NETWORK MANAGEMENT INFORMATION
SYSTEMS DATA OWNERSHIP
Michael A. LaFond
Patricia J. Smith
“The ELECTRONIC ELITE have taken over the world”
Current Health Care Conditions and Activities
- Buyers of Health Care Services
- Frustrated with high and growing costs
- Determined to reduce costs of providing health care services to employees - Becoming more sophisticated
- Organizing Buyer Coalitions - Sharing cost information
- Hiring knowledgeable and experienced staff
- Calling for the reorganization of health care providers to develop: - Integration and coordination of care
- Provider management staff with greater expertise and experience in managed care
- Systems that eliminate the duplication of services and generate cost efficiencies
- Requiring new reports from health care providers of: - Integration and coordination of care
- Use of practice parameters - Outcomes
- Cost of episodes of care
- Value analyses - comparisons of outcomes to costs - Health Care Reform Initiatives - New Reports Required - Federal - Health Security Act
- Requirement for Performance Reports - § 5005
- Each prospective Alliance to compile annual performance reports that outline the performance of each health plan
- Reports shall be of performance measured against national measures of quality performance
- Reports shall include results of consumer surveys
- National Measurements of Quality Performance - § 5003b - Access to health care services by consumers
- Appropriateness of health care services provided - Outcomes of health care services and procedures - Health promotion
- Prevention of diseases, disorders and other health care conditions - Consumer satisfaction with care
- States - MinnesotaCare reporting requirements, perhaps, are representative
- Total number of patients served
- Sites at which physician services provided - Number of employees, by type, by provider
- Services for which no payment is received and the cost of such services - Total revenues by types of payers
- Revenues from research activities, education activities and donations - Outcomes
- Consumer satisfaction - Provider and Insurer Initiatives - Medical Groups Reorganizing
- Merging into larger, single specialty groups
- Joining and contracting with single-specialty and multi-specialty networks - Contracting with physician-hospital organizations
- Selling assets to hospitals and health plans - Hospitals
- Merging to form multi-hospital systems - Acquiring medical practice groups
- Organizing physician-hospital organizations - Joining physician-hospital joint ventures
- Developing and operating Management Services Organizations - Joint venturing and merging with health plans
- Developing new management information systems - Health Plans
- Down-sizing physician provider numbers
- Acquiring and joint venturing with medical practice groups and networks - Joint venturing and merging with hospitals
- Developing new management information systems for their own use and for use by others
Joint Venture Networks - Structures and Operations - Distinguish from single owner, full integrated delivery systems - Integrated Medical Group Network
- Should identify by structure and health care delivery systems - Structures and operations will vary substantially
- Business plan is the key element, should be developed first before structure determined and should identify the integrated and coordinated health care services to be provided
- Common ownership of bricks and mortar and equipment does not necessarily enhance the integration and coordination of care, enhance quality of care or improve access for patients
- Structure and operations of Integrated Medical Group Network are not necessarily, or generally, the same as those of “Independent Practice Associations”
- Structure and operations not necessarily designed to be temporary transition to full integration
- Maintenance of geographic dispersion and “patient friendly” setting are as important as the development of physical proximity to enhance the management of services delivery
- Structure
- Professional corporation - Business Corporation - Partnership
- Limited liability company - Operations
- Quality Assurance
- Utilization review/management - Management Information Systems
- Link electronically the Integrated Medical Group Network and participating medical practice groups through existing personal computers
- Provide patient eligibility and benefits information - Pay claims, manage capitation
- Provide shared electronic medical record - permit utilization of practice parameters - Track outcomes
- Provide value analyses comparing outcomes and costs - Permit the elimination of redundant services
- Physical-Hospital Joint Venture - Business Plan is key
- Market analysis
- Business goals and objectives - Joint marketing program
- Management information systems
- Quality assurance and utilization review/management - Governance
- Corporate/partnership and operating structures - Budget, financial projections, financing - Management Information Systems
- Link electronically participating medical practice groups and networks, participating hospital(s) and participating sub-acute care facilities - Provide patient eligibility and benefits information
- Pay claims, manage capitation
- Provide electronic medical record for outpatient and inpatient use - Permit utilization of practice parameters
- Track outcomes
- Provide value analyses comparing outcomes and costs - Permit the elimination of redundant services
- Structure
- Business corporation - Limited liability company - Partnership
- Management Services Organization - Business Plan is key
- Scope of services to be provided
- Scope of clinic asset purchases and ownership - Capitalization required
- Nature and extent of equity ownership
- Other provisions as outlined for Physician-Hospital Joint Venture Business Plans
- Management Information Systems
- Link electronically participating medical practice groups, Management Services Organization and other providers coordinating and integrating care with the medical practice groups
- Provide patient eligibility and benefits information - Pay claims, manage capitation
- Provide electronic medical record for outpatient and inpatient use - Permit utilization of practice parameters
- Track outcomes
- Provide value analysis comparing outcomes and costs - Permit elimination of redundant services
Network Agreements - Interests and Concerns of the Participants - Prospective Federal Regulation - Health Security Act
- National Health Board to regulate the collection and dissemination of health care information and to propose to the President and the Congress a program for privacy protection of individually identifiable health information
- Standards established by the National Health Board shall supersede and preempt any contrary provision of state law, except as otherwise determined by the Board in certain limited circumstances
- Standards shall apply to all individually identifiable health information and shall incorporate the following principles
- Disclosure - Permitted only
- by authorization in writing of the Patient
- by other permitted persons in designated and authorized circumstances - Minimal Disclosure - limited to the minimum information required for
the valid disclosure purposes
- Risk Adjustment - information cannot be used by health plans for risk adjustment purposes
- Required Safeguards - administrative, technical and physical - Patient's Right to Know - who maintains or uses identifiable health
information and purposes for which such information is used or maintained
- Patient's Right to Access - to see information - to copy information
- to have notations made of patient's request for amendments and corrections
- Patient's Right to Notice
- of the purposes for which individually identifiable health information is to be used or disclosed
- of the right to access the health information identified above - No use for employment decisions of individually identifiable health
information
- National Health Board to develop standard forms for enrollment, patient encounters and claims submission and payment
- Patient Consent/Authorization Form
- Must be prepared in writing and a copy should be provided to the patient - Must contain sufficient and specific information and explanation to permit and
facilitate knowing consent and authorization by the patient - Should provide for
- use of individually identifiable health information
- by network and other providers appropriately engaged or consulted in connection with patient care
- in internal and required external quality assurance and utilization/review management programs
- electronic storage and transmission of individually identifiable health information
- extraction of health data and information and use of non-individually identifiable health information in network database, analyses, reports and presentations
- notices and information to patient required by applicable laws - Medical Services Provider Agreement - Provisions
- Medical Groups and Physicians shall
- participate in and comply with network administrative programs, including programs for utilization of standardized forms
- contribute all relevant patient information to and agree to utilize shared paper and electronic medical records
- participate in and comply with the requirements of the network's programs for management information systems and quality assurance and utilization review/management
- cooperate and participate in the development by the network of periodic internal and external reports and presentations
- Network shall - Provide access to
- shared medical records
- physician, medical group and network utilization data and information - network analyses, studies and reports
- network financial information, including information of capitation allocations and risk pool balances
- Develop and maintain
- network administrative programs, including standardized forms - quality assurance and utilization review/management programs - management information systems
- compile and submit required reports to governmental agencies and buyers of health care services
- audit and correct, as appropriate and on behalf of participating medical practice groups. Report Card information to be published governmental agencies or other parties
- grant to withdrawing medical practice groups, for a designated period of time, access to shared medical record information, utilization data and information and network analyses, studies and reports
- refrain from publishing outside the network data and information concerning specific medical group or physician performance except as required appropriately by regulatory agencies or authorized agreements between the network and buyers of health care services
- Administrative Services Agreement - Basic service bureau agreement
- Reduces start-up capital requirements and facilitates use of vendor credit - Provisions for term and termination are important to vendor
- Provisions for ownership and control of data and information and provisions for transition to another system upon termination are important to the customer - Physician-Hospital Marketing Joint Venture Agreements
- Distinguish from hospital owned and controlled Physician-Hospital Organization documents and agreements
- Agreements can be presented in forms of
- Business corporation articles of incorporation, bylaws and shareholder agreements
- Joint venture agreement - Key provisions
- Identification and definition of the purposes for the joint venture - Development of the Business Plan
- Market analysis
- Functions and scope of joint venture activities
- Review of proposed functions against regulatory requirements and restrictions
- Capital requirements and funding - Management and governance
- Disposition of assets upon dissolution Conclusions
- Licensed physicians are basic provider units
- Must coordinate and integrate care of physicians and allied health professionals - Must coordinate and integrate outpatient and inpatient services
- Must establish and reestablish balance of economic incentives and risks to assure - provision of appropriate care to patients
- elimination of redundant services
- development of cost efficiencies in providing appropriate care - Information systems
- provide new capabilities to develop and implement shared electronic medical records, manage care, identify and report outcomes, determine the costs for episodes of care and prepare value analyses
- generate substantial capital requirements and operating costs
- Data information generated by the management information systems - will be required in real time to facilitate diagnostic and treatment
decision-making
- with standardization of data elements will create new opportunities and abilities to compare quality and cost effectiveness of the services rendered and the providers rendering the services
- will become extremely valuable to those who own the data and have access to the data and rights to review, audit, analyze, present and report the data and information
- New and substantially different relationships are being developed among providers and other participants in the health care industry
- Reasonable and adequate provisions must be made for the different and conflicting interests of the patients, payers and providers
INTEGRATED MEDICAL GROUP NETWORK
Request for Information/ProposalsI. Overview
Introduction
HealthCare Network (the “Network”) has been organized as an Integrated Medical Group Network. Integrated Medical Group Networks are collections of medical group practices, professionally and economically integrated, that are geographically dispersed/ They are designed and structured to implement business plans of the affiliated medical groups, to continue the private practice of medicine and to present new medical service delivery products that are competitive and responsive to the changing requirements and opportunities of the marketplace.
The Network will allow participating medical practice groups to gain the advantages of streamlined administration, enhanced care management,
utilization, risk and quality improvement techniques that have become standard for managed care.
The physicians who own and operate the Network will develop protocols for the coordination of medical services, quality management programs, medical outcomes management information systems and other programs and systems to enhance the delivery of medical services. The medical practice groups
affiliated with the Network will share economic risk and reward and will negotiate jointly for the provision of medical services, but they will remain discreet participants in the Network and will retain substantial discretion and control over their daily clinic operations.
Operational Phases
There will be three distinct operational phases for the Network, each characterized by the unique features required for the respective stages of business development.
Phase I :
Initially, the Network will organize the full complement of providers needed to manage effectively all the care needed by its patients. This organized group of physicians and ancillary providers will be structured to manage effectively the risk of capitation-based enrollees and fee-for-service-based managed care contracts. The Business Management systems required for Phase I include the following:
• Centralized eligibility verification
• Member identification and primary care designation • Centralized claims adjudication ability
• Effective financial management ability among participating medical practice groups, the central office of the Network and contracted managed care plans
• Referral authorization tracking and review
• Electronic data transfer for these services between the administrative offices of the Network and each member clinic
• Effective credentials verification and updating process
• Implemented, uniform service standards for all participating medical practice groups, including but not limited to:
- After-hour call standards - Phone answering standards
- Appointment availability standards for different types of services - Appointment waiting time standards
- Medical record charting standards
A patient recall system to implement preventative health screening standards for all participating medical practice groups for key services including: - Immunization standards
- Health screening standards (mammograms, colon, etc.)
Phase II :
The second phase will include significant automation of key care management features. Up to this point the Network will meet the community standards in the use of clinic-based preventative health screening standards in a written forms as identified in Phase I. However, with Phase II, the Network intends to introduce the use of clinical protocols for selected diagnostic categories. Effective implementation of such protocols will include the implementation of an automated medical record.
It is anticipated that Phase II will begin approximately one year from the date the Network begins providing care to enrolled members. The planning for this phase has already begun in that the Network is seeking, through this Request for Information/Proposal, to establish relationships with vendor(s) to meet this requirement for the automation of critical care management features.
Phase III :
In Phase I and II, the Network will provide health care services and the necessary administrative and management support for only a portion of the patient population of participating medical practice groups. In Phase III, however, more complete integration is contemplated, and the network plans to administer and manage full range of commercial, public and managed care patients of participating medical practice groups.
Network Characteristics
The Network will include a primary care physician complement of at least ___________physicianscapable of serving as care managers or “gatekeepers.” These physicians will be specialistsin family medicine, pediatrics, general internal medicine and general OB/GYN. Eachphysician will practice in a group setting or possess the backup necessary for the 24-hour callcoverage required by managed care plans. All primary care physicians in the Network willbe committed to the delivery of well-managed health care services for his/her enrolledmembers.
These ___________primary care physicians will practice in at least ___________distinct geographic locationsproviding appropriate member choice for health plans. The Network will also includebetween
___________and ___________referral specialists, who, like their primary care physician counterparts,are committed to working effectively within a managed care environment.
The office of all affiliated physicians of the Network are to be linked by computer with the central administrative office of the Network, allowing for immediate verification of patient eligibility for service under various managed
care organizations with which the Network has contracts. This electronic link will permit referral tracking and the transfer of pertinent clinical information as patients are referred from one provider to another or from one facility to another.
II. Products and Services
The Network intends to integrate physicians now practicing in small groups into a multi-specialty group practice capable of negotiating and managing risk contracts with managed care organizations, enhancing the management and functioning of affiliated practices and utilizing data and other tools to seek improvements in health care service delivery and outcomes.
In contrast to outright merger of medical practices, affiliated physicians of the Network will remain employed by their existing professional corporations or other practice entities. However, by jointly owning and participating in the Network, these physicians will b able to secure many of the same advantages enjoyed by their colleagues in a larger, fully integrated multi-specialty group practices.
Physicians of the Network will have access to top-quality administrative support, will be able to purchaser goods and services on a cost-effective basis and will be able to coordinate closely in planning, delivering and assessing the care rendered to patients.
Set forth below is a brief description of the products and services of the Network:
Business Management Services:
Phase I operations will be designed to enhance the management and functioning of participating practices.
Marketing :
The Network intends to market aggressively the services of its participating medical practice groups to various managed care plans. Such participating medical practice groups, organized and operating as the Network, will be better positioned to participate in Integrated Services Networks and other integrated delivery systems.
Contract/Partnership Negotiation :
The Network will negotiate key purchaser contracts.
Credentialing :
The Network will undertake to credential physicians. This credentialing process will meet the requirements of even the most rigorous process used by a managed care plan in this market. The Network will also conduct a
recredentialing process that meets all current requirements including NCQA standards.
Implementation and Monitoring of Administrative Performance Standards :
Most managed care plans and buyers have begun to demand that providers set forth certain performance standards and report on their success in meeting such standards. The Network intends to identify standards in key areas and provide a“scorecard” for measuring performance against those standards. Some areas include phone answering requirements (how many rings), appointment
availability by type of visit, clinic waiting times, claim filing and referral filing requirements and after-hour call standards.
Communications/Networking :
All medical groups will be linked to the central office of the network via computers linked by telecommunication lines and modems. The Network intends to implement gradually a paperless system of communicating all information including eligibility query, claims filing, referral filing, scheduling, message/memos (i.e. E-mail) and reporting back to clinics on their utilization and financial performance.
Centralized Eligibility Query :
Through the electronic link between member clinics and the Network, clinic staff will have the ability to verify insurance eligibility for all members of the Network through the central eligibility database.
Centralized Preauthorization and Referrals :
The Network will consolidate information from the various managed care organizations with whom it does business and communicate new requirements to participating medical practice groups. In most instances, the staff of the Network, working with member physicians, will complete the preauthorization process, eliminating duplicative services by each managed care plan. The Network will manage the referral authorization process for its participating medical groups and forward authorizations to the appropriate managed care plan/payor.
Centralized Claim Filing and Adjudication :
Again, through the electronic link, the Network will receive HCFA 1500 forms from participating medical practice groups, screen them for accuracy and adherence to filing standards and forward them to the appropriate insurer.
Care Management Services
The critical elements of the vision of the Network are the care management services and the ability to seek improvements in health care service delivery and outcomes. The Network intends to complete implementation of Phase I business operations in the first year and initiate detailed planning of critical care management services for implementation in Year 2.
Standardized Medical Record Charting :
The Network will assist participating medical practice groups in implementing a standardized medical record charting process during Phase I operations. Guidelines will be developed by the Network to assist clinics in meeting all current standards of documentation. The system of charting that is developed during Phase I will also lay groundwork for implementing automated patient records in Phase II operations.
Quality Improvement/Outcome Management :
measuring, monitoring and continuously improving the quality of health care provided. Closely aligned with the management information system selected, will be an array of programs, policies and practices developed in Phase II. Such programs and practices will be utilized by physicians of the Network for the purpose of maintaining the delicate balance between quality of care, cost of care and administrative efficiencies.
Preventive Health Screening :
The Network will develop guidelines for preventive health screening, including a patient recall system to prevent illness and to better manage the health of the enrolled population.
Practice Guidelines :
The Network will develop practice parameters or adopt existing practice parameters to serve as decision support tools for reviewing diagnosis, treatment and resource selection for most episodes of care. The guidelines will provide consistent criteria and practice parameters against which quality of care and related costs can be measured.
Utilization Review :
In an effort to manage effectively the delivery of health care services,
utilization review standards and reports will be developed. Such standards and reports will enable the Network to monitor its performance across a variety of measures (days/1000, admissions/1000, prescription rates, visits/1000, services/visit, cost per visit, etc.) for all patients.
Risk Management :
The Network will undertake to offer risk management services to assist physicians to manage better the medical risk component of their practices. These services may include purchasing combined risk insurance, establishing guidelines for proper risk management activities, including incident reporting, record keeping, early identification of critical cased and other preventive risk management techniques.
Reporting and Performance Monitoring :
The Network intends to use a relational database to support its risk management program and to report its performance against financial,
utilization, administrative and care management standards to its participating medical group practices, contracting managed care plans and buyers.
III. Marketing Strategy
The Network will function as a large multi-specialty group practice. This large network practice of primary care and referral specialist physicians will be offered to a variety of potential partners, including HMOs, PPOs, ISNs, buyer coalitions and self-insured employers. Participating medical group practices will agree to be available for all offerings of the Network. While this does not mean that physicians will be required to participate exclusively in the Network, it does mean that the Network will be able to market an identifiable, committed group of providers for all health plan offerings.
principal, strategic alliances with aggressive, innovative managed care organizations. Such alliances will be win-win-win for both parties and the patients they serve.
In response to particular market needs, the Network may joint venture with other physician networks, as permissible. The networks might together for joint marketing, administration and the provision of health care services.
IV. General proposal Requirements
The Network desires to establish long term, mutually beneficial partnership(s) with one or more vendors who are able to meet or agree to meet the following general requirements
- - Provide highly creative administrative and software solutions in order to minimize start-up costs of the Network and to get the Network operational as soon as possible.
- Provide both “systems only” and “systems plus administrative support services: proposals (vendors may respond only to the RFI requirements section(s) that represent their particular area of expertise, but they would have to describe how their system could be interfaced with other systems).
- Suggest new approaches to coordinate resources, such as joint vendor proposals.
- Request minimal initial capital investment in licensing or development costs.
- Confirm that system specifications/intelligence may be owned by the vendor, but clinical, administrative and financial data shall be owned by the Network.
- Provide plan and estimated costs for transition from vendor supported systems and possible administration (purchased admin. service) to in-house systems management and administration in the event the Network determined to secure and operate systems directly.
- Confirm that vendor's system is able to interface with existing business office systems currently in use in each participating medical practice group of the Network.
- Confirm that vendor is able to incorporate the fee schedule(s) and other provider payment arrangements of the Network.
The Network expects that it will have to integrate the services of two or more specialized vendors in order to accomplish its business and care management objectives.
V. Business Management System Requirements
Vendors must fully describe their existing capabilities to deliver the following systems:
- Groups and Benefits.
• Adaptable software to handle flexible benefits programs and address the unique needs of various health plans and employer groups.
Eligibility Verification
member databases electronically. Provider Network Database
• On-line tracking for physician credentialing and recredentialing as part of Phase II.
Claims Processing
• Electronic papers processing for in-network claims • Out-of-network repricing and claims
• Coordination of benefits
• Purchased services for claim adjudication
• Vendor must be able to accept claim data electronically from third party claim payers, e.g. out-of-network claims
Physician/Practice Reimbursement
• Resource Based Relative Value System - Fee for Service • Capitation
Member Service Tracking and Reporting Financial Management
• Comprehensive reports of results by practice and network. Operational Performance Standards Reporting
• Examples: claim target guarantees claim processing accuracy, turnaround hospital readmission rates, telephone access, appointment availability, wait times
• On-line capability in each office
• Electronic Mail
• Word Processing
• Appointment Scheduling for Referrals in Phase II • Work station capability for ad hoc report generation • Using relational database that permits easy report creation
VI. Care Management System
- Phase I
• Referral and in-patient tracking
• Comprehensive utilization reports • Physician practice pattern/referral analysis
• Recall system to manage preventive health screening protocols and to generate reports of results against standards
Phase II
• Case management process to focus on medical appropriateness in accordance with practice guidelines.
• Automated medical record and sharing of key clinical information between offices.
• Physician accountability measures, including monitoring quality outcome indicators based upon compliance with established clinical practice
parameters/protocols.
• On-line interactive treatment protocols and clinical information for physician access.
VII. Network Communications
The Network seeks to establish electronic communication system linking all affiliated medical practice groups of the Network. Describe how you would establish this on-line capability in each physician office. On-line
communication is essential to the success of the Network and must include eligibility look-up, encounter and referral entry in Phase I . Vendors must identify communication equipment needed and its cost. Assume that communication link in Phase I is between affiliated offices and the central administrative office of the Network. Phase II will include communication linkages among all affiliated offices and the central office of the Network.
VIII. Administrative Services Support
Vendors who offer administrative support services in addition to systems software/hardware should respond. The Network is interested in creative use of purchase administrative services as a way of minimizing investment in
administrative staff in the early stages of operations. Vendors responding to this section should also be prepared to describe how services could be transitioned to the Network in the event a decision was made to do so. - Describe capabilities
• Will you need to add staff to take on the Network business? If so, how many. Will the Network be able to participate in the selection process?
What pricing methodology will you use for these services? The Network is interested in transaction or per member per month based pricing in order to budget its administrative costs.
IX. Systems Hardware
- Describe hardware requirements, including network communications equipment needed for linking each office with the central office of the Network.
- Looking for creative solutions to minimize investment in costly hardware during the early stages of development of the Network.
- Describe the technology that drives the vendor system. How does vendor perform during the maintenance and backup?
- Provide a detailed description of the costs for the proposed system.
X. Data Security
- Describe technology and procedures to provide general business security.
- Describe how your system would protect clinical patient information, particularly in Phase II.
- Describe implementation team. Who will lead the team? - Present a detailed schedule of installation.
- Describe how all system users, including physicians and administrative staff in each office, will be trained.
- Address the interest of the Network in being operational by —, 19— and provide creative solutions for this challenge.
XII. References and Qualifications
- Provide names of at least three clients who will permit observation of your system in operation.
- Describe your general experience, qualifications and general approach including, without limitation, the following:
- Current or past performance on similar projects, - Facilities available for this project,
- Depth and variety of personnel skills, and - Technology
- Demonstrate that you have the financial, administrative and managerial resources to meet your obligations to the Network over the long term. Public companies must be prepared to provide such financial and other information as the Network may require to verify their financial condition and general
stability.
XIII. Proposal Process and Schedule
Schedule
Deliver Request for Information to all potential vendors
Information/Discussion meetings with vendors Notice of intent to propose to the Network by ___________
Final Request for Information sent to vendors indicating intent to propose Proposals due
Vendor filed narrowed for site visits Finalist meetings/site visits
Vendor(s) selected and agreements negotiated
Systems development, installation, testing and training
Proposal Process
Questions: Vendors may seek clarification to the material presented in this Request for Information draft at any time up to ___________by contacting the Network in writing at the address given below:
The Network
______________________ ______________________
ATTN: Request for Information Questions
for Information.
Written Material Prevails : Once the final Request for Proposal has been issued on ___________, only written communications signed by an authorized person will be binding on the Network. Any oral communication or
representation not confirmed in writing shall not be binding on the Network. In the event of any difference between any oral discussion between the Network and vendor, or any oral comments made by people connected with the Network with respect to this Request for Information, and any written communication covering the same topic, the written communication shall control.
Letter of Intent : to assist in planning the evaluation process, vendors are requested to submit a non-binding Letter of Intent to propose on or before ___________. Such Letter of Intent will not bind the vendor to submit a proposal, and proposals may be submitted without a Letter of Intent. Information/Proposal Delivery and Due Date : Information/Proposals, including all supporting materials must be submitted on or before 1:00 Noon, Central Daylight time, ___________, 19___________, to the following address The Network
______________________ ______________________
and must be clearly marked “Proposal for Data Systems.”
Late proposals, including proposals in transit, on the due date, will not be accepted.
Proposal Format and Copies
Copies: Ten (10) copies of the Information/Proposal and all supporting materials must be submitted.
Binding: All copies of the proposal, including all supporting material must be bound. Three ring binders are acceptable. The Network will not be responsible for loss of, or for not considering, any unbound material submitted.
Page Numbering: All pages in the proposal must be numbered.
Cover Letter .
Information/Proposals must be submitted under cover of a letter which is signed by a person or persons authorized to bind the vendor to terms and conditions of the proposal and states that the proposal is binding on the vendor for 120 after the date of submission.
Evaluation
The evaluation process will have three main steps leading to the final contract award:
Initial review and ranking: Except to provide clarification and verification of specific items as may be thought necessary by the evaluators of the Network, this review will be based solely on the written proposals received.
Finalists meeting/site visits: Site visits will be conducted with vendors selected as finalists . This meeting will be considered as an elaboration of the proposal to further assist the Network in evaluating and ranking the proposals.
selected for contract award to agree upon mutually acceptable contracts. ATTACHMENTS
Services to be Provided by Vendor 3.1 Referral and Utilization Services 3.1
Buyer/Enrollee Data Recording and Access Services 3.1 Repricing, Encounter and Claims Payment Services 3.1 Fiscal Services 3.1
Financial Services 3.1
Report Preparation Services 3.1
Data Systems and Processing Services 3.1 Buyer Agreements 3.2
Provider Agreements 3.3
PEPM (Per Enrollee Per Month) Rate 3.4 Performance Standards 3.4
Interactive Data Services 4.1
Research and Development Projects 4.3 Aggregate Enrollee Months 9.4
