FA3 Attachment T-2: Explanations and Deviations Representations made by the Offeror in this proposal become contractual obligations that must be met during the contract term. Instructions: All deviations from the specifications of the Request for Proposal (RFP) must be clearly defined below Explanations must be numbered to correspond to the question number and section number to which it pertains. If additional space is required, submit a separate attachment labeled “FA3 Attachment T-2b: Explanations and Deviations” using the same table format. Most importantly, keep all explanations brief. In the absence of any identified deviations, your organization will be bound to the terms of the RFP. Section # / Question # Indicate "Explanation" or "Deviation" Offeror Response Please indicate if FA3 Attachment T-2b: Explanations and Deviations is provided.
St. Mary's County # accepting new patients Washington Metro District of Columbia # of providers # accepting new patients Montgomery County # of providers # accepting new patients Prince George's County # of providers # accepting new patients Western Maryland Allegany County # of providers # accepting new patients Frederick County # of providers # accepting new patients Garrett County # of providers # accepting new patients Washington County # of providers # accepting new patients Instructions: For the states and locations shown below, list the total number of participating providers by specialty. State General Dentist Oral Surgeon Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada
the service center handling the State account. PG-3 Processing of Enrollment Eligibility Update Information Plan will process tape or electronic interchange of State enrollment information by 7:00 AM of the second business day after receipt. If tape is received after 12 noon, record will reflect it as having been received as of the next business day. Time over which standard is measured: Quarter Report Card - Vendor to maintain log and system generated reports for review by the State's contract auditor. Frequency of report: Quarterly 0.20% of fees for each calendar day, or portion thereof, of PG-4 Accuracy of Processing Enrollment Eligibility Information Plan will process electronic interchange of State enrollment with at least 98% accuracy. Time over which standard is measured: Quarter Report Card - Vendor to maintain log and system generated reports for review by the State's contract auditor. Frequency of report: Quarterly 0.20% of fees for each percentage or fraction thereof, under 98%. PG-5 Contractor attendance at State plan management meetings and State-sponsored open enrollment meetings. Attendance by plan representatives at 100% of meetings scheduled by the State, for 100% of the meeting's duration. Representative must arrive early enough to have their table set-up prior to meeting start time. Display must be organized and include appropriate covering of table. Representative must have detailed plan knowledge, interact with members, and exhibit professional appearance and behavior. Sign-in sheets at meetings or minutes of State meetings. Frequency of report: Quarterly 0.05% of fees for each scheduled meeting date that vendor fails to attend.
must be filled in correctly.) Frequency of report: Quarterly Fourth Quarter (Oct – Dec) Due: February 1st PG-9 Delivery of Rate Renewal Reports Delivery to the State and to the State's actuarial consultant of reports required for annual rate renewal process by 6:00 PM May 31st of each contract year for the next contract year. At a minimum, the renewal reports must include (but not be limited to) the following**: Date-stamp of receipt by the and completeness required Frequency of report: ● projection of incurred claim costs for renewal year ● estimate of IBNR reserves at end of current year; including the most recent 36 months of incurred/paid triangular reports ● complete documentation of the methodology and assumptions utilized to develop the projected costs ● disclosure of supporting data used in the calculations, including monthly paid claims and enrollment, large claims analysis, trend analysis, demographic analysis, etc.
● substantiation of any proposed increase in fixed costs via a thorough analysis of activities and costs covered by those fees ● explanations for any unusual trend results (high relative to the market, low relative to the market) PG-10 Provider Turnover A turnover rate of less than 5% annually will be maintained for both the general dentist and specialty network. Calculation should include all terminations regardless of reason for termination. Quarterly vendor report 3% of fees if turnover is greater than 5%, 6% of fees if greater than 7%. PG-11 Network Access Urban: 2 open locations within 8 miles = 99%. Time over which standard is measured: Quarter Quarterly vendor report 3% of fees if not met. Suburban: 2 open locations within 8 = 95%. Time over which standard is measured: Quarter Quarterly vendor report 3% of fees if not met. Rural: 2 open locations within 8 miles = 60% Time over which standard is measured: Quarter Quarterly vendor report 3% of fees if not met. PG-12 Employee Satisfaction A 90% or higher member satisfaction rate. Time over standard is measured: Annual Survey results of the State’s annual Customer Satisfaction Survey. Frequency of report: Annually 1% of fees if performance is less than standards.
PG-13 Member call resolution 85% of member calls resolved on first call. Time over which standard is measured: Quarter Quarterly vendor report including phone and customer service system reporting. 1% of fees if performance is less than the standard. PG-14 Provision of Plan Documents Evidence of Coverage for plans and Summary Plan Description for the fully-insured plans Draft Plan Document Provided to the State at least 2 months prior to the first day of the plan year. This should be an error-free (content and grammar) document. Receipt date as documented by vendor and confirmed by State. $500 per day for the first three calendar days that the draft document is not received. $1,000 per calendar day for each day the draft document is not received for the fourth calendar day and beyond. PG-15 Provision of Final Plan Documents Evidence of Coverage for plans and Summary Plan Description for the fully-insured plans Plan Document Includes all of the required edits and in the format ready for posting to State intranet. Returned to the State within 10 calendar days of the carrier’s receipt of the State’s edits. Receipt date as documented by vendor and confirmed by $500 per day for each calendar day the draft plan document is not received for the first 3 calendar days. $1,000 per day for each day the plan document is not received for the fourth calendar day and beyond. PG-16 Claims Accuracy 99% of claim dollars processed accurately. Measured by the independent auditor as part of the annual claims audit. Measured to two (2) decimal places. Measures the gross dollars paid incorrectly (overpayments plus underpayments) subtracted from total paid claim dollars, divided by total paid claim dollars within the audit sample. 2.00% of fees if between 97% - 98.99%, 4.00% of fees if less than 97%. Choose an item.