Opportunity Detail

Questions and Answers

Third Party Liability Services
Document #:  JFSR1213078000


Question:   1. ODJFS will consider only vendors whose proposals demonstrate the following: Three (3) years experience performing third-party liability activities for local, state or federal operations that administer a public health program. Page 8. Section 2.2 (A) Would ODJFS consider adding vendors having demonstrated Three (3) years of experience performing TPL activities for commercial clients to meet this mandatory requirement? 2. ODJFS offers this contingency-fee contract for the identification and recovery of identified thirdparty resources, which resources do not include credit balances resulting from non-third-party liability overpayments or estate cases. Page 11. Section 2.3 (A) Will ODJFS allow contingency fee pricing for cost avoidance and recovery to put incentive on maximizing cost avoidance to incent a more proactive and prospective model? In past contracts ODJFS awarded contracts for cost avoidance why isn’t this form of TPL part of the RFP? 3. Effective December 7, 2010, ODJFS plans to implement MITS, which will replace MMIS. Page 2. Section 1.3. Will the MITS system be doing the eligibility transactions (270/272) and the billing transactions (837) Please describe the TPL improvements that the new system will feature? 4. CMS to identify Medicaid consumers eligible for Medicare coverage using the Enrollment Data Base (EDB). Page 11. Section 2.3 (C). Will the vendor have the opportunity to expand files to use Bendex, SVES or the MMA to identify Medicare or are these files exclusive to ODJFS? 5. The selected vendor must incorporate all identified legally liable third party resources into the state’s eligibility case file and third-party database. Page 12. Section 2.3 (F) Does this requirement include casualty recoveries when a legal liability has been determined such as workers compensation or auto insurance? 6. …coordinating with Medicaid funded managed care plan’s to collect paid claim information Page 13. Section 2.3 (I). Does the state require that the managed care plan perform TPL? Will the selected vendor be coming-behind the managed care plans? 7. The selected vendor must allow for a one month delayed data match recovery file run. Page 14. Section 2.3 (L). What is the purpose or rationale for the delayed data match recovery file run? 8. The selected vendor must establish a local project office to conduct casualty recovery activities ….at a location agreed to by ODJFS. Page 14. Section 2.4 (A). What is the current staffing level for casualty recovery activities and where is the office located? What were the recoveries for casualty recovery in SFY 08, 09, 10? 9. The selected vendor must invoice for services based solely upon its TPL recoveries. Page 15. Section 2.4 (B). What were the TPL recoveries for SFY 08, 09, &10? Will the new MITS system reduce the opportunity for recoveries shifting the focus to cost-avoidance? 10. Will ODJFS accept two contingency rates of payment (1) for TPL data matching and recovery activities (2) for casualty-related recoveries?

Answer:   1. No 2.(A) Vendors are to submit one contingency fee that results from third party pay-and-chase recoveries. (B) In 2008, ODJFS investigated contracting for cost avoidance services and found the resulting bids not to be cost effective. No contract was awarded. ODJFS views the data matching of Medicaid recipients to various carrier files to be part of the pay-and-chase process and thus is requiring--as part of the RFP--that the vendor supply these matches in a specified format. For example, if a vendor compares a Medicaid recipient file to Insurance company A and finds 10,000 recipients that have a Medicaid span that overlaps the insurance coverage span of Insurance company A, ODJFS expects the vendor to submit all 10,000 records to it in a file. Thus, the file ODJFS expects to receive is not just the billings to an insurance carrier for recovery but all data matches. 3. MITS implementation has been delayed and is expected to be in place in early 2011. MITS will not do 270/271 transactions at "Go Live" but will do so at a later date; MITS is also expected to handle 837 transactions to facilitate the claims adjustment process for claims submitted by the vendor for TPL recoveries. 4. ODJFS will share the MMA and EDB files only. 5. Yes 6. (A) Does the state require that the managed care plan perform TPL? Yes, but not tort. The selected vendor is expected to handle all tort recoveries as well as Rx. (B) Managed care plans must cost avoid and pay-and-chase against commercial insurance; the vendor will only be doing pay-and-chase for fee-for-service recipients. Because most Rx is not part of Managed Care, the vendor will be doing pay-and-chase for Rx claims for all Medicaid recipients. 7. ODJFS will submit paid claims once a month. For example, ODJFS will send January paid claims to the vendor in February; thus, there will be a delay in receiving the paid claims data. 8. Office is located at 350 Westerville Rd., Suite G, Westerville, Ohio 43082 Staffing: 14 people 2008 2009 2010 TOTALS $16,133,506.11 $17,486,833.81 $19,203,336.02 9. Yes, MITS will reduce recoveries. The chart below illustrates the decline in pay-and-chase due to increased cost avoidance efforts and growth in Managed Care enrollment. SFY2008 SFY2009 SFY2010 Health $40,029,698.44 $43,732,454.14 $35,192,580.98 Health-MMIS $15,285,330.46 $7,558,152.65 MCR A $20,809,586.23 $15,725,757.55 $14,756,872.80 Total $60,839,284.67 $74,743,542.15 $57,507,606.43 10. No

Date: 12/2/2010

Inquiry: 21058


Question:   1) In section 1.3 (Background) ODJFS mentions that in SFY 2009 Ohio’s Medicaid population exceeded 2 million. Is the Department able to share a break out of its recipient population terms of the following categories? a. Fee-for-service recipients b. Primary Care Case Management recipients c. Managed Care Plan recipients 2) Also, in relation to Ohio’s 2 million Medicaid population can the Department please give an approximate percentage of recipients that have: 1) Medicare and separately 2) other commercial insurance? 3) In Section 3.8 (Minority Business Enterprise) the Department strongly encourages vendors to subcontract a minimum of 15% of the total contract price with an Ohio certified MBE. Will the Department please clarify if meeting this recommendation or if failing to meet this recommendation will in any way affect the vendor’s technical score or be criteria during the final selection process? 4) Is the Department able to share the dollar amounts of third-party liability recoveries that it attributes to its incumbent vendor for each of the past three SFY years? 5) Is the Department able to share the dollar amounts of third-party liability cost-avoidance that it attributes to its incumbent vendor for each of the past three SFY years?

Answer:   1)In section 1.3 (Background) ODJFS mentions that in SFY 2009 Ohios Medicaid population exceeded 2 million. Is the Department able to share a break out of its recipient population terms of the following categories? a.Fee-for-service recipients 543,934 in 2009 b.Primary Care Case Management recipients Case management for those on waiver most recently was 72,912 (September 2010) c.Managed Care Plan recipients 1,493,487 in 2009 2)Also, in relation to Ohios 2 million Medicaid population can the Department please give an approximate percentage of recipients that have: 1) Medicare and separately 2009 dual-eligible percentage is 14.1 2) other commercial insurance? 2009 percentage was 10 3)In Section 3.8 (Minority Business Enterprise) the Department strongly encourages vendors to subcontract a minimum of 15% of the total contract price with an Ohio certified MBE. Will the Department please clarify if meeting this recommendation or if failing to meet this recommendation will in any way affect the vendors technical score or be criteria during the final selection process? Does not affect the technical score and is not part of final selection process 4)Is the Department able to share the dollar amounts of third-party liability recoveries that it attributes to its incumbent vendor for each of the past three SFY years? SFY2008SFY2009SFY2010 Health$40,029,698.44$43,732,454.14$35,192,580.98 Health-MMIS $15,285,330.46$7,558,152.65 MCR A$20,809,586.23$15,725,757.55$14,756,872.80 Tort$13,429,174.08$14,544,501.24$17,281,225.01 Total$74,268,458.75$89,288,043.39$74,788,831.44 5)Is the Department able to share the dollar amounts of third-party liability cost-avoidance that it attributes to its incumbent vendor for each of the past three SFY years? Zero

Date: 12/2/2010

Inquiry: 21064


Question:   Is there an incumbent vendor for this procurement?

Answer:   Yes, HMS. Inc. is the current vendor.

Date: 12/1/2010

Inquiry: 21071


Question:   1. Section 2.4.D, Specification of Deliverables,Page 15. Under the current contract, a match is considered verified when a third party payment or non-eligibility denial is received. Will this same process meet the Departments requirements for the new contract period? 2. Cost Proposal Affirmation Form. On the cost proposal form, it appears that all recovery services have the same percentage rate. Since some services have a higher service delivery cost, would ODJFS consider revising the cost proposal to include separate percentage rates for each recovery function, such as: - Insurance Billing XX% - Subrogation XX%

Answer:   1. Section 2.4.D, Specification of Deliverables,Page 15. Under the current contract, a match is considered verified when a third party payment or non-eligibility denial is received. Will this same process meet the Departments requirements for the new contract period? ODJFS views the data matching of Medicaid recipients to various carrier files to be part of the pay-and-chase process and thus is requiring--as part of the RFP--that the vendor supply these matches in a specified format. For example, if a vendor compares a Medicaid recipient file to Insurance company A and finds 10,000 recipients that have a Medicaid span that overlaps the insurance coverage span of Insurance company A, ODJFS expects the vendor to submit all 10,000 records to it in a file. Thus, the file ODJFS expects to receive is not just the billings to an insurance carrier for recovery but all data matches. 2. Cost Proposal Affirmation Form. On the cost proposal form, it appears that all recovery services have the same percentage rate. Since some services have a higher service delivery cost, would ODJFS consider revising the cost proposal to include separate percentage rates for each recovery function, such as: - Insurance BillingXX% - Subrogation XX% No, ODJFS will not consider separate percentage rates.

Date: 11/30/2010

Inquiry: 21066


Question:   Regarding an answer ODJFS provided: Section 2.2.C, page 10: Regarding years of experience for key personnel, will ODJFS recognize the following Project and Office management qualifications as acceptable: 2.a. Project Manager: Project Management support from a dedicated manager with bachelors degree and a minimum of Five (5) years Ohio third-party liability, cost-avoidance and casualty experience, to be supported by a regional manager with a minimum of seven (7) years of experience in each of the specific areas of responsibility identified in this section? yes 2.b. Office Manager: Office Manager support from a dedicated on-site office manager with a bachelors degree and a minimum of Five (5) years management experience, supported by an on-site manager with over 25 years of experience in each of the specific areas of responsibility defined in this section. yes 1) Is it ODJFS intent to change the requirements? Specifically, requiring a minimum of Five (5) years Ohio third-party liability experience, and an on-site manager with over 25 years of experience in each of the specific areas of responsibility.

Answer:   ODJFS does not intend to change requirements; we are looking for rough equivalent qualifications and view the qualifications that were submitted as roughly equivalent.

Date: 11/30/2010

Inquiry: 21063


Question:   1.Section 1.1, 1.10, 2.3(C), 2.4 (D) and 2.3(F) and elsewhere refers to verifying eligibility and transferring information to Ohio systems. 1.a. Will ODJFS please clarify what it considers a verified policy? 1.b. It is our understanding that ODJFS already performs a significant amount of data matching with top PBMs and major medical carriers in the state of Ohio. Is it ODJFS’ intent that theVendor will verify ODJFS’ data match results? 2. Section 2.2.C, page 10: Regarding years of experience for key personnel, will ODJFS recognize the following Project and Office management qualifications as acceptable: 2.a. Project Manager: Project Management support from a dedicated manager with bachelors degree and a minimum of Five (5) years Ohio third-party liability, cost-avoidance and casualty experience, to be supported by a regional manager with a minimum of seven (7) years of experience in each of the specific areas of responsibility identified in this section? 2.b. Office Manager: Office Manager support from a dedicated on-site office manager with a bachelors degree and a minimum of Five (5) years management experience, supported by an on-site manager with over 25 years of experience in each of the specific areas of responsibility defined in this section. 3. Section 4.2.A, page 25: For the instructions for Tab 3, please confirm that bidders should include additional Sub-Tabs 3h through 3m under Scope of Work. In addition, should additional Sub-Tabs for the Specifications of Deliverables continue the numbering structure (e.g., Section 2.4(A) would equate to Sub-Tab 3n, 2.4(B) would be Sub-Tab 3o, etc.) or should bidders merely incorporate the Specification of Deliverables in their respective write-ups under the Scope of Work Sub-Tabs 3a through 3m? 4. Section 4.2.B.2.b, page 26: The requirement mentions "loan processing times." Will ODJFS cite how loan processing times apply to the TPL services being procured? 5. Attachment F, Phase 1, Item #2: The Proposal Acceptance Criteria cites Cost Proposals submitted "in a separate, appropriately labeled, sealed envelope." Section 4.2.B.5. (page 27), however, asks for the Cost Proposal to be included behind Tab 5 but not be sealed or submitted separately from the Technical Proposal. Will ODJFS clarify how the Cost Proposal should be submitted? 6. Attachment I, Number 4: Would the state define what is meant by "changed or shifted" in relation to where services are to be performed? 7. General. Is it acceptable for a Vendor to submit an Executive Summary with the technical proposal ?

Answer:   1.Section 1.1, 1.10, 2.3(C), 2.4 (D) and 2.3(F) and elsewhere refers to verifying eligibility and transferring information to Ohio systems. 1.a. Will ODJFS please clarify what it considers a verified policy? Policy where the person in the carrier file is the same person in the Medicaid recipient file. 1.b. It is our understanding that ODJFS already performs a significant amount of data matching with top PBMs and major medical carriers in the state of Ohio. Is it ODJFS intent that the Vendor will verify ODJFS data match results? No- vendor will be NOT be verifying any JFS matches. 2. Section 2.2.C, page 10: Regarding years of experience for key personnel, will ODJFS recognize the following Project and Office management qualifications as acceptable: 2.a. Project Manager: Project Management support from a dedicated manager with bachelors degree and a minimum of Five (5) years Ohio third-party liability, cost-avoidance and casualty experience, to be supported by a regional manager with a minimum of seven (7) years of experience in each of the specific areas of responsibility identified in this section? yes 2.b. Office Manager: Office Manager support from a dedicated on-site office manager with a bachelors degree and a minimum of Five (5) years management experience, supported by an on-site manager with over 25 years of experience in each of the specific areas of responsibility defined in this section. yes 3. Section 4.2.A, page 25: For the instructions for Tab 3, please confirm that bidders should include additional Sub-Tabs 3h through 3m under Scope of Work. In addition, should additional Sub-Tabs for the Specifications of Deliverables continue the numbering structure (e.g., Section 2.4(A) would equate to Sub-Tab 3n, 2.4(B) would be Sub-Tab 3o, etc.) or should bidders merely incorporate the Specification of Deliverables in their respective write-ups under the Scope of Work Sub-Tabs 3a through 3m? Yes the Scope of Work should be tabbed as well. 4. Section 4.2.B.2.b, page 26: The requirement mentions "loan processing times." Will ODJFS cite how loan processing times apply to the TPL services being procured? Please disregard any and all reference to Loan processing times. It was inadvertently inserted. 5. Attachment F, Phase 1, Item #2: The Proposal Acceptance Criteria cites Cost Proposals submitted "in a separate, appropriately labeled, sealed envelope." Section 4.2.B.5. (page 27), however, asks for the Cost Proposal to be included behind Tab 5 but not be sealed or submitted separately from the Technical Proposal. Will ODJFS clarify how the Cost Proposal should be submitted? The Cost Proposal needs to be submitted in a separate sealed envelope. 6. Attachment I, Number 4: Would the state define what is meant by "changed or shifted" in relation to where services are to be performed? The vendor is required to have an office in the central Ohio area. The intent is some work would be done there and some work may be done in other parts of the USA. The proposal should specify what work would be done where and if that were to change, then the State should be notified. 7. General. Is it acceptable for a Vendor to submit an Executive Summary with the technical proposal ? Yes it is acceptable

Date: 11/23/2010

Inquiry: 21042


Question:   Please email me a copy of the RFP. My company and others may be interested in bidding. thank you

Answer:   The RFP is available on the website where this question was submitted, just click "Click to View JFSR1213078000.PDF" link. It can be printed along with all the attachments.

Date: 11/19/2010

Inquiry: 21023


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Inquiry period ended:  12/6/2010 8:00:00 AM