Gavin Newsom
Mayor
Micki Callahan
Human Resources Director
3/20/08, Pre-Proposal Conference Questions:
1.
Will there be any user fees associated with use of the VOS portal system? a. No. There is no access fee .
2.
What is the average caseload per adjuster? a. The existing contract is not to exceed 160. CCSF adjusters have an average caseload of between 125 - 130 claims, which does not include handling Future Medical claims, because the City has dedicated Future Medical claims adjusters.
3.
How many Future Medical adjusters will the TPA need to have? a. It is up to each proposer to determine how to best craft its proposal. The
City's WCD has three (3) dedicated Future Medical Adjusters.
4.
Can the TPA's location be outside the City of San Francisco? a. Yes, our current TPA is located in Sacramento.
5.
Please provide a medical examiner definition? a. There is a medical examiner adjuster, and .5 future medical adjuster .
6.
Does the contract involve "takeover" or just new claims? a. The selected TPA shall be responsible for handling the entire pending caseload .
7.
Are all the departments covered by the TPA identified? a. Appendix B of the RFP identifies the departments currently covered.
8.
What is the average duration for a claim being open? a. The requested information is not available at this time.
9.
Who shoulders the IT responsibility for the portal? a. There are technical requirements for the system to work and it is necessary for
TPA to have the ability to meet those requirements - speed etc. If there are problems connecting or meeting those requirements, it is the responsibility of the TPA.
10.
Do the monthly, quarterly and yearly reports come out of the system?

a. Yes.
11.
When did the six month extension of the current contract begin? a. February 1, 2008. The City intends to have a new contract in effect by August
1, 2008 .
12.
What is the current examiner makeup. a. The current examiner makeup is identified in Appendix A of the Amendment of the current contract. The current contract is located at the following OCA web address: http://mission.sfgov.org/OCABidPublication/BidDetail.aspx?K=925
13.
Where are closed files stored? With the TPA? a. Closed files that the TPA is handling are stored with the TPA. We just moved our files to a new off-site file storage facility. There will be occasions where the selected TPA will need to request the files from our off-site storage facility.
14.
HRC - Mandatory vendor participation? (14b) a. The services that would normally be subbed-out, have already been contracted with the City. As such, all sub-contracting goals have been met and the sub-contracting goals were waived for this contract.
15.
Do we currently have mandatory scheduled meetings - TPA/CCSF? a. The current contract will not have any bearing upon, or relevance to, the contract to be awarded to the selected TPA. In the contract awarded to the selected TPA, the
City shall have the right to meet with TPA representatives at any time and for any reason the
City deems appropriate. Currently, there is no formal meeting schedule with the Department of Human Resources. However, there are a number of departments that have quarterly reviews, meetings and the like.
16.
Can you explain your medical management, and Bill Review? a. The City contracts with outside entities to provide medical case management and utilization review.
17.
Are we interested in receiving data transfer from other systems? Would you (WC) be interested in receiving your information from another data source? a. The City utilizes the VOS system exclusively. The selected TPA shall utilize the VOS system .
18.
Do we work from paper files, or are we paperless? a. We currently have hard files with a desire to switch to paperless. The current system supports scanned documents and reports.
19.
Can you comment on the status of EAMS? a. The City anticipates that at some point during the term of this TPA contract,
EAMS will be implemented in the State of California. The selected TPA shall be responsible for complying with any and all EAMS requirements as an express material part of its contractual obligations towards the City.
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3/17/08 email:
1. Please advise whether the Valley Oaks Systems (VOS) is accessed through the city or whether the TPA would need to lease the system separately. a. The City and County of San Francisco funds the VOS system so there would be no additional cost of ‘leasing ‘the VOS system.
2. Please advise as to how many medical only and other than medical only claims are received per month. a. Annual reports from 04/05, 05/06 and 06/07 are located at the CCSF Office of
Contracts (OCA) and Administration - Bids and Contract database: http://mission.sfgov.org/OCABidPublication/BidDetail.aspx?K=925
3/18/08 email:
Claims Information:
§ How many of the current open pending claims are Medical Only? a. 187
§ How many of the current open pending claims are Future Medical? a. 530
§ How many of the current open pending claims are Indemnity? a. 1238
§ For Fiscal Years 04/05, 05/06, 06/07 and 07/08 (YTD) please indicate how many of the new claims were indemnity vs. med only a. Annual reports from 04/05, 05/06 and 06/07 are located at the CCSF
Office of Contracts (OCA) and Administration - Bids and Contract database: http://mission.sfgov.org/OCABidPublication/BidDetail.aspx?K=925
Document Requests:
§ Can we get a copy of your page 2 of your last annual report (SIP)? a. Yes. Annual reports from 04/05, 05/06 and 06/07 are located at the
CCSF Office of Contracts (OCA) and Administration - Bids and Contract database: http://mission.sfgov.org/OCABidPublication/BidDetail.aspx?K=925
§ Can we get a copy of your 04/05 loss report, valued as of 06/30/05? a. See OCA posting at: http://mission.sfgov.org/OCABidPublication/BidDetail.aspx?K=925
§ Can we get a copy of your 05/06 loss report, valued as of 06/30/06? a. See OCA posting at: http://mission.sfgov.org/OCABidPublication/BidDetail.aspx?K=925
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§ Can we get a copy of your 06/07 loss report, valued as of 06/30/07? a. See OCA posting at: http://mission.sfgov.org/OCABidPublication/BidDetail.aspx?K=925
§ Can we get a copy of your current TPA contract? a. The current contract, including amendment and attachments, is available at the following OCA web address: http://mission.sfgov.org/OCABidPublication/BidDetail.aspx?K=925
§ Can we get a copy of your current Cost Containment contract? a. Not applicable to RFP.
Current Administrator:
§ Who is your current TPA? a. Intercare Insurance Services.
§ How many adjusters/clerical staff work on your account? a. 21. Please review the current contract at the following OCA web address: http://mission.sfgov.org/OCABidPublication/BidDetail.aspx?K=925
§ What are your current claims administration fees? a. Please review the current contract at the following OCA web address: http://mission.sfgov.org/OCABidPublication/BidDetail.aspx?K=925
§ Are the special handling requirements you have with your current administrator available for review? a. Please refer to the current contract available at the following OCA web address: http://mission.sfgov.org/OCABidPublication/BidDetail.aspx?K=925
Bill Review: a. The following questions are immaterial to this RFP because the City handles this aspect of the claims process in its entirety.
§ Who provides your bill review service?
§ What are your current bill review fees?
§ Which PPO do you access?
§ Can we get a copy of the last cost containment report which includes the last 12 months, or the calendar year of 2007, which includes:
- Number of bills processed
- Total billed
- OMFS reductions
- PPO reductions
- Recommended payment
- % of savings
- Return on Investment
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Medical Provider Network: a. The following questions are immaterial to this RFP because the City handles this aspect of the claims process in its entirety.
§ Do you use a medical provider network?
§ If yes, which MPN do you use?
§ What are your MPN administration fees, if any?
Utilization Review: a. The following questions are immaterial to this RFP because the City handles this aspect of the claims process in its entirety.
§ Who provides your UR service?
§ What are your current UR fees?
Case Management: a. The following questions are immaterial to this RFP because the City handles this aspect of the claims process in its entirety.
§ Who provides your case management service?
§ What are your current case management fees?
Misc:
§ If you have union involvement, do you currently have or are you considering an ADR program? a. Currently, there is no ADR program.
§ Do you have a relationship with particular investigation firms? a. The firms are selected through the RFP process.
§ If so, who are those firms? a. J.H. Askins, Frye, MJM, RJM, Curry Investigations and Immendorf .
§ Do you have a relationship with particular law firms? If so, who are those firms? a. The City Attorney’s office handles all of the workers’ compensation litigation.
§ What has been your greatest challenge in your workers’ compensation program in the past two years? a.
Trying to balance the demands of the City, the requirements of the
State and the pace of technological and other changes.
3/26/08 email:
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In the RFP it indicates the staffing requirement based on the number of open and new claim inventory. During the Pre-Bid Conference, Robin indicated that the Adjuster Caseload internally had changed and was now between 120-135. Can you please tell us if this means that the proposers shall offer a staffing model based on a 120-135 caseload instead of 150-160? a. 160 claims as the maximum is based on an adjuster handling indemnity files that include future medical claims. The in-house program has a set up in which the line adjusters handle only indemnity claims and very few future medical claims. Our TPA chose to follow our model of caseloads that are, with few exceptions, pure indemnity files not yet settled.
3/27/08 email:
1. Is the current TPA located in the city and/or county of San Francisco? a. No, they are located in Sacramento.
2. Do you have a preferred pricing methodology? a. No.
3. Will the new TPA be responsible for handling tail claims? a. The TPA will be responsible for the entire pending caseload.
4. Will you provide a loss run history for pricing purposes: volume, incurred and actual expenses, indemnity and med only etc.? a. Please see the annual reports located at the OCA web address: http://mission.sfgov.org/OCABidPublication/BidDetail.aspx?K=925
5. Our current Benefits Plan does not cover employees with domestic partners. This seems to be a requirement that our policies match those of the City and County of San Francisco. Would noncompliance with this provision disqualify us? a. Yes. The selected TPA shall comply with any and all applicable provisions of the San Francisco Charter, Administrative Code, RFP, and TPA contract.
6. In Section G. Errors and Omissions in Proposal, it reads “Failure by the Department to object to an error, omission, or deviation in the proposal will in no way modify the RFP or excuse the vendor from full compliance with the specifications of the RFP or any contract awarded pursuant to the RFP.” Does this mean that the Department can disregard any exceptions we take to the RFP and require that we comply with the RFP"as is?" a. In the event of conflicts, errors, omissions and/or deviations from the RFP by the selected TPA in its proposal, the selected TPA shall nevertheless fully comply with any and all parameters and/or requirements set forth in the RFP and attachments, appendices and enclosures thereto, regardless of the contents of the TPA's proposal. Moreover, in the event of conflicts, errors, omissions and/or deviations from the P-500 contract (version 11/07) by the selected TPA in its proposal, the selected TPA shall nevertheless fully comply with any and all terms of the P-500 contract, regardless of the contents of the TPA's proposal.
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7. Section I Introduction and Schedule on page 1 of the RFP states "TheWCD currently uses
Valley Oaks System (VOS) as its claims management and risk management information system.
Proposers must agree to use this system to administer the City's claims." This indicates that we
"must agree to use" the VOS system. a. The City utilizes the VOS system. The selected TPA shall utilize the VOS system. It shall be the responsibility of the selected TPA to organize and implement use of the
VOS system within its organization for all City cases.
§ Does this mean that our management of the claim throughout the claim life-cycle will be done directly in the VOS system? a. The City utilizes the VOS system. The selected TPA shall utilize the
VOS system. It shall be the responsibility of the selected TPA to organize and implement use of the VOS system within its organization for all City cases.
§ Will that mean double entry/management of data for us? a. The City utilizes the VOS system. The selected TPA shall utilize the
VOS system. It shall be the responsibility of the selected TPA to organize and implement use of the VOS system within its organization for all City cases.
§ How does this relate to the potential system /data interfaces with the VOS system? a. The City utilizes the VOS system. The selected TPA shall utilize the
VOS system. It shall be the responsibility of the selected TPA to organize and implement use of the VOS system within its organization for all City cases.
§ Can double entry and direct use of the VOS system be avoided with implementation of systems/data interfaces? a. The City utilizes the VOS system. The selected TPA shall utilize the
VOS system. It shall be the responsibility of the selected TPA to organize and implement use of the VOS system within its organization for all City cases.
8. Will we be converting data for takeover claims from the Valley Oaks
System? a. The City utilizes the VOS system. The selected TPA shall utilize the VOS system. It shall be the responsibility of the selected TPA to organize and implement use of the
VOS system within its organization for all City cases.
9. Will there be any historical (closed) claims data conversion required? a. The City utilizes the VOS system. The selected TPA shall utilize the VOS system. It shall be the responsibility of the selected TPA to organize and implement use of the
VOS system within its organization for all City cases.
10. The requirement for interfacing with VOS within the Check Writing section would imply that we will be exchanging data with VOS throughout the claim life-cycle. Is this the case? If
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so, how does this relate to the requirement that we use the VOS system directly. Can we get a better understanding of the data exchange expectation between our system and VOS? a. The City utilizes the VOS system. The selected TPA shall utilize the VOS system. It shall be the responsibility of the selected TPA to organize and implement use of the
VOS system within its organization for all City cases.
11. Are there data interfaces that will need to be established with any of the city-designated vendors? a. The City utilizes the VOS system. The selected TPA shall utilize the VOS system. It shall be the responsibility of the selected TPA to organize and implement use of the
VOS system within its organization for all City cases.
3 / 27/08 email -
T e c h n o l l o g y
1.
Will the selected TPA be responsible for any portion of the cost or operation of
Valley Oaks software, its servers, or its maintenance? a. No. However, there are technical requirements for the system to work and it is necessary for TPA to have the ability to meet those requirements - speed etc. If there are problems connecting or meeting those requirements, it is the responsibility of the TPA.
2.
Will the selected TPA be responsible for any costs of network connectivity between CCSF and their colleagues? a. Assuming that "network connectivity" refers to a TPA's access to the internet, the selected TPA shall be responsible for any such cost.
3.
Will the selected TPA be responsible for providing all technology infrastructures
(other than VOS servers and software) necessary to support proposers’ colleagues
(i.e. phone, computer workstation, etc)? a. Yes. a. The City utilizes the VOS system. The selected TPA shall utilize the VOS system. It shall be the responsibility of the selected TPA to organize and implement use of the VOS system within its organization for all City cases.
4.
What version of VOS is CCSF operating currently? Are there any plans to upgrade? If so, when? a. CCSF is currently operating VOS Version 5.0. Upgrades are, and will continue to be examined in the future.
5.
What modifications, if any, has CCSF made to its version of VOS that change functionality? a. There have been very minor changes to the existing current version.
6.
If the selected TPA’s colleagues have issues with or questions about VOS software functionality what is the protocol for escalating issues? Is the selected TPA responsible for contacting VOS independently for all/any issues related to software
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bugs? Assuming CCSF retains operational responsibility for VOS application and server. a. Yes
7.
How does CCSF handle document imaging? a. CCSF is working toward paperless processing.
8.
How is intake performed and who is responsible for that? a. New claims are processed by the administrator of record, meaning all inhouse claims are set up in-house, all TPA claims are set up with the TPA.
S t t a f f f f i i n g
9.
Is there a fee model preference? Will CCSF accept a fixed fee proposal? a. Please review RFP, Section III, C, 9 - Fee Proposal.
10.
Will CCSF accept Oakland as a claims servicing site? a. CCSF will entertain any proposal responsive to the RFP.
11.
Please provide more information about the requirement to provide staff "hourly rates" and "expenses"? Is all or a portion of the contract intended to be on a "passthrough" or cost plus fee basis? a. The City may request "pass-through" payments as necessary.
12.
The RFP indicates claim counts may change with regard to the in-house and outsourced programs. Will the selected TPA be allowed to modify its contract and fees in accordance with such change? a. Proposers shall base their proposals upon the specific information and claim counts set forth in the RFP
.
13.
Future Medical claims have a separate examiner. How many Future Medical
claims does that examiner handle? a. About 240.
14.
Is the Future Medical examiner included in the 11 examiner count, if not, how
many examiners handle Future Medical claims? a.
At the pre-bidder’s conference there was a mistake in the change of the
TPA’s staff. There are 10 examiners, 5 claims assistants .
15.
What is the process for claims administration changing from CCSF’s responsibility
to a SCMS adjuster? a. A transition plan will be developed with timelines, testing and implementation.
16.
Since it is Sedgwick CMS policy to restrict claimant name changes to a Claims
Accounting unit, can this be accommodated? a. No, only the administrator can change names in the system.
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17.
How are disputes between the selected TPA and vendor partners resolved, should a dispute arise? a. The TPA is expected to work in cooperation with CCSF in resolving all vendor partner (client) disputes.
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B a n k i i n g
18.
Please respond to the following questions concerning banking: a. The answer to following nine questions is that all banking is handled by
CCSF.
 Would CCSF be sending their EDI check file to the selected TPA with all
CCSF check or only the checks processed by our dedicated unit?
What bank account would be used?
Who would reconcile the bank account?
How are voids, stops and miscellaneous refunds handled?
How is the bank account funded?
Who requests funding for the account?
Is the account on Positive Pay and are cleared items downloaded from the bank and posted to the claim system?
If the account is on Positive Pay, how are daily exceptions handled?
Will positive pay/return interface from the check printing process be a requirement?
19.
If the selected TPA will be responsible for check writing and assuming that operation of the VOS system remains a CCSF responsibility, what resources for developing an interface for check printing are available to work with provider’s technology team?
a. All checks are printed by a contract service provider using information provided by VOS system and handled by CCSF.
20.
Can the selected TPA choose the location where the checks are printed or will they have to be printed locally? a. All checks are printed by a contract service provider using information provided by VOS system and handled by CCSF.
21.
Is CCSF processing their own DE 542 returns and mailing to the state FTB or would the selected TPA be expected to file for them? a. CCSF handles the 1099 processing. The combined State and
Federal file is sent to the IRS annually.
M i i s s c e l l l l a n e o u s s
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22.
How would vendors be controlled? Who enters/changes vendor records? a. Vendor performance is defined under the CCSF/vendor terms.
23.
Please provide a copy of your most recent Self Insurance Plans (SIP) annual report and, if possible, for the past 3 years.
a. See annual reports located at OCA web address: http://mission.sfgov.org/OCABidPublication/BidDetail.aspx?K=925
24.
How will Bill Review and Managed Care services be performed? Will the TPA provide these services for the applicable claims administered by CCSF? a. This question is immaterial to this RFP because the City handles this aspect of the claims process in its entirety.
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