FA1 Attachment T-4: DHMO Provider Network Access Amendment 6 Instructions: Provide the following access information for each type of in-network provider listed in the access request (General/Family dentists, Endodontists, Oral Surgeons, Prosthodontists, Pedodontists, Periodontists, Orthodontists, and Other Specialist Dentists). Provide access two ways: 1) all employees and retirees currently enrolled in the DHMO and 2) all employees and retirees (entire census population). (Please note that the total number of employees/retirees excludes those employees/retirees located in Guam, Puerto Rico, Virgin Islands, countries other than the United States and APO addresses.) A. All employees and retirees currently enrolled in DHMO Provider Type Access Criteria Average Distance to Providers Total Number of Employees / Retirees Employees Matched Employees Not Matched Number Percent Number Percent General/ Family Dentist 2 in 8 28,640 28,613 Endodontists 2 in 10 28,640 28,613 Oral Surgeon 2 in 10 28,640 28,613 Prosthodontist 2 in 10 28,640 28,613 Pedodontist 2 in 10 28,640 28,613 Periodontist 2 in 10 28,640 28,613 Orthodontist 2 in 10 28,640 28,613 Other Specialist Dentist 2 in 10 28,640 28,613 B. All employees and retirees Provider Type Access Criteria Average Distance to Providers Total Number of Employees / Retirees Employees Matched Employees Not Matched Number Percent Number Percent General/ Family Dentist 2 in 8 119,000 119,272 Endodontists 2 in 10 119,000 119,272 Oral Surgeon 2 in 10 119,000 119,272 Prosthodontist 2 in 10 119,000 119,272 Pedodontist 2 in 10 119,000 119,272 Periodontist 2 in 10 119,000 119,272 Orthodontist 2 in 10 119,000 119,272 Other Specialist Dentist 2 in 10 119,000 119,272
FA1 Attachment T-5: DHMO 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/ Metro 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
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
● members covered under all dental plans administered or insured ● members covered under all DHMO plans administered or insured ● claim dollars paid under dental plans administered or insured in the State of Maryland ● Total claim dollars paid under DHMO plans administered or insured in the State of Maryland ● Total members covered under all dental plans administered or insured in the State of Maryland ● Total members covered under all DHMO plans administered or insured in the State of Maryland Q-7 On average, by what percentage have premiums for the DHMO plan proposed increased over the last three years? Q-8 For your proposed network for the State of Maryland, what percentage of participating providers in your proposed network were not accepting new patients during the following calendar years? Calendar Year 2011 ● General/Family dentists ● Orthodontists ● Pedodontist ● Periodontist ● Oral Surgeon ● Endodontist Calendar Year 2012 ● General/Family dentists ● Orthodontists ● Pedodontist ● Periodontist ● Oral Surgeon ● Endodontist Q-9 Can members nominate non-participating dentists? Q-10 Does your provider directory (both on-line and hardcopy) indicate the following information for each network provider? ● Handicap accessible ● Multi-lingual ● Distance from member location ● If accepting new patients ● Specialty Q-11 Are you anticipating any material changes (+/- 5%) in network size (for either general/family dentists or specialists) in the network area serving of Maryland employees and retirees during the next 12 months? NETWORK MANAGEMENT Q-12 Who conducts the provider credentialing process? Please indicate the qualifications of the person(s) or organization(s) responsible for conducting this review. Q-13 Are onsite visits conducted during the credentialing process? Q-14 How are Specialty dentists re-credentialed? How Q-15 Do you conduct provider satisfaction surveys?
PG-2 Telephone Call Abandonment Rate Measurements must be or for only the service center handling the State account. Abandonment rate of less than 3%. Time over standard is measured: Quarter Report Card and supporting data (to be submitted by the Vendor). Frequency of report: Quarterly 0.10% of fees for each percentage point, or fraction thereof, over 3%. 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 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 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 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 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.
knowledge, interact with members, and exhibit professional appearance and behavior. Time over which standard is measured: Quarter PG-6 Account Management Plan representatives will return all messages received from DBM (whether voice mail, 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 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 State 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 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 Delivery to the State by 6:00 pm on the following dates**: receipt by Benefit i.e., mailing data First Quarter (Jan – Mar) Due: May 1st
State's Consultant (see Attachment U-1 exhibits) and verification of completeness. (All required fields must be filled in correctly.) Frequency of report: Quarterly Second Quarter (Apr – Jun) Due: August 1st Third Quarter (Jul – Sep) Due: November 1st 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