SELF-INSURED HEALTH CLAIMS AUDITOR

Agency:	County of Clark
State:	Washington
Type of Government:	State & Local
NAICS Category:	541611 - Administrative Management and General Management Consulting Services
Posted Date:	Nov 20, 2023
Due Date:	Dec 6, 2023
Solicitation No:	RFP Number: 876
Bid Source:	Please Login to View Page
Contact information:	Please Login to View Page
Bid Documents:	Please Login to View Page

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REQUEST for PROPOSAL #876

PROFESSIONAL, TECHNICAL AND EXPERT SERVICES

Clark County Washington

RELEASE DATE: WEDNESDAY, NOVEMBER 8, 2023

DUE DATE: WEDNESDAY, DECEMBER 6, 2023 by 1:30 pm

Request for Proposal for:

SELF-INSURED HEALTH CLAIMS AUDITOR

SUBMIT:

One (1) Original

Four (4) Complete Copies

of the Proposal to:

Shipping Method of your Choice or Hand Delivery

Clark County

ATTN: Office of Purchasing

1300 Franklin Street, 6th Floor, Suite 650

Vancouver WA 98660

564-397-2323

United States Postal Service

Clark County

ATTN: Office of Purchasing

PO Box 5000

Vancouver WA 98666-5000

564-397-2323

Office Hours: 8:00 am – 3:00 pm, Monday – Friday, except Legal Holidays.

No electronic submissions.

**Proposals must be delivered to the Purchasing office – No Exceptions

**Proposals must be date and time stamped by Purchasing staff by 1:30 pm on due date.

**Proposal shall be sealed and clearly marked on the package cover with RFP #, Title & Company Name

Refer Questions to Project Manager:

Amie Johnson

Sr. HR Rep / Human Resources

Amie.Johnson@clark.wa.gov

564-397-2465

General Terms and Conditions

ADMINISTRATIVE REQUIREMENTS - Contractors shall comply with all management and

administrative requirements established by Washington Administrative Code (WAC), the

Revised Code of the State of Washington (RCW), and any subsequent amendments or

modifications, as applicable to providers licensed in the State of Washington.

ALL proposals submitted become the property of Clark County. It is understood and agreed

that the prospective Proposer claims no proprietary rights to the ideas and written materials

contained in or attached to the proposal submitted. Clark County has the right to reject or

accept proprietary information.

AUTHORSHIP - Applicants must identify any assistance provided by agencies or indivi-

duals outside the proposers own organization in preparing the proposal. No contingent

fees for such assistance will be allowed to be paid under any contract resulting from this

RFP.

CANCELLATION OF AWARD - Clark County reserves the right to immediately cancel an

award if the contractual agreement has not been entered into by both parties or if new state

regulations or policy make it necessary to change the program purpose or content,

discontinue such programs, or impose funding reductions. In those cases where

negotiation of contract activities are necessary, Clark County reserves the right to limit the

period of negotiation to sixty (60) days after which time funds may be unencumbered.

CONFIDENTIALLY - Proposer shall comply with all applicable state and federal laws

governing the confidentiality of information.

INDEPENDENT PRICE DETERMINATION - The prospective contractor guarantees that,

in connection with this proposal, the prices and/or cost data have been arrived at

independently, without consultation, communication, or agreement for the purpose of

restricting competition. This does not preclude or impede the formation of a consortium

of companies and/or agencies for purposes of engaging in jointly sponsored proposals.

INTERLOCAL AGREEMENT - Clark County has made this RFP subject to Washington

State statute RCW 39.34. Therefore, the proposer may, at the proposers option, extend

identical prices and services to other public agencies wishing to participate in this RFP.

Each public agency wishing to utilize this RFP will issue a purchase order (or contract)

binding only their agency. Each contract is between the proposer and the individual agency

with no liability to Clark County.

LIMITATION - This RFP does not commit Clark County to award a contract, to pay any

costs incurred in the preparation of a response to this RFP, or to procure or contract for

services or supplies.

LATE PROPOSALS - A proposal received after the date and time indicated above will not

be accepted. No exceptions will be made.

ORAL PRESENTATIONS - An oral presentation may be required of those prospective

contractors whose proposals are under consideration. Prospective contractors may be

informed that an oral presentation is desired and will be notified of the date, time and

location the oral presentation is to be conducted.

CONFLICT OF INTEREST - All proposals submitted must contain a statement disclosing

or denying any interest, financial or otherwise, that any employee or official of Clark County

or the appropriate Advisory Board may have in the proposing agency or proposed project.

OTHER AUDIT/MONITORING REQUIREMENTS - In addition, auditing or monitoring for

the following purposes will be conducted at the discretion of Clark County: Fund

accountability; Contract compliance; and Program performance.

CONSORTIUM OF AGENCIES - Any consortium of companies or agencies submitting a

proposal must certify that each company or agency of the consortium can meet the

requirements set forth in the RFP.

COST OF PROPOSAL & AWARD - The contract award will not be final until Clark County

and the prospective contractor have executed a contractual agreement. The contractual

agreement consists of the following parts: (a) the basic provisions and general terms and

conditions, (b) the special terms and conditions, (c) the project description and goals

(Statement of Work), and (d) the budget and payment terms. Clark County is not

responsible for any costs incurred prior to the effective date of the contract. Clark County

reserves the right to make an award without further negotiation of the proposal submitted.

Therefore, the proposal should be submitted in final form from a budgetary, technical, and

programmatic standpoint.

DISPUTES - Clark County encourages the use of informal resolution to address complaints

or disputes arising over any actions in implementing the provisions of this RFP. Written

complaints should be addressed to Clark County – Purchasing, P.O. Box 5000, Vancouver,

Washington 98666-5000.

DIVERSITY IN EMPLOYMENT AND CONTRACTING REQUIREMENTS - It is the

policy of Clark County to require equal opportunity in employment and services subject

to eligibility standards that may be required for a specific program. Clark County is an

equal opportunity employer and is committed to providing equal opportunity in

employment and in access to the provision of all county services. Clark County's Equal

Employment

Opportunity

Plan

available

http://www.clark.wa.gov/hr/documents.html. This commitment applies regardless of

race, color, religion, creed, sex, marital status, national origin, disability, age, veteran

status, on-the-job injury, or sexual orientation. Employment decisions are made without

consideration of these or any other factors that are prohibited by law. In compliance with

department of Labor Regulations implementing Section 504 of the rehabilitation Act of

1973, as amended, no qualified handicapped individual shall be discriminated against

in admission or access to any program or activity. The prospective contractor must agree

to provide equal opportunity in the administration of the contract, and its subcontracts or

other agreements.

ENVIRONMENTALLY RESPONSIBLE PURCHASING PROGRAM - Clark County has

implemented an Environmentally Responsible Purchasing Policy with a goal to reduce

negative impacts on human health and the environment. Negative environmental

impacts include, but are not limited to, greenhouse gases, air pollution emissions, water

contamination, waste from the manufacturing process and waste in packaging. This

policy also seeks to increase: 1) water and energy efficiency; 2) renewable energy

sources; 3) use of products with recycled content; 4) product durability; 5) use of

products that can be recycled, reused, or composted at the end of its life cycle. Product

criteria have been established on the Green Purchasing List

https://clark.wa.gov/sites/default/files/dept/files/general-

services/Purchasing/ERP%20Policy.pdf

PRICE WARRANT - The proposer shall warrant that the costs quoted for services in

response to the RFP are not in excess of those which would be charged any other individual

or entity for the same services performed by the prospective contractor, in a similar

socioeconomic, geographical region.

PROTESTS - Must be submitted to the Purchasing Department.

PUBLIC SAFETY - May require limiting access to public work sites, public facilities, and

public offices, sometimes without advance notice. The successful Proposer’s employees

and agents shall carry sufficient identification to show by whom they are employed and

display it upon request to security personnel. County project managers have discretion

to require the successful Proposer’s employees and agents to be escorted to and from

any public office, facility or work site if national or local security appears to require it.

ACCEPTANCE or REJECTION OF PROPOSALS - Clark County reserves the right to

accept or reject any or all proposals received as a result of this RFP, to negotiate with any

or all prospective contractors on modifications to proposals, to waive formalities, to

postpone award, or to cancel in part or in its entirety this RFP if it is in the best interest of

Clark County to do so.

SUBCONTRACTING - No activities or services included as a part of this proposal may

be subcontracted to another organization, firm, or individual without the approval of

Clark County. Such intent to subcontract shall be clearly identified in the proposal. It is

understood that the contractor is held responsible for the satisfactory accomplishment

of the service or activities included in a subcontract.

VERBAL PROPOSALS - Verbal proposals will not be considered in making the award of

any contract as a result of this RFP.

WORKERS COMPENSATION INSURANCE – The contractor shall comply with R.C.W.

Title 51- with minimum coverage limits of $500,000 for each accident, or provide

evidence that State law does not require such coverage.

FOR ALTERNATIVE FORMATS

Clark County ADA Office: V: 564-397-2322

ADA@clark.wa.gov

Request for Proposals

Table of Contents

PART I

PART II

PROPOSAL REQUIREMENTS

Section IA: General Information

1. Introduction

2. Background

3. Scope of Project

4. Project Funding

5. Timeline for Selection

6. Employment Verification

Section IB: Work Requirements

1. Required Services

2. County Performed Work

3. Deliverables and Schedule

4. Place of Performance

5. Period of Performance

6. Prevailing Wage

7. Debarred / Suspended

8. Americans with Disabilities Act (ADA) Information

9. Public Disclosure

10. Insurance/Bond

11. Plan Holders List

PROPOSAL PREPARATION AND SUBMITTAL

Section IIA: Pre-Submittal Meeting/Clarification

1. Pre-Submittal Meeting

2. Proposal Clarification

PART III

Section IIB: Proposal Submission

1. Proposals Due

2. Proposal

Section IIC: Proposal Content

1. Cover Sheet

2. Project Team

3. Management Approach

4. Respondent’s Capabilities

5. Project Approach and Understanding

6. Proposed Cost

7. Employment Verification

PROPOSAL EVALUATION & CONTRACT AWARD

Section IIIA: Proposal Review and Selection

1. Evaluation and Selection

2. Evaluation Criteria Scoring

Section IIIB: Contract Award

1. Consultant Selection

2. Contract Development

3. Award Review

4. Orientation/Kick-off Meeting

ATTACHMENTS

A: Proposal Cover Sheet

B: Letter of Interest

C: Certification Regarding Debarment, Suspension and Other Responsibility Matters Form

D. Questionnaire

E. Sample Contract

Request for Proposal #876

Self-Insured Health Claims Auditor

Part I

Proposal Requirements

Section IA

1. Introduction

General Information

Clark County is requesting proposals from auditors qualified to perform an audit of the

processing of medical/prescription and dental claims by our self-funded third-party

administrators, Regence and Delta Dental.

This RFP solicits proposals for the services of an Auditor with expertise in all areas related to

claims auditing. The Auditor must possess excellent analytical capabilities and in-depth

industry knowledge and provide expert advice.

If your company contact details are not on the Plan Holder List at

https://clark.wa.gov/internal-services/request-proposal-1

Attachment B, Letter of Interest must be submitted to participate in this RFP.

Proposers shall respond to all sections to be considered.

Clark County has made this Request for Proposal subject to Washington State statute RCW

39.34. Therefore, the proposer may, at the proposers’ option, extend identical prices and

services to other public agencies wishing to participate in this RFP. Each public agency wishing

to utilize this proposal will issue a purchase order (or contract) binding only their agency. Each

contract is between the proposer and the individual agency with no liability to Clark County.

2. Background

Clark County has two, third-party administrators that administer self-funded plans: Regence and

Delta Dental. Regence provides a PPO and an HDHP medical plan with prescription coverage.

Delta Dental provides a single dental plan.

There are about 1,700 members enrolled in these plans. For 2022, medical claims totaled

$15,837,228 and dental claims $1,174,140.

We will provide plan booklets and contracts during the audit.

3. Scope of Project

Clark County is requesting proposals from qualified vendors to provide a claims audit of the

Regence Blue Cross/Blue Shield of Oregon, medical and pharmacy claim services, and Delta

Dental of Washington, dental claim services to meet the claims management standards under

WAC 200-110-120. We anticipate the successful vendor will begin work on this project in April

2024.

4. Project Funding

Allocation of funds for this RFP will be established based on the funds requested in the selected

proposal.

Title VI Statement

Clark County, in accordance with the provisions of Title VI of the Civil Rights Act of 1964 (78

Stat. 252, 42 U.S.C. §§ 2000d to 2000d‐4) and the Regulations, hereby notifies all bidders that

it will affirmatively ensure that any contract entered into pursuant to this advertisement,

disadvantaged business enterprises will be afforded full and fair opportunity to submit bids in

response to this invitation and will not be discriminated against on the grounds of race, color, or

national origin in consideration for an award.

El Condado de Clark, de acuerdo con las disposiciones del Título VI de la Ley de Derechos

Civiles de 1964 (78 Stat. 252, 42 U.S.C. §§ 2000d a 2000d‐4) y el Reglamento, por la presente

Request for Proposal #876

Self-Insured Health Claims Auditor

notifica a todos los postores que se asegurará afirmativamente de que cualquier contrato

celebrado de conformidad con este anuncio, las empresas comerciales desfavorecidas tendrán

la oportunidad plena y justa de presentar ofertas en respuesta a esta invitación y no serán

discriminadas por motivos de raza, color u origen nacional en consideración a un laudo.

5. Timeline for

Selection

The following dates are the intended timeline:

RFP Release

Deadline for Questions and Answers

Last Date an Addendum Issued

Proposals Due

Proposal Review Period

Finalist Interviews / Demonstrations

Selection Committee Recommendation

Contract Negotiation / Implementation

Finalization / Signatures

Contract Effective Date

November 8, 2023

November 15, 2023

November 20, 2023

December 6, 2023

December 7 – 29, 2023

January 5 – 17, 2024

January 18 – 31, 2024

February 1 – March 29, 2024

April 1, 2024

6. Employment

Verification

To be considered responsive to this formal Clark County RFP, all proposers shall submit

before, include with their response or within 48 hours after submittal, a recent copy of their E-

Verify MOU or proof of pending enrollment. The awarded contractor shall be responsible to

provide Clark County with the same E-Verify enrollment documentation for each sub-

contractor ($25,000 or more) within thirty days after the sub-contractor starts work.

Contractors and sub-contractors shall provide a report(s) showing status of new employees

hired after the date of the MOU. The status report shall be directed to the county project

manager at the end of the contract, or annually, whichever comes first. E-Verify information

and enrollment is available at the Department of Homeland Security web page:

www.dhs.gov/E-Verify

How to submit the MOU in advance of the submittal date:

1. Hand deliver to 1300 Franklin St, Suite 650, Vancouver, WA 98660, or;

2. E-mail: koni.odell@clark.wa.gov or priscilla.ricci@clark.wa.gov

Note : Sole Proprietors shall submit a letter stating exempt.

Section IB

1. Required Services

Work Requirements

The selected claims auditing firm is expected to perform the following services:

1. Meet with the Clark County benefits contact, in person or by conference call, to review

the timeline and gather/understand data and discuss:

a. audit components (i.e. eligibility, no duplicate claims, coordination of benefits,

claims within the effective date, etc.)

SELF-INSURED HEALTH CLAIMS AUDITOR

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