Newport News Public Schools RFP#
ATTACHMENT F1
QUESTIONNAIRE
The following questionnaire will assist the Schools in evaluating the quality of care and benefits being offered to employees/retirees and dependents as well as assist in the evaluation of the financial and contractual information requested of the Offeror. An Offeror’s evaluation score will not be adversely impacted if a specific question does not apply.
INSTRUCTIONS
1. This questionnaire includes questions that pertain to Medical, Dental and Vision plans. Please complete the sections of the questionnaire that are relevant to the proposal you are offering. The table below outlines the sections that should be completed for each option.
QuestionnaireSection / Medical / Dental / Vision
General Information / √ / √ / √
Enrollment/Eligibility and Administration / √ / √ / √
Networks / √ / √ / √
Prescription Drug Program / √
Managed Mental Health Program / √
Vision / √ / √
Health Management Services / √ / √ / √
Data Management / √ / √ / √
Financial / √ / √ / √
Dental / √
2. Each question and response must be provided in Tab IV as instructed in Section IV. An electronic copy of your responses is also requested.
3. Answer all questions fully, clearly and concisely unless a specific question is inapplicable to the service you are proposing to provide.
4. Each response must immediately follow the respective question. The question as well as the answer shall be typed. All questions and responses shall be numbered/labeled exactly as in this Questionnaire.
5. If the Offeror is unable to answer a question or the question does not apply, the Offeror shall indicate why.
6. If the Offeror is unwilling to disclose particular information asked in a question, the Offeror shall indicate why.
7. Samples of documents requested in the Questionnaire should be labeled with the corresponding question number and submitted in Tabs as specified in Section IV of the RFP.
GENERAL INFORMATION
1. Type in the following information:
Point of Contact:Title:
Company:
Address:
Telephone/Fax:
E-Mail:
2. Have the proposal requirements been fully met as requested in this RFP?
Yes No
If not, please summarize all deviations and include the summary in Tabs I and II as requested in Section IV.
3. Please fill in the tables below, indicating 1) the number of employees within your organization and 2) the number of group health plan members.
Number of employees of your firm in: / # of employeesNewport News Service Area
Virginia
Nationwide
Number of Enrolled Group Health Plan Members in: / PPO / POS / HMO
Newport News Service Area
Virginia
Nationwide
4. Please provide pertinent financial data that demonstrates your organization’s ability to successfully perform this contract. Please provide your most recent ratings by each of the following:
Fitch
Standard & Poors
Moody’s
A.M. Best
5. Please identify all subcontractors (including consultants, advisors, network managers and suppliers) to be used and describe specific responsibilities, qualifications, and background experience of all key personnel. Include financial ratings for each major subcontractor, consultant, or advisor.
6. Is your organization currently compliant with HIPAA HITECH legislation as it pertains to Private Health Information and EDI Standards?
ENROLLMENT/ELIGIBILITY AND ADMINISTRATION
7. What is the location of the claims office that will be processing claims and providing general administration for this account? Indicate if locations are different for medical, prescription drug, and managed mental health. Identify service center locations for each of the following functions:
Function / Service Center LocationClaims Processing
Eligibility
Billing
Claims Management & Reporting
Accounting
Underwriting
Account Management
Contract Generation
ID Card Generation
8. Provide an implementation schedule (in Tab IV of your proposal)
a. Detail specific activities, target dates, data requirements, and responsibilities for completion.
b. Detail any expenses involved and whether these expenses are included in your pricing.
9. Provide information on any electronic communication that would be required from the Newport News Public Schools system.
10. Please specify the methodology used to interface your computer system to our personnel/benefits management system for data transfer and integration purposes. Please be as specific as possible and include any electronic interchange standards, file layouts or technical documentation available. Explain in detail the automated process that we would use to upload and transmit data to your servers and the process for returned errors to our system.
11. List any options NNPS would have interfacing to your system. Provide details regarding setup, testing and implementation of the interface, and include a suggested timetable.
12. Please provide the name and contact information of a client that uses Oracle EBusiness successfully with you as the provider, as the source for their HRMS data.
13. Please explain in detail your support team, response time for emailed questions, response time for phone calls, and how problem escalations are handled for data interface related issues.
14. Describe the process and time required to setup accounts for technical users involved in interface operations/maintenance for your system
15. Describe your ongoing enrollment procedures and annual open enrollment assistance.
a. Indicate the services you would be willing to provide, such as on-site assistance with employees, etc.
b. Identify any services that would require a separate fee to be paid outside the administrative fees included in the Price Quotations.
16. Please indicate whether you are providing members with uniform explanation of coverage documents, or Summary of Benefits Coverage (SBC).
a. Please indicate the processes in which they will be provided to clients, and the timeline required for generating the documents.
17. Do your systems have the following capabilities? If yes, indicate if there are additional charges for any of these:
/ YES / NO /Can you accept current eligibility records electronically for initial enrollment? / ¨ / ¨
18. Please list the administrative services that are provided as part of your “standard fees”.
19. Will you issue ID cards directly to plan members? ¨ Yes ¨ No
20. Please explain the process NNPS must follow to add and delete employees to and from your eligibility system.
a. How long does it normally take for your billing department to make requested changes to the bill or monthly accounting statement (additions/deletions) and
b. How long does it normally take for the proper adjustments in fees or premium?
21. Will you allow NNPS to pay fixed fees based on their internal enrollment records rather than paying your invoice “as billed”?
a. How quickly can your system generate adjusted bills (based on enrollment/eligibility changes)?
22. How long will you allow retroactive changes to be made to the bill?
23. Do you provide automated, interactive telephone service? ¨ Yes ¨ No
a. Is there always an option to default to a customer service representative?
¨ Yes ¨ No
b. During what hours is a customer service representative available to take calls?
24. Do the customer service representatives have the authority to resolve problems immediately? ¨ Yes ¨ No
a. What is the percentage of problems that are resolved during the initial call?
25. Confirm that your claims processing system can administer separate accumulators for deductible and out-of-pocket maximums.
26. Please provide your performance standards and quarterly results for 2011 and 2012 in the chart below. The results should include the performance of the service team, which would be responsible for NNPS. If different units would be responsible for the different plans, provide standards and results separately for each unit. Input your standard on each measure.
Product(s): / ResultsThe results below include the following service units: / 2011 / 2012
Q1 / Q2 / Q3 / Q4 / Q1 / Q2 / Q3 / Q4
Timeliness of claims processing:
Standard:
Results:
Claims processing accuracy:
Standard:
Results:
Telephone inquiry/wait time:
Standard:
Results:
Telephone inquiry/ abandonment rate:
Standard:
Results:
27. Will there be any additional cost to NNPS for you to prepare and print employee membership materials?
28. Confirm that you will allow NNPS to review and approve all School-specific communication pieces before they are sent to their employees.
29. To what extent will the NNPS be allowed to customize the enrollment and communication materials that will be provided to members?
a. What additional costs will be associated with customization?
30. Will your company accept responsibility for errors and overdraws created by your personnel in processing claims? ¨ Yes ¨ No Please explain.
NETWORKS
31. How much advance notice must the provider give you if they wish to cancel their contract with you?
32. What is your process for notifying members when a physician leaves the network?
33. Do you provide on-line tools that allow members to evaluate the quality and/ or price transparency to support point-of-care decisions associated with specific hospitals, physicians, and/or medical procedures? If so, please describe.
34. What is your contracting strategy with regard to hospital-based radiologists, anesthesiologists, pathologists, and ER physicians (specify for each network)?
a. What is your standard protocol for processing these types of claims if these providers are not in your network but are utilized by a NNPS ’ member at an in-network facility?
35. Do you have network arrangements for alternative medicine, chiropractic, and acupuncture providers?
a. Explain your credentialing process for these providers.
36. Will you include emerging technologies such as telemedicine, mobile applications, e-visits and data-enabled kiosks in your network of providers? If not now, when?
37. If a physician or hospital cancels or fails to renew their network contract, how would transition of care be handled for an inpatient or critical/chronic case or a maternity case?
a. Confirm your compliance with Commonwealth of Virginia continuity of care mandates.
38. How and how often is patient satisfaction measured with providers? What regions/networks are included in the results you are providing?
39. How and how often is provider satisfaction measured?
40. Are your provider reimbursements tied to performance – including quality of care, efficiency and health outcomes? Please explain thoroughly how this will impact the population health management of our group over the five years, ten years, 15 years.
41. Are your networks segmented and tiered to differentiate between high-performance providers?
42. Are providers offered incentives (or penalties) for coordinating care and using emerging technologies or evidenced-based treatments?
43. Are providers paid on a fee-for-service basis or a methodology that holds them accountable for cost of episodes?
44. How are member/subscriber grievances against providers handled?
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NNPS RFP# 13-344098/D
45. Please complete the following information for each hospital/facility you have under contract in the Newport News service area as of November 2013. Also provide anticipated changes for 2014 & 2015.
Name of Hospital/Facility
/ Type of Contract (1) / Services not Included / Contract Effective Date / Length of Contract / Types of Products Accessing Network / Includes All Attending Physicians Yes or No / List Specialists not included (2) / Average DiscountBON SECOURS DEPAUL MEDICAL CENTER
BON SECOURS HEALTH CENTER AT HAR
CHILDRENS HOSPITAL OF THE KINGS DAUGHTERS
NEWPORT NEWS VAMC
MARY IMMACULATE AMBULATORY SURGERY
MARY IMMACULATE HOSPITAL INC
MARYVIEW HOSPITAL
MEDICAL COLLEGE OF VIRGINIA HOSP
PENINSULA SURGERY CENTER
RIVERSIDE REGIONAL MEDICAL CENTER
SENTARA CAREPLEX HOSPITAL
SENTARA LEIGH HOSPITAL
SENTARA NORFOLK GENERAL HOSPITAL
SENTARA OBICI HOSPITAL
SENTARA WILLIAMSBURG REG MED CTR
Indicate your average aggregate inpatient hospital discount for the Newport News service area:
Indicate your average aggregate outpatient discount for the Newport News service area:
(1) Per Diem, Capitation, DRG, Per Case, Discount off Charges, Other - please explain. Indicate inpatient and outpatient reimbursement methods separately.
(2) Anesthesiologists, radiologists, emergency room physicians, etc.
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NNPS RFP#
46. Please provide a geographic access report for each network using the zip code listing provided in the census file. Access is defined as: 2 PCPs within 5 miles, 2 specialists within 5 miles and 1 hospital within 10 miles. Do not use other access parameters in your response. Please include reports for detailing zip codes that do not meet access criteria. (Include in Tab V of your proposal.)
47. Do you have Centers of Excellence for specific specialty care, surgery, etc.?
a. If yes, list the facilities by specialty.
b. Describe your program, including how centers are selected and details on services offered to family members when travel and overnight stays are involved.
c. Is your Centers of Excellence program voluntary? ¨ Yes ¨ No
48. Complete the table below and explain in detail the coverage options available and how benefits are paid for each of the following members (discuss for each product if different). Indicate how the member would be covered for ongoing treatment for a chronic illness.
COBRA enrollee outside the service area
Retiree living permanently outside the service area
Retiree living three to six months outside the service area
Dependent spouse and/or child of an active employee living permanently outside the service area
Dependent attending college outside the service area
49. Is your HMO/POS NCQA accredited? ¨ Yes ¨ No
a. Is your PPO URAC accredited? ¨ Yes ¨ No
b. If accredited, at what level?
c. If no, have you applied for accreditation?
50. For all networks included in your quote, do you own the network?
a. If yes, how long have you owned the network?
b. If no, who owns the network?
c. Explain your responsibility and accountability for the network.
51. Please complete the Hospital, Provider and Drug Checklist (Attachment E) as instructed and include both a hard copy and an electronic copy (in Excel file format) of the completed exhibits in Tab VI of your proposal.
PHARMACY
52. If NNPS uses a different PBM, will you charge a fee for integration?
53. Will your reinsurance cover pharmacy claims from an outside PBM?
54. How will you track pharmacy claims towards the out of pocket maximum if an outside PBM is chosen?
MANAGED MENTAL HEALTH PROGRAM
55. Do you administer the program included in your quote or do you subcontract the services? If services are subcontracted, specify the vendor.