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HomeMy WebLinkAboutRESPONSE - RFP - 7649 DENTAL ADMINISTRATOR (9)Delta Dental of Colorado Section VI — Questionnaire Responses 1 1.5 Proposal Instructions Do not deviate from the requested formats. Provide your proposed rates and fees as specified in this RFP. Confirmed. The City is seeking an initial premium/administration cost that runs for at least 24 months (January 1, 2015 – December 31, 2016). Please confirm this time period is applicable to your proposed rate/fee guarantees. Confirmed. Administrative services for dental plan should be quoted for a self-funded plan. Define specifically what services are included in the fees your company has quoted. Specify any charges for services that your company has not included in the fees quoted above, including any start-up fees, materials, etc. Confirmed. Adhere to the instructions in this section when organizing your proposal. Confirmed. SECTION 2.0 SERVICES TO BE PROVIDED In addition to the plan provisions set forth in the attachments, the City has specific vendor requirements needed to support its day-to-day operations. 2.1 Specific Requirements • Account Management The account executive and service representative(s) will deal directly with the City. This environment requires the account management team to: o Be able to devote the time necessary to the account, including being available for frequent telephone and on-site consultations with the City. Proposers who are not committed to serious account service will not receive serious consideration; o Be extremely responsive; o Be comprised of individuals with specialized knowledge of the proposing company’s: § Claims and Eligibility Systems § Provider Networks (where applicable) § Systems Reporting Capabilities § Claims Adjudication Policies and Procedures § Administrative Services Contract Wording § Standard and Non-Standard Banking Arrangements § Relationships with Third Parties; o Be thoroughly familiar with virtually all of the proposing company’s functions that relate directly or indirectly to the account; o Act on behalf of the City in “cutting through the red tape”. This facet of account management cannot be emphasized enough – the account management team must be able to effectively advance the interests of the City through the vendor’s corporate structure. Confirmed. • Enrollment/Eligibility The City will provide initial enrollments electronically or on paper. The initial enrollment and updates will be provided directly to the selected vendor by the City. Delta Dental of Colorado Section VI — Questionnaire Responses 2 The selected vendor will perform direct eligibility certification to providers and verify coverage as a part of the claims management and adjudication process. A quarterly reconciliation between payroll and eligibility will be required of the selected vendor. Confirmed. • Fee Administration Dental vendor will invoice the City. The City may calculate the fees/ premiums payable on a monthly basis and will submit these fees directly to the selected vendor. Confirmed. • Customer Service The selected vendor must have as its primary focus efficient and effective processing of all inquiries. Satisfactory customer service will include prompt, courteous and accurate responses to the City and employee inquiries regarding claim submissions, applicable provider networks, plan design and provisions, etc. A toll free number should be available for eligibility certification and claim submission inquiries. Confirmed. • Financial Accounting On a monthly basis, the selected vendor must provide an accounting reconciliation of any “central bank” accounts utilized. The selected vendor must provide a quarterly written report detailing all administrative expenses charged outside the Administrative Services Agreement. The selected vendor must present a report detailing and justifying proposed fees for the coming year by September 1st of the preceding year. Confirmed. • Right to Audit The selected vendor must agree to allow the City, or its representative, the right to audit all claims, applicable provider credentialing, financial data and other information relevant to the City’s account. Confirmed. • Data and Management Information Reporting The selected vendor must provide monthly paid claim summaries and detailed claim listings, preferably in Excel format or through a secure website. The vendor must also provide its standard reporting package. Ad hoc reports will periodically be requested. Enrollment, claims and premium/fee information must be accurate and supplied in a timely manner upon request. Please describe your online claim reporting and look-up capabilities that will be available to the City. Confirmed. • “No Loss/No Gain” for Covered Employees It is critical that there will be no loss of coverage for any employees. Therefore it is required that your proposal waives any “actively at work”, “dependent confinement”, or any other rules that would prevent 100% continuity of coverage for any employees or dependents that are currently covered under the plans. Confirmed. Delta Dental of Colorado Section VI — Questionnaire Responses 3 GROUP DENTAL QUESTIONNAIRE Administrative Services Only 1. Do you agree to provide without limitation services to all employees/dependents enrolled as of December 31, 2014? Yes. Agreed. 2. Will you agree to replicate each of the current plan’s provisions? If not, please list the specific provisions you will not replicate, along with the reason you elect not to replicate the provision(s). If you do not identify those specific provisions you cannot replicate and you are selected as the City’s dental services provider, you may be required to make the necessary adjustments in order to achieve replication. Otherwise, your selection may become null and void. Yes. Agreed. 3. What is your monthly administrative fee; expressed in terms of dollars per month, per employee? Delta Dental of Colorado is offering a two-year administrative fee of $4.05. 4. Include additional costs, if any, for adding a 3rd exam to the plan provisions. There is no change to the Delta Dental administration fee for this option; however, the projected impact to claim-funding rates is approximately 3.3%. This includes both the 3rd exam and adult orthodontia option requested. Please see our proposal exhibit in Section IX of this RFP response. 5. Include additional costs, if any, for adding adult orthodontia at a $1,500 lifetime coverage. There is no change to the Delta Dental Administration fee for this option; however, the projected impact to claim-funding rates is approximately 3.3%. This includes both the 3rd exam and adult orthodontia option requested. Please see our proposal exhibit in Section IX of this RFP response. 6. For each geographic area in which you have a network applicable to employee population, provide the following information: • Geo-Access, using 2 dental providers in 10 miles; provide a map if available • Most recent participating provider directory and summary of the number of participating providers in each of the applicable areas (dentists, specialists, etc.). Also provide the website where provider information can be found. Please see the enclosed geo-access report (in Section IX) and provider directory directly following this questionnaire. The most up-to-date provider information is on our website at deltadentalco.com. Subscribers can also get current provider information on our Delta Dental mobile app for Android and iPhones. 7. For each network, describe the specific measures used by your organization to monitor participating provider access. Provide the most recent corresponding statistics available for: • Dentist to member ratios No ratios have been established. Delta Dental of Colorado Section VI — Questionnaire Responses 4 • Average waiting period for an appointment We do not capture this information, but we do contact the provider if we receive a member complaint. Delta Dental does not track dentist-to-member ratios or average waiting periods for appointments. We strive to provide a network that matches or exceeds competitors. Nearly nine out of every ten Colorado dentists are part of Delta Dental’s network. 8. What percentage of your providers have limited their practice to current patients? None. 9. What is your organization’s financial rating (e.g., Best & Co., S&P)? Delta Dental of Colorado’s financial strength is demonstrated by our financial reserves, which greatly exceed the amount required by the Department of Insurance. In addition, we carry no debt. Thus, we have chosen not to be rated by these services. We are confident that our ability to continue to provide excellent products, services, and satisfaction to our many customers is not hindered by our decision to remain unrated. Our audited financial statements for the past two years are included in Section VII Financial Exhibits. 10. Please describe your credentialing procedures. Prior to being accepted as a provider by Delta Dental, dentists must complete and send in the following: • Participating Dentist Agreement Summary Disclosure Form • Substitute Form W-9 • Provider Credentialing Form: State Board of Health 6CCR 1014-4 Colorado Health Care Professional Credentials Application • A copy of Colorado Dental License • A copy of dental diploma • A copy of DEA registration • A copy of current malpractice insurance declaration page • Basic life support certification • Specialty certification, if applicable • National Provider Identifier (NPI) Official Notification Delta Dental of Colorado’s credentialing department will process documents and conduct primary source verification. Additionally, DDCO checks the Department of Regulatory Agencies (DORA), the Office of Inspector General, and the National Practioner Database for sanctions against dental license. Upon satisfactorily meeting the required criteria, a provider may join the DDCO network. Providers are recredentialed every three years. 11. What type of reimbursement/payment method is used to reimburse participating providers? Please provide a breakdown by method of review. Delta Dental uses proprietary fee schedules for our Delta Dental Premier® and Delta Dental PPOSM networks. These re4imbursement levels are developed directly from our participating dentists’ filed fees. Fees are collected for each procedure by geographic regions throughout the United States. Fee schedules are reviewed annually to ensure they keep up with current costs and changes in dental treatment patterns. Delta Dental of Colorado Section VI — Questionnaire Responses 5 12. In addition to routine reimbursement and any withholding provisions, can your providers increase the total reimbursement received from your plan, e.g., by provider incentive programs? If so, please explain. No. We currently do not offer any provider incentive programs. 13. If provider discounts are used, state the basis of the agreement. Are discounts based on provider charges or actual cost of service? Providers contractually agree to Delta Dental’s reimbursement schedules. These schedules contain the discounts providers are allowed to charge. Discounts are based on the average submitted charge. 14. Is there a formal committee that establishes quality assurance policies and reviews the results on a regular basis? Yes. 15. Do you capture all utilization data? Yes. 16. What claims experience and utilization reports are available? If there is additional cost, please specify. Delta Dental provides clients with an extensive reporting menu. Our online reporting tool is a dynamic, self-serve reporting system that allows access to reports 24 hours a day, seven days a week. Charts and reports load quickly and allow analysis and copying for use in other documents. Following are examples of reports available: • Quick Look Report (claims, enrollment, premium) • Claims Utilization Report • Network Utilization Comparison All of these are available at no additional cost. (See Section IX for our standard reporting package.) We are also able to provide custom reports to our clients upon request. 17. Describe patient satisfaction surveys that you perform. Every year, Delta Dental of Colorado contracts with an external health care research company to survey our subscriber population to determine an overall level of member satisfaction. The research company randomly selects subscribers to be surveyed each month until they achieve a sufficient sample size. There are five global satisfaction questions and one open-ended question, “What could Delta Dental do to improve your satisfaction with us?” Any changes or trends are identified with the monthly feedback we receive. A copy of the customer satisfaction survey results is included in Section IX. 18. Do you have an agreement that prohibits providers from billing or collecting from patients more than the designated coinsurance or co-payment in the plan design? Yes. 19. Please describe your method for calculating renewal rates. Delta Dental’s renewal administrative fee is calculated using group subscriber Delta Dental of Colorado Section VI — Questionnaire Responses 6 counts and the number of processed claims per subscriber. 20. Do you provide a toll-free number for employees to call with questions on claims, plan provisions or requests for dentist referrals? Delta Dental of Colorado has a toll-free number for customer service (including claims). It is 1-800-610-0201. In addition to being able to talk with a representative Monday through Friday, 8 a.m. to 6 p.m., subscribers can access information 24 hours a day, seven days a week through our automated call center or our website, deltadentalco.com. 21. Do you provide a care hotline that employees can call with questions about proper levels of care? No. 22. Will you provide a dedicated Representative for the City’s Human Resources Department with telephone and email contact information? Delta Dental of Colorado’s dedicated account representative for the City of Fort Collins will be Barb Kelty. The City will have access to her direct line and email. 23. Will you perform pre-treatment estimates? If yes, what is your average turnaround time? Yes, our providers can submit a pre-treatment estimate. Our May 2014 turn-around time for pre-estimates was approximately 98% in 15 days. 24. Please certify that you are in compliance with HIPAA privacy regulations and include a copy of your privacy statement or policy. Certified. We are in compliance with the HIPAA Privacy regulations. Our Notice of Privacy Practices is included. Signature: