COMMONWEALTH of VIRGINIA

COMMONWEALTH of VIRGINIA

DEPARTMENT OF MEDICAL ASSISTANCE SERVICES 600 East Broad Street, Suite 1300 Richmond, VA 23219 May 29, 2020

ADDENDUM No. 3 TO VENDORS:

Reference Request for Proposal: RFP Dated: Proposal Due Date:

RFP 2020-02 March 27, 2020 June 15, 2020

Below are updates that may delete, add, modify or clarify certain aspects of the aforementioned RFP. Please incorporate as necessary.

1. See Attachment A for changes that may delete, add, or modify certain aspects of RFP 202002.

2. See Attachment B for the Department of Medical Assistance Services' responses to questions/inquiries as submitted by potential Offerors.

A signed acknowledgment of this addendum must be received by this office, either prior to the proposal due date and hour required or attached to your proposal response. Signature on this addendum does not substitute for your signature on the original proposal document. The original proposal document must be signed.

Sincerely,

Whitney Wallace

DMAS Procurement & Contract Officer

RFP 2020-02 Addendum #3

Name of Firm: _____________________________________ Signature and Title: _________________________________ Date:____________________________________________

RFP 2020-02 Addendum #3

Attachment A

Below are updates that may delete, add, modify or clarify certain aspects of the aforementioned RFP. Please incorporate as necessary.

1. 3.17 Implementation and Project Plan- has been updated to read:

3.19 Implementation and Project Plan

2. 3.19 Implementation and Project Plan - has been updated to read: Any changes required to the Contractor's processes as identified through readiness review activities shall be made by the Contractor prior to operations. Costs associated with these changes shall be borne by the Contractor. The Contractor's inability to demonstrate, to the Department's satisfaction and as provided in this section, that Contractor is fully capable of performing all duties under this contract on a mutually agreed upon date, shall be grounds for the immediate termination of the Contract by the Department pursuant to the Department Special Terms and Conditions, Termination.

3. 3.18 System Vulnerabilities - has been updated to read: 3.20 System Vulnerabilities

4. 3.19 Appropriate Technology - has been updated to read: 3.21 Appropriate Technology

5. 3.20 Enterprise Cloud Oversight Services (ECOS) & Cloud Services- has been updated to read: 3.22 Enterprise Cloud Oversight Services (ECOS) & Cloud Services

6. 4.11.6 Chapter Eight: Required Forms- has been updated to read: 4.11.6 Chapter Six: Required Forms

RFP 2020-02 Addendum #3

Question Number

1. 2.

3.

4. 5.

Section 1.1 1.1

1.2

1.3 1.3

Attachment B Question/Comment

DMAS Response

The exception to the Prompt Payment Act is noted. Is there a new time No, a new time limit has not been defined. limit defined for prompt payment for the claims subject to this process?

As per the RFP: 'House Bill 2015 of the 2019 General Assembly session amended ? 32.1-319.1 of the Code of Virginia, which directs DMAS to conduct a pilot program to use predictive analytics to mitigate risk of improper payments to providers."

The budget is listed in the accompanying documents to the bill. The total budget will depend upon the approved level of match CMS provides for this project.

Can DMAS advise if a budget for this effort was also allocated for the solution and/or the Proof of Concept? If so, could DMAS advise what the budget is today?

The fifth bullet indicates that the solution will include notification of providers, requesting documentation, reviewing that documentation to determine if it supports the claim as billed, and communicating the result of that review (pay/deny/adjust) back to the claims processing systems. For this objective, is the State envisioning that the claims would go to the Contractor post adjudication but prior to payment for review? If so, does this apply to both FFS and Encounter claims the same? If encounter, will the MCOs pend payment until there is a response back from the Contractor?

Yes, the claims would adjudicate and then pend prior to payment for the Contractor's review. This would apply in both the managed care and fee-for-service environment.

Have encounters been validated as accurate and complete, and will Encounters are validated and DMAS data

they contain the dollars actually paid by the MCOs?

does contain dollars paid by the MCOs.

Please further define the term "claims." Is this a) a single medical A claim in this document refers to a single claim/encounter (to include from/through dates) submitted; b) a series medical claim/encounter.

RFP 2020-02 Addendum #3

Question Number

6. 7. 8. 9. 10. 11.

12.

Section 1.3 1.3

Question/Comment

DMAS Response

of claims (e.g. recurring claims); and/or c) an entire beneficiary claim history?

What does "any available managed care encounters" mean? What type of managed care data will be provided to the vendor?

It means any encounters that DMAS provides to the contractor. The managed care data will be in similar format to the fee for service claims.

Page 12 states "data on claims." Does this mean granular claim detail Granular claim detail. or aggregate managed care reporting (e.g., HCC)?

1.3

We understand the claim types included in the scope are UB and 1500. All medical services are in scope.

Are all services (i.e., inpatient acute care, rehabilitation, home health,

durable medical equipment, etc.) in scope?

1.3

What is the level of detail available on these managed care claims? Is Granular claim detail.

this aggregate summary encounter data?

2.2

What is the breakdown of claim types (bill type ? i.e., 11x, 13x, 83x) This data is not currently available for the

within each volume of fee-for-service (FFS) and managed care claim volumes listed in the contract.

encounter volumes provided?

2.2

Current FFS and Managed Care Breakdown states "Currently, DMAS No provider type exclusions and the only

processes an average of about 1.6 million FFS claims and 2.7 million claim type exclusions were capitation

encounters per month." Are all claims and service types included in payments,

management

fees,

this process? Are there any exclusions based on provider types or claim administrative fees and assessments.

types for analytics or review?

Can DMAS provide total claim volumes for the last three years by See Table 2 Below. service/provider type?

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