HomeMy WebLinkAboutRFP - 7562 THIRD PARTY CLAIMS ADMINISTRATOR SERVICES (2)Addendum 1 - Page 1 of 5
ADDENDUM No. 1
REQUEST FOR PROPOSAL
Description of BID 7562: Third Party Claims Services
OPENING DATE: 3:00 PM (Our Clock) October 31, 2013
To all prospective bidders please see the attached questions and answers.
RFP Questions & Answers:
See attached questions and answers. Also attached are the following new attachments:
1. Five (5) Years Property, Liability, and Auto Days Open – Question 8
2. Five (5) Years Workers Compensation Days Open – Question 8
3. All Open Property, Liability, and Auto Prior to 2008 – Question 22
4. All Open Workers Compensation Prior to 2008 – Question 22
5. Five (5) Year Loss Run Report Adjuster Handled– Question 23
Please contact Gerry Paul, Director Purchasing and Risk Management at (970)
221-6779 with any questions regarding this addendum.
RECEIPT OF THIS ADDENDUM MUST BE ACKNOWLEDGED BY A WRITTEN
STATEMENT ENCLOSED WITH THE BID/QUOTE STATING THAT THIS
ADDENDUM HAS BEEN RECEIVED.
Financial Services
Purchasing Division
215 N. Mason St. 2nd Floor
PO Box 580
Fort Collins, CO 80522
970.221.6775
970.221.6707
fcgov.com/purchasing
Addendum 1 - Page 2 of 5
Addendum #1
Questions and Answers
1. How frequently is the property/liability adjuster contacted by the City for immediate
response?
Answer: Staff with the City of Fort Collins Risk Management office are in daily contact
with the property/casualty adjuster. Contacts requiring immediate assistance or
external customer contact may occur at any time but on average of 2-3 times a week.
2. Section 2. G.: Who provides cost containment programs to the City including bill
review and medical case management?
Answer: Our current TPA, CCMSI provides all cost containment programs including
medical bill review. At this time, the City does not contract with a separate provider for
these services. However this is not to say that the City may at some point in time
contract these programs / services to an outside party.
3. Section 2. G. Please provide a summary of the last year or 12 months of bill review
savings including number of bills, billed charges, fee schedule reductions, PPO
reductions, and fees to help determine the cost benefit analysis.
Answer: Please adjust Question in Section 2 G to read: “Describe how medical bill
review services take place within your firm or contractor and how the City could benefit
from these services”. We understand it would be difficult to provide a cost benefit
analysis without current data and we will not be providing this data at this time.
4. What are the current fees for bill review, PPO reductions and other related cost
containment fees including fees for nurse case management?
Answer: Current contract fees are all inclusive in a flat annual fee billed monthly.
5. Does the City have any of its own direct PPO provider contracts for discounts below
the fee schedule?
Answer: No. See #2 above.
6. Section 2. H. It appears the TPA issues checks for the City from a city bank account vs.
an escrow account established by the TPA. Is the TPA required to utilize City check
stock, or may the TPA use its own check stock with a minimum of the following security
features:
• UV Dull
• Florescent fibers
• Artificial watermark
• Bleach reactive, full solvent reactive
• Toner grip
• Void pantograph (says VOID when copied)
• Micro printing
• Border copy warning
• Gradient colored check face
• Special pantograph in signature area
• Thermochromic ink (heat sensitive spot)
Addendum 1 - Page 3 of 5
Addendum #1
Questions and Answers (Con’t.)
Answer: The current TPA issues checks from a City bank account but uses its own check
stock with specific security features. This should be considered an appropriate method
of issuing payments in the future as well.
7. Section 2. I: Does the City’s TPA currently use an independent adjuster, and if yes, for
what services, and which independent adjuster/firm?
Answer: All adjusters specifically assigned to the City of Fort Collins work for the current
TPA, CCMSI.
8. Will the City please provide loss runs in Excel to help obtain a full understanding of
claim shelf life for appropriate underwriting?
Answer: See attachments.
9. Section 3.B. E.: Does the City currently have an interface between the TPA and J.D.
Edwards One World Workforce System? Please describe the current interface, purpose
and how frequently data is exchanged.
Answer: There currently is no interface between the current TPA and City databases.
However the City is not opposed to this type of interface in the future depending on
security and compatibility of systems.
10. Section 3.B.G: How many users require access to the claim system? Do any users
require an access restrictions, and if yes, how many and what restrictions are required?
Answer: The City currently has 5 employees with full access to TPA database features
subscribed to by the City.
11. Does the City prefer an office (or an adjuster) in the City of Fort Collins for workers’
compensation claims or only for liability/property type claims?
Answer: A local adjuster is only preferred for liability and property claims. The City
investigates all work related injuries internally and has no need for a local WC adjuster.
12. Does the City require an office or is a resident adjuster(s) (working at home)
acceptable to the City?
Answer: A “work from home” situation would be acceptable. The City’s concern is that
when we need an adjuster at a local claim, a Denver adjuster can be over an hour
away from Fort Collins even on a good traffic and weather day. The City’s philosophy is
rapid deployment and / or intervention to a situation is desirable. On rare occasion an
adjuster may be called upon after normal working hours.
13. What is the current staffing model utilized for the City claims? How many adjusters (%
of FTE - dedicated or partly designated) for each claim type, i.e., liability claims,
indemnity claims and medical claims?
Addendum 1 - Page 4 of 5
Addendum #1
Questions and Answers (Con’t.)
Answer: The number or percentage would be up to the management of the TPA for its
own adjusters work load. The RFP requests a response in 4 E for claims ratio per adjuster.
This number will be used as part of the scoring process when evaluating submissions.
Other helpful information in making this determination includes the fact that The City
staffs an internal “Risk Management Technician” to manage smaller property and
liability claims where responsibility clearly lies on the City. This person provides
assistance, direction and provides authorization to adjusters assigned to property,
liability and workers compensation claims.
14. Section 4.E.: By claims ratio do you mean open caseload or number of newly
reported claims assigned to an adjuster?
Answer: Number of open active claims per adjuster.
15. Section 5.A: Indicates the City currently pays a guaranteed one-time fee for a
specified number of claims. Is that a specified number of newly reported claims and
specified number of open claims? What are the current contracted rates and
thresholds? How many denied claims, by claim type, does the City have per year?
Answer: If a new TPA is selected through the RFP process, the new TPA will be expected
to take on all currently open claims through a data transfer. Pricing can be quoted at a
flat rate or cost per claim however all claims must be managed through the life of the
claim. The City currently pays a flat annual fee for the life of the contract up to a
specified number of claims (by line of coverage). If the specified number of claims is
exceeded, the City pays a cost per claim.
16. Who currently handles query and reporting to CMS, and how much is the City
currently being charged for services?
Answer: The TPA handles all interaction with CMS reporting and fees are built into the
flat rate charged in the contract.
17. Does the city currently pay additional fees for recovery of subrogation losses,
and if yes, how much?
Answer: The City does not pay additional fees for subrogation work. Currently,
subrogation for workers compensation is performed by the TPA. Property and liability
subrogation is taken on (mostly) by the City.
18. Section 5.F. Please provide the Tax ID numbers used by WorkWell and University of
Colorado Health.
Answer: Tax ID numbers can be obtained directly through WorkWell and University of
Colorado Health by the TPA when a contract is awarded. The City will remain in close
contact with these providers and provide notification of any changes of TPA services.
Addendum 1 - Page 5 of 5
Addendum #1
Questions and Answers (Con’t.)
19. Section 5.F. Does the City have any of its own provider contracts, and if so, with who
and for what services?
Answer: The City conducts an RFP process every five (5) years with annual renewals for
workers compensation medical services. The TPA is not expected to contract directly
with these providers. The City’s current providers are WorkWell and University of
Colorado Health. Both of which have offices in Fort Collins.
20. Who does the City currently use for the prescription drug program and what are the
fees associated with the program? What is the current cost of brand and generic and
home delivery drugs for the City?
Answer: The City’s current prescription drug program is administered through the
current TPA and is included in the flat annual fee charged.
21. Section III: Does the City require a response to every item point or just areas that
may be an issue, or need clarification?
Answer: The City desires to know why your firm is the best choice in choosing a TPA. We
believe the questions posed in the RFP for response will provide us with the information
from which to make an informed decision and base scoring on an even platform.
Should you choose not to answer specific questions in the RFP, is the choice of the firm.
Keeping in mind, those questions not answered, may be asked again in an interview
process.
22. Exhibit 1: Will the City please provide loss runs in Excel for all years? Or please provide
the number of open claims by claim type that may be open prior to Year 2008 if any.
Answer: See attachments
23. Exhibit 1: Indicates the City handles approximately 100 of the auto and general
liability claims in-house. Is it possible for the City to provide a loss run in Excel of the
claims that the TPA has handled in the past that are not just claims where the TPA either
issues a check or denial letter?
Answer: See attachment