B. QUESTIONS AND ANSWERS

B. QUESTIONS AND ANSWERS
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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