.240 / Can the Premium Billing Contractor interact with KHPA's eligibility system? / Yes, we have planned for an interface
between iC PB&C and KAECSES/SEHP.
2.250 / Describe how issues with incorrect billing amounts would be resolved. / If a statement is generated with an incorrect
billing amount and the member notifies EDS
that the amount was incorrect, we would
open a grievance on the member’s behalf.
Research would be conducted to validate
the amount billed against the data received
from the source entity. If the amount was
incorrect, a corrected statement would be
generated and mailed to the member. The
member would be contacted by telephone
with the outcome of the research, and the
grievance would be closed. If the incorrect
amount was the result of applying an
overpayment to the next month’s amount
due, and the member notifies us requesting
a refund, we would adjust the balance owed
in the system, reversing the overpayment
that was applied. A corrected statement
would be generated and mailed to the
member, and a refund request would be
submitted to KHPA.
3.000 / Billing Consolidation Application
3.100 / Is the application exclusive to the company or do you use a specific software application for your automated back office? (software “homegrown” or purchased from a technology provider?) / iC PB&C is exclusive to EDS.
3.200 / Is the application available to the group and administrators via the web? / The user interface of iC PB&C is
PowerBuilder-based, like the MMIS. Access
to iC PB&C will be handled like access to
the MMIS is handled today. Web-based
report delivery required by the RFP is
provided by BusinessObjects.
3.300 / Can the group reconcile and pay bills on line? Can adds and deletes be done on line? / iC PB&C supports paying bills online.
Members can enroll and disenroll in online
payment and presentment through the Web
site. iC PB&C also provides a one-time
payment option without registration.
3.400 / Is the application available 24/7 to the client? / Yes, iC PB&C is available 24/7 through the
Web.
3.500 / What has the system uptime been over the last 3 years? / Uptime has been 99.9 percent, with the
exception of scheduled system maintenance
time.
3.600 / Can the system be private labeled? / Yes
3.700 / Does the system have multiple layers of access based on the administrator's specific role? / Yes
3.800 / Can the primary administrator assign user names and passwords for subordinate administrative personnel? / Yes
3.900 / How long does the system retain the history of transactions? / Statements are retained on the Web for six
months. Payment history is retained in iC
PB&C for five years.
3.100 / Can the system handle multiple data exchange methods including automated electronic data transfer via secure FTP site, wire transfer, e-mail, magnetic tape, diskette or other electronic media? / Yes, these methods are supported by iC
PB&C.
3.110 / Can the system support Automatic Clearinghouse (ACH), Electronic Fund Transfer (EFT), Direct Deposit, and manual checks as payment method from the group(s) to the Premium Billing Contractor? / Yes, these forms of payments are
supported.
3.120 / Can the system support multiple methods of payment (see 3.11 above) to the carriers? / Per the answer to Question 104 of RFP
Amendment 2, the vendor is not responsible
for carrier payments in the SEHP.
Remittance to carriers other than those
supporting SEHP can be handled through
EFT or by including the payment on the file
transmitted to STARS for other payments
required under this scope of work. We will
finalize our handling of carrier remittances
during the requirements validation process.
3.130 / Is there an audit trail of changes made and the specific administrator responsible in making the change? / Yes. As a component of interChange, iC
PB&C includes audit trail functionality
currently approved by KHPA for the
interChange MMIS environment. Changes
made through online pages within the iC
PB&C environment capture values before
and after changes, as well as the user ID
and a date and time stamp to document the
change.
3.140 / Will the application track eligibility of employees for each benefit product? / Yes. Based on eligibility data provided by
KHPA, the application will track eligibility of
employees for each benefit product.
3.150 / Will the system track compliance for 403(b) and 457 programs? / Currently iC PB&C does not support either
of these programs. Although this is not a
requirement under the scope of work for this
RFP, iC PB&C can be modified to add
functionality to track compliance for 457
deferred compensation programs and
403(b) retirement plans for nonprofit
organizations, if KHPA desires.
3.160 / Will the system provide imaged document storage associated with payroll deduction forms, enrollment forms, and other documents? / Yes, images associated with premium billing
and collections will be stored in the image
system provided by KHPA.
3.170 / What is the system capacity with respect to transactions? Participants? / System capacity is scalable to support any
volume of transactions or participants
needed. The proposed solution has been
sized to support volumes documented in the
RFP.
3.180 / Can Carriers/Providers and Benefit Brokers access the system? Is the system partitioned accordingly? / Although this is not a requirement under the
scope of work for this RFP, iC PB&C can be
modified to allow access to the system by carriers or providers and benefit brokers.
The security necessary to allow this is
already present in iC PB&C.
3.190 / Can the system allow real time changes for benefit products and premiums in the current statement? / Although this is not a requirement under the
scope of work for this RFP, iC PB&C
supports updates in a real-time environment.
Statements are produced in a batch
process. As long as the change in premium
is entered prior to the statements being
generated, the change will be reflected on
the current statement.
3.200 / Can the system block real time premium changes when not permitted by the carrier due to the specific benefit product? / Although this is not a requirement under the
scope of work for this RFP, iC PB&C can be
modified to support this function.
3.210 / Can the system support multiple products under a single payroll slot? / Although this is not a requirement under the
scope of work for this RFP, iC PB&C can be
modified to support this function.
3.220 / Can the system be set up so that centralized administrators can have access to the entire group while satellite office and department level administrators/managers can only have access to their own locations/departments? / Although this is not a requirement under the
scope of work for this RFP, iC PB&C can be
modified to allow the access described. The
security necessary to allow this is already
present in iC PB&C.
3.230 / Is the system now supporting state, county or local government groups? / Yes
3.240 / Can employees access the application on line? / Yes. iC PB&C is accessible through the
Web. Enrollment to receive statements and
make payments is handled through the
Web. KHPA and EDS employees supporting
premium billing and collections services will
access iC PB&C through PowerBuilder
windows.
3.250 / Can the application manage eligibility for the group? / Yes. As requested in the RFP, iC PB&C will
support eligibility feeds from KAECSES and
SEHP.
4.000 / Integration
4.100 / Are multiple pay groups supported? What is the maximum capacity? / Our proposed solution is scalable to support
any volume of pay groups needed, and it
has been sized to support the volumes
documented in the RFP.
4.200 / Are multiple locations supported? / Yes. Based on the answer to Question 28 of
RFP Amendment 2, we will support multiple
locations.
4.300 / What is the Premium Billing Contractor's file format flexibility when importing or exporting data? / Our proposal assumes that we will modify iC
PB&C to support the file format currently
being provided to the existing vendors.
4.400 / Can the Premium Billing Contractor import eligibility information? / Yes. As requested in the RFP, iC PB&C will
support eligibility feeds from KAECSES and
SEHP.
4.500 / Can the Premium Billing Contractor interact with KHPA eligibility system? / Yes. As requested in the RFP, iC PB&C will
support eligibility feeds from KAECSES and
SEHP.
4.600 / Can KHPA view copies of premium statements and correspondence sent to consumers at anytime? / Yes. As requested in the RFP, we will
provide images of premium statements and
correspondence to the KHPA-provided
image system.
4.700 / Can the Premium Billing Contractor import enrollment information? / Yes. As requested in the RFP, iC PB&C will
support eligibility feeds from KAECSES and
SEHP.
4.800 / Can the Premium Billing Contractor track payroll deduction for each participant on an ongoing basis? / Yes. We will document payroll deduction
requests in our contact tracking system. The
method by which members have made
arrangements to pay their premiums will be
tracked on premium records.
4.900 / What frequency can the Premium Billing Contractor support in receiving/sending files? / Daily
4.110 / Are both manual and automatic file transfer methods available? / Yes
4.120 / Is FTP supported? Is PGP encryption supported? / Yes, we will support FTP (secured and
encrypted). PGP is an open source public
encryption code without having to send keys
and can be installed if the Sun FTP software
does not support the PGP protocol.
4.130 / Intentionally left blank
4.140 / Does the Premium Billing Contractor have experience in integrating with state, county or local government payroll systems? / iC PB&C is not currently integrated with any
payroll systems. However, based on the
RFP requirements, we have planned for an
interface with the current payroll system for
SEHP members.
4.150 / Can the system accept multiple payroll files and consolidate the updates across the entire group? / Yes. iC PB&C can receive payment files as
inputs to apply to premiums across multiple
groups or plans.
5.000 / Security
5.100 / Has the Premium Billing Contractor been through a security audit? / Yes, an annual Level 2 SAS-70 audit is
conducted on the Topeka location.
5.200 / Is the Premium Billing Contractor and application HIPAA compliant? / Yes
5.300 / Please describe in detail your current activities related to compliance with HIPPA including: Administration, Simplification, Privacy and Security. / EDS has a HIPAA privacy and compliance