Q1. Is there a document imaging solution available or will the vendor need staff to travel to procure documents?
A1. No paper documents are used; all billing information is extracted from our Laboratory Information Management System (LIMS) in digital format. Claims will be submitted electronically to the vendor in X12 5010 837 format.
Q2. Are there opportunities to data share with other facilities? Is any data sharing established currently?
A2. There is some possibility of data sharing, however no strong sources exist. None.
Q3. Is there a vendor currently providing these service? A3. No.
Q4. Can DOH describe some of the existing quality and performance KPI metrics for the staff/vendor currently performing the work? (A/R Days, Denials Turnover, Zero Balance Recovery rate, etc.)
A4. There were no such metrics employed in our previous contracts, telephone and onsite conferences were used report/resolve issues and discuss vendor performance.
Q5. How will the prospective vendor receive correspondence?
A5. All contract related correspondence (correspondence, not process data) will be in writing, via secure and traceable mail/package delivery services. General operational procedure discussions, etc. may be made via email and/or telephone conversations.
Claim submission and ERA files will be sent to/received from the vendors’ secure FTP server.
Q6. Are there specific requirements for post back files for ERA’s, insurance updates, billing or account notations?
A6. ERAs are required to be made in a machine readable X12 5010 835 format. Other files can be in a mutually agreed upon digital format. Q7. Is there a geographic preference of where the services should be
delivered? A7. No.
Q8. What is the tentative time to begin the transition? Duration of transition? Tentative go live?
A8. There is no specific time-table for these stages, other than as soon as is practical. DOH is prepared to begin immediately upon award of a contract.
Q9. DOH would like the vendor to take on LB fees. What are the existing costs and services provided?
A9. The fee varies depending on account activity, averaging $620/month. Services include lockbox service such as image web maintenance, image document processing, CD-ROM of documents, ACH services and CPO online subscription.
Q10. What is the anticipated volume (count and open balance) of accounts and AR under each financial class category?
A10. We do not know the actual amount the previous vendor submitted to insurers.
Q11. Are there any planned Exclusions other than patient billing? A11. None.
Q12. What’s the average Medicaid claim charge amount and average reimbursement amount?
A12. The average per newborn charge amount is $142.20, the average payment $113.85.
Q13. Does DOH have a contract management system? Are there records of existing payment challenges such as over or under
payments? Does DOH have a list of participating insurance carriers and reimbursement rates?
A13. DOH does not have a contract management system. There are no records of existing payment challenges such as over or under payments. DOH does not maintain a list participating insurance carriers and reimbursement rates. These are all tasks undertaken by the 3rd party billing vendor—from our perspective we expect this to be a “turn-key” operation.
Q14. The vendor is expected to provide monthly ERA to DOH including denials, Is Denial Management included in the scope of this work? If so, is a detailed denial report available?
A14. Yes it expected that the vendor will provide denial management services. No such report is available.
Q15. What percentages of payments are current posted electronically? A15. 100%.
Q16. What percentage of insurance verification is currently handled electronically? What is the existing first pass rate? (% claims paid within the first 45 days of submission)?
A16. Percentage is unknown. First pass rate is unknown. he previous vendors provided “turn-key” services, as will be expected of the successful bidder for this solicitation.
Q17. How much are the bank fees charged each month for lockbox and other banking services for which the winning vendor would be responsible?
Q18. If only 20% of the 3500 claims have complete billing information, where does the information for the remaining 80% come from and is it the vendor's responsibility to track down missing information? If so, from what sources and how is the information obtained?
A18. It is the vendor’s responsibility to “track down” missing information. It is the vendor’s responsibility to determine appropriate resources for doing so.
Q19. "Other laboratory services" -- total number of such "other" services billed in 2013 and average reimbursement for such.
A19. There were no “other laboratory services”—I.e. services other than Newborn Screening”— billed under this contract in 2013. The clause exists to establish the possibility of our doing so, the anticipated volume for such other services indicates they would be a small fraction of the Newborn Screening claims.
Q20. Vendor will not be submitting any Medicaid claims -- this is being done by the Dept. of Health, correct?
A20. Known Medicaid claims will not be submitted to the selected vendor based on current processes. However, The Bureau of Public Health Laboratories is in the process of transitioning to the new Medicaid Managed Care and this could necessitate a change in the way these claims are handled.
Q21. Collections for period 7/1/13 - 12/31/13 were $1,754,728: What was the gross amount billed for this net amount?
A21. We do not know the actual amount the previous vendor submitted to insurers.
Q22. For 2012 and 2013, what was the total number of claims billed, # of claims paid, # of claims denied and written off? For same periods, what was total amount billed and total collected?
A22. Due to imprecise (not machine readable) reporting requirements in our previous contracts this information is not available.
Q23. How long did the previous vendor service this account and did they terminate the contract or did the Department of Health? What is the name of the previous vendor?
A23. Four years, six months; the maximum number of renewals had been reached, requiring a new solicitation. Public Consulting Group.
Q24. Other than missing billing information, what other problems and/or issues arose during the previous vendor's term?
A24. Reporting requirements were not well defined, in particular that a machine readable reimbursement advice be submitted; reports were received in the form of highly narrative worksheets. This prompted the specific requirement for X12 5010 835 reporting found in this ITB.
