FA2 Attachment T-5: DPPO Dental Providers Representations made by the Offeror in this proposal become contractual obligations that must be met during the contract term. Instructions: For the counties shown below, list the total number of participating in-network providers by specialty. Also indicate the number of providers accepting new patients, by specialty. County/ Area Category General/ Family Dentist Orthodontist Pedodontist Periodontist Oral Surgeon Endodontist Total Dental Providers Central Maryland Anne Arundel County # of providers # accepting new patients Baltimore City # of providers # accepting new patients Baltimore County # of providers # accepting new patients Carroll County # of providers # accepting new patients Harford County # of providers # accepting new patients Howard County # of providers # accepting new patients Eastern Shore Caroline County # of providers # accepting new patients Cecil County # of providers # accepting new patients Dorchester County # of providers # accepting new patients Kent County # of providers # accepting new patients Queen Anne's County # of providers # accepting new patients Somerset County # of providers # accepting new patients Talbot County # of providers # accepting new patients Wicomico County # of providers # accepting new patients Worcester County # of providers # accepting new patients Southern Maryland Calvert County # of providers # accepting new patients Charles County # of providers # accepting new patients # of providers
SQ-6 Provide the addresses, including city and state, for the subcontractor's following activities: ● Corporate/ Firm Management Office ● Customer Service Office ● Provider Service Office ● Account Management/ Client Services Office ● Technical Support Office SQ-7 Does the subcontractor have contractual relationships with third party administrators/ organizations in which the subcontractor pays service fees or other fees that you (the Offeror) are directly or indirectly charged for? If so, identify the outside organizations that receive these service fees and explain the nature of the relationship. SQ-8 What fidelity and surety insurance, general liability and errors and omissions or bond coverage does the subcontractor to protect its clients? Describe the type and amount of each coverage that would protect this plan. Please furnish a copy of all such policies for review.
the service center handling the State account. PG-3 Processing of Enrollment Eligibility Update Information Plan will process tape or electronic interchange of 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 contract auditor. Frequency of report: Quarterly 0.20% of fees for each calendar day, or portion thereof, of delay. PG-4 Accuracy of Processing Enrollment Eligibility Information Plan will process electronic interchange of 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 point, 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.
Time over which standard is measured: Quarter PG-6 Account Management Plan representatives will return all messages received from DBM (whether voice mail, email or other communication method) promptly. Messages received before 12 Noon will be replied to the same day. Messages received after 12 Noon will be replied to by 12 Noon of the following business day. Time over which standard is measured: Quarter Report Card - Vendor to maintain log for review by the State's contract auditor. Frequency of report: Quarterly 0.01% of fees for each delayed response. PG-7 Delivery of Quarterly Plan Performance Measurement Report Card to the State Delivery to the by 6:00 pm on the following dates**: Date-stamp of receipt by the State. Frequency of report: Quarterly .20% of fees for each week, or fraction thereof that Report Card is not received. First Quarter (Jan –Mar) Due: May 1st Second Quarter (Apr – Jun) Due: August 1st Third Quarter (Jul – Sep) Due: November 1st Fourth Quarter (Oct – Dec) Due: February 1st PG-8 Delivery of Quarterly Utilization and Case Management Data Reports to the State and the State's Consultant (see Attachment U-1 exhibits) Delivery to the State by 6:00 pm on the following dates**: receipt by Benefit i.e., mailing data and completeness. required fields must be filled correctly.) First Quarter (Jan – Mar) Due: May 1st Second Quarter (Apr – Jun) Due: August 1st Third Quarter (Jul – Sep) Due: November 1st
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 $500 per day for the 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 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 State. $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 draft plan document is not received for the fourth calendar day and beyond. * Determination of results and any applicable damages will be conducted by the State's contract auditor and be based on actual administrative fees included in the total premium rates. ** If due date falls on a state / vendor holiday or a weekend, Report Card and reports are due next business day. REMINDER: All "No" responses must be addressed in FA2 Attachment T-2: Explanations and Deviations.