QUESTIONS AND ANSWERS CENTER FOR MEDICARE & MEDICAID SERVICES REPORTING COMPLIANCE RFP IN1150416 JUNE 20, 2011 1. What is driving this procurement? It appears that a manual process is being requested to replace a manual process. Answer: Yes, it is. If other vendors can provide a manual process with better pricing and a better manual process, then the State has to allow them to bid on the service. Most State Worker’s Compensation procured services have a five (5) year contract limit then the State must complete another Request for Proposal (RFP) process. 2. How many State Claims Staff does the State have that will be accessing the MMSEA reporting system? Answer: Currently 2 or 3 3. Typically how many Work Comp claims is the State of Wisconsin opening on an annual basis? Answer: Counting only “medical,” and “lost time,” claims for the last three (3) fiscal years the State incurred the following new claims: FY08 = 3561, FY09 = 3424, and FY10 = 3033. 4. Typically how many State of Wisconsin Comp claims are Medicare eligible on an annual basis? Answer: This is hard for the state to know since the first State CMS file was sent March 1, 2011. The State is estimating 50-100 will be Medicare eligible and 500-800 will be queried with CMS. 5. Why does the State require potential vendors to be “fully knowledgeable” of STARS 9.3, when it is a proprietary system with no publicly available information? Additionally, “…the State is not requesting the chosen contractor to electronically interface with STARS for the purpose of CMS compliance.” Answer: This is a good question. What the State means is that the vendor must be willing to understand the STARS claims system, what fields the State utilizes within the STARS system and what fields the State is capable of pulling information from for the purposes of CMS compliance. The vendor doesn’t have to have a complete and full knowledge of STARS, but be willing to become acquainted and familiar with the STARS system. 6. Who is the current contractor? Answer: CorVel 7. What is current contractor’s annual compensation? Answer: We cannot provide an annual fee, as the State transmitted the first CMS file in March 2011. We have not completed a full year of transmittal. 8. Is there a reason the state wishes to enter claims into the system manually? Would it not prefer a more automated solution? Answer: Due to budget constraints and the strong likelihood CMS mandatory criteria will change in the future, the State is opting OUT of EDI, in an effort to save time and money. The State would rather extract their own information and then manually input the information into the vendors system. 9. Section 4.1.8 sates that “the contractor shall provide hours of operation (central time) for telephone and email inquiries, but not less than 8:00 am through 5:00 pm, Monday through Friday.” Would you please provide information about current volume and/or staff currently dedicated by current contractor and the general nature of calls? Answer: Current call volume is minimal and generally occurs when the vendor and the Sate is preparing to transmit the quarterly file. Shortly before the quarterly file transition and especially if some of the claims reject from CMS, the State may need to communicate with the vendor for advice and guidance. This can be completed either via email or phone. If the State were to estimate the number of calls/e-mails per month, the State would estimate between 10 and 20, max. 10. Please describe the Worker’s Compensation claims data (e.g., where does it sit, how will contractor access, etc.?) Answer: The claims data is all stored within STARS, the State’s RMIS system. The State is able to extract claim data via adhoc reports the State has created. The State is capable of extracting any data within claim files on the RMIS system. The State would do the actual report running and would then have the capability of forwarding reports to the vendor if needed. 11. In Section 1.2.4, it appears that the state wishes to continue doing the identification of potential cases itself. However, in Section 4.1.1, the RFP states that the “contractor shall be required to implement claims identification and reporting procedures.” Please describe what the state is identifying and what the contractor is required to identify. Answer: The State currently extracts claims using the criteria set forth on the CMS website, however, the State requests guidance and reassurance from the vendor as to which claims to extract and fit the criteria. In short, the State need the vendor to be knowledgeable and confident regarding the criteria set forth by CMS.
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