200167-CONTRACT - CORVEL HEALTHCARE CORPORATIONL.DOCX
Extracted text (via pymupdf)
96429 characters
SERIAL 200167-RFP
WORKERS’ COMPENSATION BILL REVIEW, PHARMACY BENEFITS,
AND PHYSICAL THERAPY SERVICES
Contract - CorVel Healthcare Corporation
DATE OF LAST REVISION: June 24, 2020
CONTRACT END DATE: June 30, 2021
CONTRACT PERIOD THROUGH JUNE 30, 2021
TO:
All Departments
FROM:
Office of Procurement Services
SUBJECT:
Contract for WORKERS’ COMPENSATION BILL REVIEW, PHARMACY
BENEFITS, AND PHYSICAL THERAPY SERVICES
Attached to this letter is published an effective purchasing contract for products and/or services to be
supplied to Maricopa County activities as awarded by Maricopa County on June 24, 2020.
All purchases of products and/or services listed on the attached pages of this letter are to be obtained
from the vendor holding the contract. Individuals are responsible to the vendor for purchases made
outside of contracts. The contract period is indicated above.
AS/mm
Attach
Copy to:
Office of Procurement Services
Shannon Murphy, Risk Management
Kathleen Kolm Risk Management
CONTRACT WORKERS’ COMPENSATION BILL REVIEW, PHARMACY
BENEFITS, AND PHYSICAL THERAPY SERVICES 200167-RFP
This contract is entered into this 24th day of June, 2020 by and between Maricopa County (“County”), a
political subdivision of the State of Arizona, and CorVel Healthcare Corporation, a California corporation
(“Contractor”) to identify a contractor(s) to provide effective and efficient medical bill review services and
check writing for Maricopa County’s workers’ compensation program (BRCWS), and Pharmacy Benefit
Manager (PBM) to provide workers’ compensation prescription benefit management services through a
network of pharmacies.
1.0
CONTRACT TERM
1.1
This contract is for a term of one year, beginning on the 24th day of June, 2020 and ending
the 30th day of June, 2021.
2.0
OPTION TO RENEW
The County may, at its option and with the concurrence of the Contractor, renew the term of this
contract up to a maximum of five additional year(s), (or at the County’s sole discretion, extend the
contract on a month-to-month basis for a maximum of six months after expiration). The Contractor
shall be notified in writing by the Office of Procurement Services of the County’s intention to renew
the contract term at least 60 calendar days prior to the expiration of the original contract term.
3.0
CONTRACT COMPLETION
In preparation for contract completion, the Contractor shall make all reasonable efforts for an
orderly transition of its duties and responsibilities to another provider and/or to the County. This
may include, but is not limited to, preparation of a transition plan and cooperation with the County
or other providers in the transition. The transition includes the transfer of all records and other data
in the possession, custody, or control of the Contractor that are required to be provided to the
County either by the terms of this agreement or as a matter of law. The provisions of this clause
shall survive the expiration or termination of this agreement.
4.0
PRICE ADJUSTMENTS
Any requests for reasonable price adjustments must be submitted 60 calendar days prior to
contract expiration. Requests for adjustment in cost of labor and/or materials must be supported
by appropriate documentation. The reasonableness of the request will be determined by comparing
the request with the Consumer Price Index or by performing a market survey. If County agrees to
the adjusted price terms, County shall issue written approval of the change and provide an updated
version of the contract. The new change shall not be in effect until the date stipulated on the
updated version of the contract.
SERIAL 200167-RFP
5.0
PAYMENTS
5.1
As consideration for performance of the duties described herein, County shall pay
Contractor the sum(s) stated in Exhibit A – Vendor Information and Pricing.
5.2
Payment shall be made upon the County’s receipt of a properly completed invoice.
5.3
INVOICES
5.3.1
The BRCWS Contractor shall submit one legible copy of their detailed invoice
before payment(s) will be made. Incomplete invoices will not be processed. At a
minimum, the invoice must provide the following information:
•
Company name, address, and contact information
•
County bill-to name and contact information
•
Contract serial number
•
County purchase order number
•
Project name and/or number
•
Invoice number and date
•
Payment terms
•
Date of service or delivery
•
Quantity (number of days or weeks)
•
Contract item number(s)
•
Arrival and completion time (if applicable)
•
Description of purchase (product or services)
•
Pricing per unit of purchase
•
Extended price
•
Total amount due
5.3.2
Workers’ Compensation Pharmacy Benefit Manager Services and Workers’
Compensation Physical Therapy Service Network invoices shall also include, but
not necessarily be limited to:
•
Individual prescription claims/individual physical therapy claims
•
County assigned claim number
•
Administrative fees
•
Any other costs and charges specified in the agreement
Invoices from PBM and PTSN shall be directed to the Bill Review Services as
directed by the County.
5.3.3
Problems regarding billing or invoicing shall be directed to the department as listed
on the purchase order.
5.3.4
Payment shall only be made to the Contractor by Accounts Payable through the
Maricopa County Vendor Express Payment Program. This is an Electronic Funds
Transfer (EFT) process. After contract award, the Contractor shall complete the
Vendor Registration Form located on the County Department of Finance Vendor
Registration Web Site https://www.maricopa.gov/5169/Vendor-Information.
5.3.5
Discounts offered in the contract shall be calculated based on the date a properly
completed invoice is received by the County.
5.3.6
EFT payments to the routing and account numbers designated by the Contractor
shall include the details on the specific invoices that the payment covers. The
Contractor is required to discuss remittance delivery capabilities with their
designated financial institution for access to those details.
SERIAL 200167-RFP
5.4
APPLICABLE TAXES
5.4.1
It is the responsibility of the Contractor to determine any and all applicable taxes
and include those taxes in their proposal. The legal liability to remit the tax is on
the entity conducting business in Arizona. Tax is not a determining factor in
contract award.
5.4.2
The County will look at the price or offer submitted and will not deduct, add, or alter
pricing based on speculation or application of any taxes, nor will the County
provide Contractor any advice or guidance regarding taxes. If you have questions
regarding your tax liability, seek advice from a tax professional prior to submitting
your bid. You may also find information at https://www.azdor.gov/Business.aspx.
Once your bid is submitted, the offer is valid for the time specified in this solicitation,
regardless of mistake or omission of tax liability. If the County finds overpayment
of a project due to tax consideration that was not due, the Contractor will be liable
to the County for that amount, and by contracting with the County agrees to remit
any overpayments back to the County for miscalculations on taxes included in a
bid price.
5.4.3
Tax Indemnification: Contractor and all subcontractors shall pay all Federal, State,
and local taxes applicable to their operation and any persons employed by the
Contractor. Contractor shall, and require all subcontractors to, hold Maricopa
County harmless from any responsibility for taxes, damages, and interest, if
applicable, contributions required under Federal and/or State and local laws and
regulations, and any other costs including: transaction privilege taxes,
unemployment compensation insurance, Social Security, and Workers’
Compensation. Contractor may be required to establish, to the satisfaction of
County, that any and all fees and taxes due to the City or the State of Arizona for
any license or transaction privilege taxes, use taxes, or similar excise taxes are
currently paid (except for matters under legal protest).
6.0
AVAILABILITY OF FUNDS
6.1
The provisions of this contract relating to payment for services shall become effective when
funds assigned for the purpose of compensating the Contractor as herein provided are
actually available to County for disbursement. The County shall be the sole judge and
authority in determining the availability of funds under this contract. County shall keep the
Contractor fully informed as to the availability of funds.
6.2
If any action is taken by, any State agency, Federal department, or any other agency or
instrumentality to suspend, decrease, or terminate its fiscal obligations under, or in
connection with, this contract, County may amend, suspend, decrease, or terminate its
obligations under, or in connection with, this contract. In the event of termination, County
shall be liable for payment only for services rendered prior to the effective date of the
termination, provided that such services are performed in accordance with the provisions
of this contract. County shall give written notice of the effective date of any suspension,
amendment, or termination under this section, at least 10 days in advance.
7.0
STRATEGIC ALLIANCE for VOLUME EXPENDITURES (SAVE)
The County is a member of the SAVE cooperative purchasing group. SAVE includes the State of
Arizona, many Phoenix metropolitan area municipalities, and many K-12 unified school districts.
Under the SAVE Cooperative Purchasing Agreement, and with the concurrence of the successful
respondent under this solicitation, a member of SAVE may access a contract resulting from a
solicitation issued by the County. If you do not want to grant such access to a member of SAVE,
state so in your bid. In the absence of a statement to the contrary, the County will assume that you
do wish to grant access to any contract that may result from this bid. The County assumes no
responsibility for any purchases by using entities.
SERIAL 200167-RFP
8.0
INTERGOVERNMENTAL COOPERATIVE PURCHASING AGREEMENTS (ICPAs)
County currently holds ICPAs with numerous governmental entities. These agreements allow those
entities, with the approval of the Contractor, to purchase their requirements under the terms and
conditions of the County contract. It is the responsibility of the non-County government entity to
perform its own due diligence on the acceptability of the contract under its applicable procurement
rules, processes, and procedures. Certain governmental agencies may not require an ICPA and
may utilize this contract if it meets their individual requirements. Other governmental agencies may
enter into a separate Statement of Work with the Contractor to meet their own requirements. The
County is not a party to any uses of this contract by other governmental entities.
9.0
DUTIES
The Contractor shall perform all duties stated in Exhibit B – Scope of Work, or as otherwise directed
in writing by the procurement officer.
10.0
TERMS AND CONDITIONS
10.1
INDEMNIFICATION
10.1.1
To the fullest extent permitted by law, and to the extent that claims, damages,
losses, or expenses are not covered and paid by insurance purchased by the
Contractor, the Contractor shall defend, indemnify, and hold harmless the County
(as “Owner”), its agents, representatives, officers, directors, officials, and
employees from and against all claims, damages, losses, and expenses (including,
but not limited to attorneys' fees, court costs, expert witness fees, and the costs
and attorneys' fees for appellate proceedings) arising out of, or alleged to have
resulted from, the negligent acts, errors, omissions, or mistakes relating to the
performance of this contract.
10.1.2
Contractor's duty to defend, indemnify, and hold harmless the County, its agents,
representatives, officers, directors, officials, and employees shall arise in
connection with any claim, damage, loss, or expense that is attributable to bodily
injury, sickness, disease, death, or injury to, impairment of, or destruction of
tangible property, including loss of use resulting therefrom, caused by negligent
acts, errors, omissions, or mistakes in the performance of this contract, but only to
the extent caused by the negligent acts or omissions of the Contractor, a
subcontractor, anyone directly or indirectly employed by them, or anyone for
whose acts they may be liable, regardless of whether or not such claim, damage,
loss, or expense is caused in part by a party indemnified hereunder.
10.1.3
The amount and type of insurance coverage requirements set forth herein will in
no way be construed as limiting the scope of the indemnity in this section.
10.1.4
The scope of this indemnification does not extend to the sole negligence of County.
10.2
INSURANCE
10.2.1
Contractor, at Contractor’s own expense, shall purchase and maintain, at a
minimum, the herein stipulated insurance from a company or companies duly
licensed by the State of Arizona and possessing an AM Best, Inc. category rating
of B++. In lieu of State of Arizona licensing, the stipulated insurance may be
purchased from a company or companies, which are authorized to do business in
the State of Arizona, provided that said insurance companies meet the approval of
County. The form of any insurance policies and forms must be acceptable to
County.
10.2.2
All insurance required herein shall be maintained in full force and effect until all
work or service required to be performed under the terms of the contract is
SERIAL 200167-RFP
satisfactorily completed and formally accepted. Failure to do so may, at the sole
discretion of County, constitute a material breach of this contract.
10.2.3
In the event that the insurance required is written on a claims-made basis,
Contractor warrants that any retroactive date under the policy shall precede the
effective date of this contract and either continuous coverage will be maintained,
or an extended discovery period will be exercised for a period of two years
beginning at the time work under this contract is completed.
10.2.4
Contractor’s insurance shall be primary insurance as respects County, and any
insurance or self-insurance maintained by County shall not contribute to it.
10.2.5
Any failure to comply with the claim reporting provisions of the insurance policies
or any breach of an insurance policy warranty shall not affect the County’s right to
coverage afforded under the insurance policies.
10.2.6
The insurance policies may provide coverage that contains deductibles or self-
insured retentions. Such deductible and/or self-insured retentions shall not be
applicable with respect to the coverage provided to County under such policies.
Contractor shall be solely responsible for the deductible and/or self-insured
retention and County, at its option, may require Contractor to secure payment of
such deductibles or self-insured retentions by a surety bond or an irrevocable and
unconditional letter of credit.
10.2.7
The insurance policies required by this contract, except Workers’ Compensation
and Errors and Omissions, shall name County, its agents, representatives, officers,
directors, officials, and employees as additional insureds.
10.2.8
The policies required hereunder, except Workers’ Compensation and Errors and
Omissions, shall contain a waiver of transfer of rights of recovery (subrogation)
against County, its agents, representatives, officers, directors, officials, and
employees for any claims arising out of Contractor’s work or service.
10.2.9
If available, the insurance policies required by this contract may be combined with
Commercial Umbrella Insurance policies to meet the minimum limit requirements.
If a Commercial Umbrella insurance policy is utilized to meet insurance
requirements, the Certificate of Insurance shall indicate which lines the
Commercial Umbrella Insurance covers.
10.2.9.1
Commercial General Liability
Commercial General Liability (CGL) insurance and, if necessary,
Commercial Umbrella insurance with a limit of not less than $2,000,000
for each occurrence, $4,000,000 Products/Completed Operations
Aggregate, and $4,000,000 General Aggregate Limit. The policy shall
include coverage for premises liability, bodily injury, broad form property
damage, personal injury, products and completed operations and
blanket contractual coverage, and shall not contain any provisions which
would serve to limit third party action over claims. There shall be no
endorsement or modifications of the CGL limiting the scope of coverage
for liability arising from explosion, collapse, or underground property
damage.
10.2.9.2
Workers’ Compensation
10.2.9.2.1
Workers’ Compensation insurance to cover obligations
imposed by Federal and State statutes having jurisdiction of
Contractor’s employees engaged in the performance of the
work or services under this contract; and Employer’s
SERIAL 200167-RFP
Liability insurance of not less than $1,000,000 for each
accident, $1,000,000 disease for each employee, and
$1,000,000 disease policy limit.
10.2.9.2.2
Contractor, its subcontractors, and sub-subcontractors
waive all rights against this contract and its agents, officers,
directors, and employees for recovery of damages to the
extent these damages are covered by the Workers’
Compensation and Employer’s Liability or Commercial
Umbrella Liability insurance obtained by Contractor, its
subcontractors, and its sub-subcontractors pursuant to this
contract.
10.2.9.3
Errors and Omissions/Professional Liability Insurance
Errors and Omissions (Professional Liability) insurance which will insure
and provide coverage for errors or omissions or professional liability of
the contractor, with limits of no less than $2,000,000 for each claim.
10.2.9.4
Cyber, Network Security, and Privacy Liability
Cyber, Network Security and Privacy Liability Insurance with a limit of
not less than $5,000,000 per occurrence. The policy shall include, but
not be limited to; coverage for all directors, officers, agents and
employees of the Contractor, losses with respect to network risks (such
as data breaches, unauthorized access or use, and ID theft of data),
invasion of privacy (regardless of the type of media involved in the loss
of private information), crisis management, identity theft response costs,
breach notification costs, credit remediation, and credit monitoring,
defense, and claims expenses, regulatory defense costs plus fines and
penalties, cyber extortion, electronic data restoration expenses (data
asset protection), network business interruption, computer fraud
coverage, funds transfer loss, third-party fidelity, theft, no requirement
for arrest and conviction, and loss outside the premises of the named
insured.
10.2.10 Certificates of Insurance:
10.2.10.1 Prior to contract award, Contractor shall furnish the County with valid
and complete Certificates of Insurance, or formal endorsements as
required by the contract in the form provided by the County, issued by
Contractor’s insurer(s), as evidence that policies providing the required
coverage, conditions and limits required by this contract are in full force
and effect. Such certificates shall identify this contract number and title.
10.2.10.2 In the event any insurance policy(ies) required by this contract is (are)
written on a claims-made basis, coverage shall extend for two years past
completion and acceptance of Contractor’s work or services and as
evidenced by annual certificates of insurance.
10.2.10.3 If a policy does expire during the life of the Contract, a renewal certificate
must be sent to County 15 calendar days prior to the expiration date.
10.2.11 Cancellation and Expiration Notice:
Applicable to all insurance policies required within the insurance requirements of
this contract, Contractor’s insurance shall not be permitted to expire, be
suspended, be canceled, or be materially changed for any reason without 30 days
prior written notice to Maricopa County. Contractor must provide to Maricopa
SERIAL 200167-RFP
County, within two business days of receipt, if they receive notice of a policy that
has been or will be suspended, canceled, materially changed for any reason, has
expired, or will be expiring. Such notice shall be sent directly to Maricopa County
Office of Procurement Services and shall be mailed, or hand delivered to
160 S. 4th Avenue, Phoenix, AZ 85003, or emailed to the procurement officer noted
in the solicitation.
10.3
FORCE MAJEURE
10.3.1
Neither party shall be liable for failure of performance, nor incur any liability to the
other party on account of any loss or damage resulting from any delay or failure to
perform all or any part of this contract, if such delay or failure is caused by events,
occurrences, or causes beyond the reasonable control and without negligence of
the parties. Such events, occurrences, or causes will include acts of God/nature
(including fire, flood, earthquake, storm, hurricane, or other natural disaster), war,
invasion, act of foreign enemies, hostilities (whether war is declared or not), civil
war, riots, rebellion, revolution, insurrection, military or usurped power or
confiscation, terrorist activities, nationalization, government sanction, lockout,
blockage, embargo, labor dispute, strike, and interruption or failure of electricity or
telecommunication service.
10.3.2
Each party, as applicable, shall give the other party notice of its inability to perform
and particulars in reasonable detail of the cause of the inability. Each party must
use best efforts to remedy the situation and remove, as soon as practicable, the
cause of its inability to perform or comply.
10.3.3
The party asserting Force Majeure as a cause for non-performance shall have the
burden of proving that reasonable steps were taken to minimize delay or damages
caused by foreseeable events, that all non-excused obligations were substantially
fulfilled, and that the other party was timely notified of the likelihood or actual
occurrence which would justify such an assertion, so that other prudent
precautions could be contemplated.
10.4
ORDERING AUTHORITY
Any request for purchase shall be accompanied by a valid purchase order issued by a
County department or directed by a Certified Agency Procurement Aid (CAPA) with a
purchase card for payment.
10.5
PROCUREMENT CARD ORDERING CAPABILITY
County may opt to use a procurement card (Visa or Master Card) to make payment for
orders under this contract.
*NOTE: Vendor has declined to accept credit card for payment.
10.6
NO MINIMUM OR MAXIMUM PURCHASE OBLIGATION
This contract does not guarantee any minimum or maximum purchases will be made.
Orders will only be placed under this contract when the County identifies a need and proper
authorization and documentation have been approved.
10.7
PURCHASE ORDERS
10.7.1
County reserves the right to cancel purchase orders within a reasonable period of
time after issuance. Should a purchase order be canceled, the County agrees to
reimburse the Contractor for actual and documentable costs incurred by the
Contractor in response to the purchase order. The County will not reimburse the
SERIAL 200167-RFP
Contractor for any costs incurred after receipt of County notice of cancellation, or
for lost profits, or for shipment of product prior to issuance of purchase order.
10.7.2
Contractors agree to accept verbal notification of cancellation of purchase orders
from the County procurement officer with written notification to follow. Contractor
specifically acknowledges to be bound by this cancellation policy.
10.8
BACKGROUND CHECK
Respondents may be required to pass multiple background checks (e.g. Sheriff’s Office,
County Attorney's Office, Courts, as well as Maricopa County general government) to
determine if the respondent is acceptable to do business with the County. This applies to,
but is not limited to, the company, subcontractors, and employees, and the failure to pass
these checks shall deem the respondent non-responsible.
10.9
SUSPENSION OF WORK
The procurement officer may order the Contractor, in writing, to suspend, delay, or interrupt
all or any part of the work of this contract for the period of time that the procurement officer
determines appropriate for the convenience of the County. No adjustment shall be made
under this clause for any suspension, delay, or interruption to the extent that performance
would have been so suspended, delayed, or interrupted by any other cause, including the
fault or negligence of the Contractor. No request for adjustment under this clause shall be
granted unless the claim, in an amount stated, is asserted in writing as soon as practicable
after the termination of the suspension, delay, or interruption, but not later than the date of
final payment under the contract.
10.10
STOP WORK ORDER
10.10.1 The procurement officer may, at any time, by written order to the Contractor,
require the Contractor to stop all, or any part, of the work called for by this contract
for a period of 90 calendar days after the order is delivered to the Contractor, and
for any further period to which the parties may agree. The order shall be specifically
identified as a stop work order issued under this clause. Upon receipt of the order,
the Contractor shall immediately comply with its terms and take all reasonable
steps to minimize the incurrence of costs allocable to the work covered by the order
during the period of work stoppage. Within a period of 90 calendar days after a
stop work order is delivered to the Contractor, or within any extension of that period
to which the parties shall have agreed, the procurement officer shall either:
10.10.1.1 cancel the stop work order; or
10.10.1.2 terminate the work covered by the order as provided in the Termination
for Default or the Termination for Convenience clause of this contract.
10.10.1.3 The procurement officer may make an equitable adjustment in the
delivery schedule and/or contract price, and the contract shall be
modified, in writing, accordingly, if the Contractor demonstrates that the
stop work order resulted in an increase in costs to the Contractor
10.11
TERMINATION FOR CONVENIENCE
Maricopa County may terminate the resultant contract for convenience by providing 60
calendar days advance notice to the Contractor.
10.12
TERMINATION FOR DEFAULT
10.12.1 The County may, by written Notice of Default to the Contractor, terminate this
contract in whole or in part if the Contractor fails to:
SERIAL 200167-RFP
10.12.1.1 deliver the supplies or to perform the services within the time specified
in this contract or any extension;
10.12.1.2 make progress, so as to endanger performance of this contract; or
10.12.1.3 perform any of the other provisions of this contract.
10.12.2 The County’s right to terminate this contract under these subparagraphs may be
exercised if the Contractor does not cure such failure within 10 business days (or
more if authorized in writing by the County) after receipt of a Notice to Cure from
the procurement officer specifying the failure.
10.13
PERFORMANCE
It shall be the Contractor’s responsibility to meet the proposed performance requirements.
Maricopa County reserves the right to obtain services on the open market in the event the
Contractor fails to perform, and any price differential will be charged against the Contractor.
10.14
CONTRACTOR EMPLOYEE MANAGEMENT
10.14.1 Contractor shall endeavor to maintain the personnel proposed in their proposal
throughout the performance of this contract.
10.14.2 If Contractor personnel’s employment status changes, Contractor shall provide
County a list of proposed replacements with equivalent or greater experience.
10.14.3 Under no circumstances shall the implementation schedule to be impacted by a
personnel change on the part of the Contractor.
10.14.4 Contractor shall not reassign any key personnel identified in their proposal without
the express consent of the County.
10.14.5 County reserves the right to immediately remove from its premises any Contractor
personnel it determines to be a risk to County operations.
10.14.6 County reserves the right to request the replacement of any Contractor personnel
at any time, for any reason.
10.15
WARRANTY OF SERVICES
10.15.1 The Contractor warrants that all services provided hereunder will conform to the
requirements of the contract, including all descriptions, specifications and
attachments made a part of this contract. County’s acceptance of services or
goods provided by the Contractor shall not relieve the Contractor from its
obligations under this warranty.
10.15.2 In addition to its other remedies, County may, at the Contractor's expense, require
prompt correction of any services failing to meet the Contractor's warranty herein.
Services corrected by the Contractor shall be subject to all the provisions of this
contract in the manner and to the same extent as services originally furnished
hereunder.
10.16
INSPECTION OF SERVICES
10.16.1 The Contractor shall provide and maintain an inspection system acceptable to
County covering the services under this contract. Complete records of all
inspection work performed by the Contractor shall be maintained and made
SERIAL 200167-RFP
available to County during contract performance and for as long afterwards as the
contract requires.
10.16.2 County has the right to inspect and test all services called for by the contract, to
the extent practicable at all times and places during the term of the contract.
County shall perform inspections and tests in a manner that will not unduly delay
the work.
10.16.3 If any of the services do not conform to contract requirements, County may require
the Contractor to perform the services again in conformity with contract
requirements, at no cost to the County. When the defects in services cannot be
corrected by re-performance, County may:
10.16.3.1 require the Contractor to take necessary action to ensure that future
performance conforms to contract requirements; and
10.16.3.2 reduce the contract price to reflect the reduced value of the services
performed.
10.16.4 If the Contractor fails to promptly perform the services again or to take the
necessary action to ensure future performance in conformity with contract
requirements, County may:
10.16.4.1 by contract or otherwise, perform the services and charge to the
Contractor, through direct billing or through payment reduction, any cost
incurred by County that is directly related to the performance of such
service; or
10.16.4.2 terminate the contract for default.
10.17
USAGE REPORT
The Contractor shall furnish the County a usage report, upon request, delineating the
acquisition activity governed by the contract. The format of the report shall be approved by
the County and shall disclose the quantity and dollar value of each contract item by
individual unit of measure.
10.18
STATUTORY RIGHT OF CANCELLATION FOR CONFLICT OF INTEREST
Notice is given that, pursuant to A.R.S. § 38-511, the County may cancel any contract
without penalty or further obligation within three years after execution of the contract, if any
person significantly involved in initiating, negotiating, securing, drafting, or creating the
contract on behalf of the County is at any time, while the contract or any extension of the
contract is in effect, an employee or agent of any other party to the contract in any capacity
or consultant to any other party of the contract with respect to the subject matter of the
contract. Additionally, pursuant to A.R.S. § 38-511, the County may recoup any fee or
commission paid or due to any person significantly involved in initiating, negotiating,
securing, drafting, or creating the contract on behalf of the County from any other party to
the contract arising as the result of the contract.
10.19
OFFSET FOR DAMAGES
In addition to all other remedies at Law or Equity, the County may offset from any money
due to the Contractor any amounts Contractor owes to the County for damages resulting
from breach or deficiencies in performance of the contract.
SERIAL 200167-RFP
10.20
SUBCONTRACTING
10.20.1 The Contractor may not assign to another Contractor or subcontract to another
party for performance of the terms and conditions hereof without the written
consent of the County. All correspondence authorizing subcontracting must
reference the bid serial number and identify the job or project.
10.20.2 The subcontractor’s rate for the job shall not exceed that of the prime Contractor’s
rate, as bid in the pricing section, unless the prime Contractor is willing to absorb
any higher rates. The subcontractor’s invoice shall be invoiced directly to the prime
Contractor, who in turn shall pass-through the costs to the County, without mark-
up. A copy of the subcontractor’s invoice must accompany the prime Contractor’s
invoice.
10.21
AMENDMENTS
All amendments to this contract shall be in writing and approved/signed by both parties.
Maricopa County Office of Procurement Services shall be responsible for approving all
amendments for Maricopa County.
10.22
ADDITIONS/DELETIONS OF REQUIREMENTS
The County reserves the right to add and/or delete materials and services to a contract. If
a service requirement is deleted, payment to the Contractor will be reduced proportionately,
to the amount of service reduced in accordance with the bid price. If additional materials
or services are required from a contract, prices for such additions will be negotiated
between the Contractor and the County.
10.23
RIGHTS IN DATA
10.23.1 The County shall have the use of data and reports resulting from a contract without
additional cost or other restriction except as may be established by law or
applicable regulation. Each party shall supply to the other party, upon request, any
available information that is relevant to a contract and to the performance
thereunder.
10.23.2 Data, records, reports, and all other information generated for the County by a third
party as the result of a contract are the property of the County and shall be provided
in a format designated by the County or shall be and remain accessible to the
County into perpetuity.
10.24
ACCESS TO AND RETENTION OF RECORDS FOR THE PURPOSE OF AUDIT AND/OR
OTHER REVIEW
10.24.1 In accordance with Section MC1-374 of the Maricopa County Procurement Code,
the Contractor agrees to retain (physical or digital copies of) all books, records,
accounts, statements, reports, files, and other records and back-up documentation
relevant to this contract for six years after final payment or until after the resolution
of any audit questions, which could be more than six years, whichever is longest.
The County, Federal or State auditors and any other persons duly authorized by
the department shall have full access to and the right to examine, copy, and make
use of, any and all said materials.
10.24.2 If the Contractor’s books, records, accounts, statements, reports, files, and other
records and back-up documentation relevant to this contract are not sufficient to
support and document that requested services were provided, the Contractor shall
reimburse Maricopa County for the services not so adequately supported and
documented.
SERIAL 200167-RFP
10.25
AUDIT DISALLOWANCES
If at any time it is determined by the County that a cost for which payment has been made
is a disallowed cost, the County shall notify the Contractor in writing of the disallowance.
The course of action to address the disallowance shall be at sole discretion of the County,
and may include either an adjustment to future invoices, request for credit, request for a
check, or a deduction from current invoices submitted by the Contractor equal to the
amount of the disallowance, or to require reimbursement forthwith of the disallowed amount
by the Contractor by issuing a check payable to Maricopa County.
10.26
STRICT COMPLIANCE
Acceptance by County of a performance that is not in strict compliance with the terms of
the contract shall not be deemed to be a waiver of strict compliance with respect to all other
terms of the contract.
10.27
VALIDITY
The invalidity, in whole or in part, of any provision of this contract shall not void or affect
the validity of any other provision of the contract.
10.28
SEVERABILITY
The removal, in whole or in part, of any provision of this contract shall not void or affect the
validity of any other provision of this contract.
10.29
RELATIONSHIPS
10.29.1 In the performance of the services described herein, the Contractor shall act solely
as an independent Contractor, and nothing herein or implied herein shall at any
time be construed as to create the relationship of employer and employee, co-
employee, partnership, principal and agent, or joint venture between the County
and the Contractor.
10.29.2 The County reserves the right of final approval on proposed staff. Also, upon
request by the County, the Contractor will be required to remove any employees
working on County projects and substitute personnel based on the discretion of
the County within two business days, unless previously approved by the County.
10.30
NON-DISCRIMINATION
Contractor agrees to comply with all provisions and requirements of Arizona Executive
Order 2009-09, including flow down of all provisions and requirements to any
subcontractors. Executive Order 2009-09 supersedes Executive Order 99-4 and amends
Executive Order 75-5 and is hereby incorporated into this contract as if set forth in full
herein. During the performance of this contract, Contractor shall not discriminate against
any employee, client, or any other individual in any way because of that person’s age, race,
creed, color, religion, sex, disability, or national origin. (Arizona Executive Order 2009-09
can
be
downloaded
from
the
Arizona
Memory
Project
at
http://azmemory.azlibrary.gov/cdm/singleitem/collection/execorders/id/680/rec/1.)
10.31
WRITTEN CERTIFICATION PURSUANT to A.R.S. § 35-393.01
If vendor engages in for-profit activity and has 10 or more employees, and if this agreement
has a value of $100,000 or more, vendor certifies it is not currently engaged in, and agrees
for the duration of this agreement to not engage in, a boycott of goods or services from
Israel. This certification does not apply to a boycott prohibited by 50 U.S.C. § 4842 or a
regulation issued pursuant to 50 U.S.C. § 4842.
SERIAL 200167-RFP
10.32
CERTIFICATION REGARDING DEBARMENT AND SUSPENSION
10.32.1 The undersigned (authorized official signing on behalf of the Contractor) certifies
to the best of his or her knowledge and belief that the Contractor, its current
officers, and directors:
10.32.1.1 are not presently debarred, suspended, proposed for debarment,
declared ineligible, or voluntarily excluded from being awarded any
contract or grant by any United States department or agency or any
state, or local jurisdiction;
10.32.1.2 have not within a three-year period preceding this contract:
10.32.1.2.1
been convicted of fraud or any criminal offense in
connection with obtaining, attempting to obtain, or as the
result of performing a government entity (Federal, State or
local) transaction or contract; or
10.32.1.2.2
been convicted of violation of any Federal or State antitrust
statutes or conviction for embezzlement, theft, forgery,
bribery, falsification or destruction of records, making false
statements, or receiving stolen property regarding a
government entity transaction or contract;
10.32.1.3 are not presently indicted or criminally charged by a government entity
(Federal, State or local) with commission of any criminal offenses in
connection with obtaining, attempting to obtain, or as the result of
performing a government entity public (Federal, State or local)
transaction or contract;
10.32.1.4 are not presently facing any civil charges from any governmental entity
regarding obtaining, attempting to obtain, or from performing any
governmental entity contract or other transaction; and
10.32.1.5 have not within a three-year period preceding this contract had any
public transaction (Federal, State or local) terminated for cause or
default.
10.32.2 If any of the above circumstances described in the paragraph are applicable to
the entity submitting a bid for this requirement, include with your bid an
explanation of the matter including any final resolution.
10.32.3 The Contractor shall include, without modification, this clause in all lower tier
covered transactions (i.e. transactions with subcontractors or sub-subcontractors)
and in all solicitations for lower tier covered transactions related to this contract.
If this clause is applicable to a subcontractor or sub-subcontractor, the Contractor
shall include the information required by this clause with their bid.
10.33
VERIFICATION REGARDING COMPLIANCE WITH A.R.S. § 41-4401 AND FEDERAL
IMMIGRATION LAWS AND REGULATIONS
10.33.1 By entering into the contract, the Contractor warrants compliance with the
Immigration and Nationality Act (INA using E-Verify) and all other Federal
immigration laws and regulations related to the immigration status of its employees
and A.R.S. § 23-214(A). The Contractor shall obtain statements from its
subcontractors certifying compliance and shall furnish the statements to the
procurement officer upon request. These warranties shall remain in effect through
the term of the contract. The Contractor and its subcontractors shall also maintain
Employment Eligibility Verification forms (I-9) as required by the Immigration Reform
SERIAL 200167-RFP
and Control Act of 1986, as amended from time to time, for all employees performing
work under the contract and verify employee compliance using the E-Verify system
and shall keep a record of the verification for the duration of the employee’s
employment or at least three years, whichever is longer. I-9 forms are available for
download at www.uscis.gov.
10.33.2 The County retains the legal right to inspect documents of Contractor and
subcontractor employees performing work under this contract to verify compliance
with paragraph 10.33.1 of this section. Contractor and subcontractor shall be given
reasonable notice of the County’s intent to inspect and shall make the documents
available at the time and date specified. Should the County suspect or find that the
Contractor or any of its subcontractors are not in compliance, the County will
consider this a material breach of the contract and may pursue any and all remedies
allowed by law, including, but not limited to: suspension of work, termination of the
contract for default, and suspension and/or debarment of the Contractor. All costs
necessary to verify compliance are the responsibility of the Contractor.
10.34
CONTRACTOR LICENSE REQUIREMENT
10.34.1 The Contractor shall procure all permits, insurance, and licenses, and pay the
charges and fees necessary and incidental to the lawful conduct of his/her
business, and as necessary complete any requirements, by any and all
governmental or non-governmental entities as mandated to maintain compliance
with and remain in good standing. The Contractor shall keep fully informed of
existing and future trade or industry requirements, and Federal, State, and local
laws, ordinances, and regulations which in any manner affect the fulfillment of a
contract and shall comply with the same. Contractor shall immediately notify both
Office of Procurement Services and the department of any and all changes
concerning permits, insurance, or licenses.
10.35
INFLUENCE
10.35.1 As prescribed in MC1-1203 of the Maricopa County Procurement Code, any effort
to influence an employee or agent to breach the Maricopa County Ethical Code of
Conduct or any ethical conduct, may be grounds for disbarment or suspension
under MC1-902.
10.35.2 An attempt to influence includes, but is not limited to:
10.35.2.1 A person offering or providing a gratuity, gift, tip, present, donation,
money, entertainment or educational passes or tickets, or any type of
valuable contribution or subsidy that is offered or given with the intent to
influence a decision, obtain a contract, garner favorable treatment, or
gain favorable consideration of any kind.
10.35.3 If a person attempts to influence any employee or agent of Maricopa County, the
chief procurement officer, or his designee, reserves the right to seek any remedy
provided by the Maricopa County Procurement Code, any remedy in equity or in
the law, or any remedy provided by this contract.
10.36
CONFIDENTIAL INFORMATION
10.36.1 Any information obtained in the course of performing this contract may include
information that is proprietary or confidential to the County. This provision
establishes the Contractor’s obligation regarding such information.
10.36.2 The Contractor shall establish and maintain procedures and controls that are
adequate to assure that no information contained in its records and/or obtained
from the County or from others in carrying out its functions (services) under the
SERIAL 200167-RFP
contract shall be used by or disclosed by it, its agents, officers, or employees,
except as required to efficiently perform duties under the contract. The Contractor’s
procedures and controls, at a minimum, must be the same procedures and controls
it uses to protect its own proprietary or confidential information. If, at any time
during the duration of the contract, the County determines that the procedures and
controls in place are not adequate, the Contractor shall institute any new and/or
additional measures requested by the County within 15 business days of the
written request to do so.
10.36.3 Any requests to the Contractor for County proprietary or confidential information
shall be referred to the County for review and approval, prior to any dissemination.
10.37
PUBLIC RECORDS
Under Arizona law, all offers submitted and opened are public records and must be
retained by the County at the Maricopa County Office of Procurement Services. Offers shall
be open to public inspection and copying after contract award and execution, except for
such offers or sections thereof determined to contain proprietary or confidential information
by the Office of Procurement Services. If an offeror believes that information in its offer or
any resulting contract should not be released in response to a public record request, under
Arizona law, the offeror shall indicate the specific information deemed confidential or
proprietary and submit a statement with its offer detailing the reasons that the information
should not be disclosed. Such reasons shall include the specific harm or prejudice which
may arise from disclosure. The records manager of the Office of Procurement Services
shall determine whether the identified information is confidential pursuant to the Maricopa
County Procurement Code.
10.38
INTEGRATION
This contract represents the entire and integrated agreement between the parties and
supersedes
all
prior
negotiations,
proposals,
communications,
understandings,
representations, or agreements, whether oral or written, expressed, or implied.
10.39
UNIFORM ADMINISTRATIVE REQUIREMENTS
By entering into this contract, the Contractor agrees to comply with all applicable provisions
of
Title
2,
Subtitle
A,
Chapter
II,
Part
200—UNIFORM
ADMINISTRATIVE
REQUIREMENTS, COST PRINCIPLES, AND AUDIT REQUIREMENTS FOR FEDERAL
AWARDS contained in Title 2 C.F.R. § 200 et seq.
10.40
GOVERNING LAW
This contract shall be governed by the laws of the State of Arizona. Venue for any actions
or lawsuits involving this contract will be in Maricopa County Superior Court, Phoenix,
Arizona.
10.41
PRICES
Contractor warrants that prices extended to County under this contract are no higher than
those paid by any other customer for these or similar services.
10.42
ORDER OF PRECEDENCE
In the event of a conflict in the provisions of this contract and Contractor’s license
agreement, if applicable, the terms of this contract shall prevail.
SERIAL 200167-RFP
10.43
INCORPORATION OF DOCUMENTS
10.43.1 The following are to be attached to and made part of this Contract:
10.43.1.1 Exhibit A – Vendor Information and Pricing
10.43.1.2 Exhibit B – Scope of Work
10.43.1.3 Exhibit B-1, Vendor Narrative
10.43.1.4 Exhibit C, Arizona Retail Pharmacies
10.44
NOTICES
All notices given pursuant to the terms of this contract shall be addressed to:
For County:
Maricopa County
Office of Procurement Services
160 S. 4th Avenue
Phoenix, Arizona 85003-1647
For Contractor:
CorVel HealthCare Corporation
Mr. Richard Schweppe
2010 Main Street, Suite 600
Irvine, CA 92614
10.45
INQUIRIES
10.45.1 Administrative telephone/email inquiries shall be addressed to:
ANDREA STUPKA, PROCUREMENT OFFICER
TELEPHONE: (602) 506-3504
Andrea.Stupka@maricopa.gov
10.45.2 Inquiries may be submitted by telephone but must be followed up in writing. No
oral communication is binding on Maricopa County.
SERIAL 200167-RFP
SERIAL 200167-RFP
EXHIBIT A
VENDOR INFORMATION AND PRICING
COMPANY NAME:
CorVel Healthcare Corporation
DOING BUSINESS AS (dba):
N/A
MAILING ADDRESS:
1850 North Central Avenue, Suite 1200, Phoenix, AZ
85004
REMIT TO ADDRESS:
PO Box 6080, Phoenix, AZ 85802
TELPHONE NUMBER:
602-288-1838
FAX NUMBER:
866-392-2919
WWW ADDRESS:
www.corvel.com
REPRESENTATIVE NAME:
Denise Maier
REPRESENTATIVE TELEPHONE NUMBER:
602-509-2548
REPRESENTATIVE EMAIL ADDRESS
denise_maier@corvel.com
YES
NO
WILL ALLOW OTHER GOVERNMENTAL ENTITIES TO PURCHASE FROM THIS
CONTRACT:
* CorVel will agree to other governmental entities to purchase from this
contract only if the original entity who has signed the agreement with CorVel
pays for all services being provided to the other entities under this agreement
and assumes all liabilities and responsibilities for other such entities. If
original entity refuses to do this, then each governmental entity wanting
CorVel to provide services to them will have to enter into a separate
standalone agreement using the same terms.
WILL ACCEPT PROCUREMENT CARD FOR PAYMENT:
PAYMENT TERMS
NET 30 DAYS
1.0 PRICING:
RESPONSE
1.1 Workers' Compensation Medical Bill Review and Check Writing
1.1.1 OPTION A: Respondent shall indicate/offer fixed percentage of "net
savings" offer, for medical bill review services. Respondent must indicate what
types of charges are to be considered to determine fees i.e. (1) BR-Bill Review
(reduction to fee schedule), (2) PPO-Preferred Provider Organizations (Network
discount below fee schedule), (3) OSR- Outside Review (Such as QMedtrix), (4)
Any other codes/modifiers to be used - please indicate and explain/outline.
9
%
1.1.3 Respondent's "guaranteed turnaround time" (calendar days) for medical
review from the date the original bill is made available for review (turnaround
time of seven (7) calendar days maximum, is required. See Section 2.1.1.9
7
DAY
1.1.4 Utilization review (all states)
1.1.4.1 Peer Review Fees
$250 plus
physician fees
1.1.4.2 Outpatient
$128.00
1.1.4.3. Inpatient
$150.00
SERIAL 200167-RFP
1.1.5 Check writing
$3.00
PER
CHECK
1.1.6 Additional Pricing
1.1.6.1 Data conversion fee
Included
FLAT FEE
1.2 Workers Compensation Pharmacy Benefit
Manager Services
1.2.1 Retail
PREFERRED
NETWORK
SECONDARY
NETWORK
1.2.1.1 AWP less discount
Brand -15%
Generic -50%
%
NA
%
1.2.1.2 Rebate on ALL
prescriptions
NA
NA
Per prescription
CorVel does not accept
rebates
1.2.1.3 Acquisition cost
NA
1.2.1.4 Dispensing fee
$2.00
NA
Per prescription
https://www.azica.gov/2019-arizona-physicians-fee-schedule
Pricing must follow ICA adopted Pharmaceutical Fee Schedules at link above per ARS 32-
1963.01
1.2.2 Specialty drugs pricing
1.2.2.1 AWP less discount
-15%
%
1.2.2.2 Rebate on ALL prescriptions
NA
Per prescription
1.2.2.3 Acquisition cost
NA
1.2.2.4 Dispensing fee
$2.00
Per prescription
https://www.azica.gov/2019-arizona-physicians-fee-schedule
Pricing must follow ICA adopted Pharmaceutical Fee Schedules at link above per ARS 32-
1963.01
1.2.3 Infusion drugs pricing
1.2.3.1 AWP less discount
We honor our rates through
PBM, invoices outside of
PBM would be subject to fee
schedule and PPO reductions
in bill review.
%
SERIAL 200167-RFP
1.2.3.2 Rebate on ALL
prescriptions
CorVel accepts a per
transaction fee in lieu of
rebates when acquiring
medications, this enables us
to recognize the impact of the
rebate in real time and apply
it across all transactions. We
pass 100% of this rebate
benefit to our customers; the
benefit is reflected and built
into the negotiated customer
rates
Per prescription
1.2.3.3 Acquisition cost
$
1.2.3.4 Dispensing fee
Per prescription
https://www.azica.gov/2019-arizona-physicians-fee-schedule
Pricing must follow ICA adopted Pharmaceutical Fee Schedules at link above per
ARS 32-1963.01
1.2.4 Injectable drugs pricing
1.2.4.1 AWP less discount
We honor our rates through PBM,
invoices outside of PBM would be
subject to fee schedule and PPO
reductions in bill review.
%
1.2.4.2 Rebate on ALL
prescriptions
CorVel accepts a per transaction fee
in lieu of rebates when acquiring
medications, this enables us to
recognize the impact of the rebate
in real time and apply it across all
transactions. We pass 100% of this
rebate benefit to our customers;
the benefit is reflected and built
into the negotiated customer rates
Per prescription
1.2.4.3 Acquisition Cost
$
1.2.4.4 Dispensing fee
$
Per prescription
https://www.azica.gov/2019-arizona-physicians-fee-schedule
Pricing must follow ICA adopted Pharmaceutical Fee Schedules at link above per ARS 32-
1963.01
1.2.5 Generic drugs
1.2.5.1 Total number of
generic drugs on MAC (see
Section 5.5.2.2.4 in the
solicitation)
NA
MAC list
Will work to determine appropriate MAC
list
SERIAL 200167-RFP
1.2.5.2 Guaranteed
OVERALL discount on generic
drugs
-50%
%
This is an annual generic rate
1.2.6 DME equipment
discount percentage
10
%
Off ICA Fee Schedule or 80th Percentile of
Fair Health's Usual and Customary Pricing
Index, whichever is lower.
Price attachment - DME Services are
Quoted at upon receipt of referral
Bill
Review Fee
$3.00/bill
For all pharmacy bills that present to bill
review.
SERIAL 200167-RFP
EXHIBIT B
SCOPE OF WORK
1.0
INTENT
Maricopa County is a self-insured and self-administered government entity providing Workers
Compensation coverage to more than 14,000 employees, and processing approximately $6.5M in
medical payments annually. The intent is to identify a contractor(s) for the purpose of providing the
following:
Effective and efficient medical bill review and check writing services (BRCWS) for Maricopa
County’s entire workers’ compensation program.
o
The average number of bills received is 9,000 annually. For fiscal year 18/19, the
number of bills received was 6,737 with a total amount billed of $6,416,015.75;
these totals are less duplicate billings.
A Pharmacy Benefit Manager (PBM) to provide workers’ compensation prescription benefit
management services through a network of pharmacies.
Maricopa County (County) reserves the right to award this contract to multiple vendors. The County
reserves the right to award in whole or in part, by item or group of items, by section or geographic
area, or make multiple awards, where such action serves the County’s best interest.
Other governmental entities under agreement with Maricopa County (County) may have access to
services provided hereunder (see also Section 7.0 and 8.0 above).
The County reserves the right to add additional contractors, at the County’s sole discretion, in cases
where the currently listed contractors are of an insufficient number or skill-set to satisfy the County’s
needs.
Once the contract has been awarded, the existing contracts for the individual scopes of work will
be terminated. This contract will take precedence over any existing contract.
2.0
SCOPE OF WORK
2.1
Minimum Technical Requirements for Workers’ Compensation Medical Bill Review and
Check Writing Services (BRCWS).
BRCWS shall be required to provide the necessary services at the direction of the
County’s Self- Insured Risk Trust Fund, Maricopa County Risk Management Department.
2.1.1
Contractor Responsibilities
2.1.1.1
Review all individual bills for all medical services received by Maricopa
County employees for an accepted industrial injury and reject or reduce
payments for bills containing charges in excess of the Industrial
Commission of Arizona’s (ICA) Physician’s Fee Schedule. Notify
provider of any rejected or reduced charges and instruct provider on
resubmission procedures.
2.1.1.2
Review individual bills and identify medically unnecessary procedures
per
Evidence
Based
Medicine
Guidelines
(https://www.azica.gov/official-disability-guidelines). Notify provider of
any rejected or reduced charges and instruct provider on resubmission
procedures.
SERIAL 200167-RFP
2.1.1.3
Review individual bills and identify improperly coded medical
procedures. Notify provider of incorrect coding, return invoice for proper
coding, and instruct provider on resubmission procedures.
2.1.1.4
Review individual bills and identify medical providers who provide
excessive utilization of their services procedures per Evidence Based
Medicine Guidelines. Provide a list of identified providers, who provide
excessive utilization of their services, to County Risk Management for
review. Report to County Risk Management as the provider is identified
but not less than yearly.
2.1.1.5
Review individual bills and identify medical procedures not covered by
the ICA Physician Fee Schedule. Notify provider of any rejected or
reduced charges and instruct provider on resubmission procedures.
2.1.1.6
Review all bills and identify duplications. BRCWS shall not charge a fee
for duplicate bill submissions.
2.1.1.7
Track prescription usage and alert the Risk Management assigned
adjuster for potential abuse when identified.
2.1.1.8
Review bills not covered under the ICA Physician’s Fee Schedule and
determine if the provider has charged according to reasonable and
customary rates established by Centers for Medicare/Medical Services
(CMS) rate schedule. Notify provider of any rejected or reduced charges
and instruct provider on resubmission procedures.
2.1.1.9
Provide a detailed accounting of all savings, duplicate bills, prescription
charges and physical therapy charges with the BRCWS invoice. Bill
review charges must be billed at least monthly.
2.1.1.10
Review, as part of BRCWS’ regular job duties, each bill within a
maximum of a seven-calendar day turnaround time, starting from the
date the bill is made available to the BRCWS. Consideration shall be
given to those BRCWS who propose a turnaround time of less than
seven calendar days, starting from the date the bill is made available to
the BRCWS.
2.1.1.11
The BRCWS shall be provided with the original bill for review and
evaluation. It is the responsibility of the BRCWS to arrange for the pick-
up and return of said bill and related documentation in a manner and
frequency that is acceptable to Risk Management. Electronic transfers
using the formats referenced in sections 2.1.1.18.4 and 2.1.1.18.6 are
preferred.
2.1.1.12
County has contracted with certain vendors at below-State-mandated
fee schedules, BRCWS shall scan, and upload bills and attachments
from these vendors into the County’s claims database, without
processing, at no additional cost.
2.1.1.13
BRCWS shall provide a dedicated quality assurance representative that
will assist in the handling of problems, disputes, and workflow
challenges. This representative shall be available to the County agency
during normal working hours, Monday through Friday, 7:30 a.m. MST to
5:00 p.m. MST, excluding County holidays (list of County holidays
available upon award), via dedicated phone (dedicated hotline
preferred) and/or email. When deemed necessary by Risk Management,
the BRCWS shall provide additional resources, at no additional cost to
SERIAL 200167-RFP
the Risk Management Department, should challenges or problems arise
and the BRCWS is unable to fulfill any requirements as stated herein.
2.1.1.14
BRCWS shall supply County with automated provider reimbursement
through
check
writing
services
in
accordance
with
provider
specifications.
2.1.1.15
A transmission reflecting the results of the hospital and medical bill
audit/review services rendered by BRCWS will be submitted and a
check for each explanation of benefits (EOB) will be automatically
generated by the BRCWS.
2.1.1.16
BRCWS will transmit, via an interface between the BRCWS and Risk
Management’s claim database, the results of all bill review integrated
services to County for the express purpose of downloading the data into
County’s claims management system, which tracks provider payments
and bill review fees back to the appropriate and corresponding County
claim file.
2.1.1.17
Check writing services shall also include Internal Revenue Service (IRS)
form 1099 filing and associated follow-up, bank reconciliation, and bank
fees specifically related to such processing.
2.1.1.18
BRCWS must be able to interface with Origami Risk Database, a web-
based risk management software system, to include the following data
interface (at minimum) at no additional cost to the County:
2.1.1.18.1
Claim file
2.1.1.18.2
Vendor file
2.1.1.18.3
Payment file
2.1.1.18.4
History load (history data to be provided by the incumbent
bill review vendor)
2.1.1.18.5
Check number and payment information import
2.1.1.18.6
Master Boot Record (MBR) interface
2.1.2
Medical Bill Review Questions
As part of a proposal for consideration for the Workers’ Compensation Medical
Bill Review and Check Writing Services, respondent must answer the questions
in Section 5.5.2.1. Responses to these questions will become part of the
resultant contract.
* See contractor narrative for responses.
2.1.3
Reporting Requirements
2.1.3.1
The BRCWS shall electronically submit a comprehensive monthly net
savings report within 15 days of each month end to the Risk
Management Department. The report shall include the following
categories:
2.1.3.1.1
Total dollar amount of bills submitted for audit
2.1.3.1.2
Bill review reductions
2.1.3.1.3
PPO reductions
2.1.3.1.4
Recommended allowance
2.1.3.1.5
Gross savings
2.1.3.1.6
Gross percentage of savings
2.1.3.1.7
Total monthly fee for service
2.1.3.1.8
Overall net savings
2.1.3.1.9
Net percentage of savings
SERIAL 200167-RFP
2.1.3.2
The BRCWS shall electronically submit comprehensive check issuance
reports to the designee in Risk Management on a scheduled to be
determined, but at least weekly, of all checks written to include the
following:
2.1.3.2.1
Check number
2.1.3.2.2
Payee
2.1.3.2.3
Claim number
2.1.3.2.4
Fees charged per check written
2.1.3.3 The BRCWS shall electronically submit to Risk Management individual
providers identified as providing excess utilization of their services per
section 2.1.1.4 above as those identifications are made but not less than
yearly on the anniversary of the contract.
2.1.3.4 The BRCWS shall electronically submit to Risk Management identification
of potential abuse of prescription medications as set forth in section 2.1.1.7
above as those identifications are made but not less than yearly on the
anniversary of the contract.
2.1.4
BRCWS Experience
2.1.4.1
The BRCWS shall have been in the workers’ compensation bill review
business for a minimum of five consecutive years. Proof of this
requirement must accompany the proposal. (i.e. business license or
documentation showing how long contractor has been in business, and
when/if incorporated).
2.2
Minimum Requirements for Workers Compensation Pharmacy Benefit Manager Services
Pharmacy Benefit Manger (PBM) services shall include management services for
pharmacy and durable medical equipment (DME). It is the expectation that the successful
contractor shall also be able to provide Preferred Networks.
2.2.1
Contractor shall provide workers’ compensation prescription benefit management
services described and/or as otherwise mutually agreed to by the parties, in
writing, including, but not necessarily limited to, general support and consultative
services regarding pharmacy benefit design and implementation, network and
rebate management, administrative and claims processing services, standard
reporting packages, marketing, customer service, and quality management and
utilization management functions. In addition, PBM may develop and implement
certain additional clinical intervention and cost-saving (e.g. voluntary tablet
splitting) programs that may be desired by the County, subject to terms and
conditions, to be agreed in writing between the parties. PBM shall manage the
current pharmacy benefit plan designs for future innovative plan designs,
notwithstanding the foregoing or any termination rights set forth. PBM may
immediately terminate or refrain from implementing any clinical program services
in any geographic area (in their entirety or for specific drugs only) if, in PBM’s sole
determination, the implementation or continued provision of such services is or
may be in violation of applicable laws, rules, or regulations governing the practice
of pharmacy or prescription benefits management, or may otherwise present an
issue related to the practice of pharmacy or prescriptions benefits management.
2.2.2
PBM, as the authorized prescription benefit manager, shall perform rebate sharing
and other clinical services described herein. These services will include, but are
not necessarily limited to, prior authorization, step-therapy, systematic prospective,
concurrent and retrospective drug utilization review, and other measures that are
deemed appropriate to effectuate program management. Accordingly, County will
SERIAL 200167-RFP
authorize PBM, as its prescription benefit manager, to perform formulary
management and other services described herein.
2.2.3
With regard to billing, PBM shall invoice the County following the close of each
monthly billing cycle. Such invoices shall include, but are not necessarily limited
to, individual prescription claims, administrative fees, and/or any other costs and
charges specified in the agreement. PBM shall pay claims independently for
services provided by pharmacies.
2.2.4
PBM’s clinical pharmacist and account manager shall work with the County to
satisfy the County’s reporting needs. This will include, but is not necessarily limited
to, standard management reports, provider profiling and analysis (e.g., identifying
drug patterns), ad hoc reporting needs, and cost-controlling methods.
2.2.5
The following relates to PBM’s commitment to providing support personnel and
general onsite educational assistance throughout the term of the contract.
2.2.5.1
Contractor shall provide a dedicated, mutually agreed upon PBM within
Maricopa County; the PBM consultant will be the County’s key clinical
pharmacist and strategist.
2.2.5.2
Maricopa County shall have a dedicated local contractor account
manager, who will be the point of contact for Maricopa County.
2.2.5.2.1
The local account manager shall communicate with Maricopa
County’s
Risk
Management
Workers’
Compensation
department regarding service issues through the County’s
contact relationship manager (CRM) case documentation
system. The PBM shall pay for the number of CRM case
documentation system licenses needed to service the
County.
2.2.6
Reporting
2.2.6.1
PBM shall report number and dollar amounts of claims processed each
month on a summary and detail level by plan and account structure.
Report shall be received by the County by the fifth of the following month.
2.2.6.2
PBM shall report monthly and year-to-date utilization reports, to be
received by the County by the fifth of the following month, indicating totals
of:
2.2.6.2.1
top 100 drugs by number of prescriptions filled and by cost;
2.2.6.2.2
generic, single-source brand and multi-source brand
dispensing rate and average ingredient costs; and
2.2.6.2.3
cost details (plan, member, and total per member per month
(PMPM) and per employee per month (PEPM) averages
ingredient
cost,
dispensing
fee,
average
discount
percentage, and generic efficiency).
2.2.6.3
PBM shall provide an annual utilization and trend report including overall
and plan-level performance analysis and recommendations for
improvements. Report must also include analysis of customer complaints
and appeals. Report shall be due to the County for fiscal year end June
30th by July 15th of the following fiscal year.
SERIAL 200167-RFP
2.2.6.4
PBM shall provide annually a Statement on Auditing Standards (SAS) 70
Audit report and other reports specified as required by the County’s
annual internal and/or external auditor. Report(s) shall be due to the
County for fiscal year end June 30th by July 15th of the following fiscal
year.
2.2.6.5
PBM must be able to interface with Origami Risk software to include the
following data interface (at a minimum) at no additional cost to the
County:
2.2.6.5.1
Claim file
2.2.6.5.2
Vendor file
2.2.6.5.3
Payment file
2.2.6.5.4
PBM must be able to post reports compatible with County’s
virtual printer driver; County currently uses Hyland Software
Virtual Printer.
2.2.6.6 PBM shall provide quarterly performance guarantee metrics, to be
documented by County and contractor on an annual basis, for fiscal year
end June 30th by July 15th the same year.
2.2.7
Claims Processing
2.2.7.1 PBM shall agree to have data utilization edits in place that identify and
deny duplicate claims, claims filed too soon, and claims requiring
authorization when such authorization is not in place and shall generate
messages to the pharmacist for review and approval or denial of the claim
due to safety issues.
2.2.8
Customer Service
2.2.8.1 PBM shall provide customer service staff that are fully trained on Maricopa
County’s pharmacy plan.
2.2.8.2 PBM shall provide a dedicated customer service team that is available
during the hours of 7:00 am to 6:00 pm MST Monday through Friday,
excluding County holidays (list of County holidays available upon award).
The PBM team will have thorough training and knowledge in the County’s
pharmacy plan designs.
2.2.9
Implementation Plan
2.2.9.1 PBM shall provide, annually, a detailed implementation plan with
mutually agreed upon tasks assignments. The implementation plan shall
be due to the County for fiscal year end June 30th by July 15th the same
calendar year.
2.2.9.2 PBM must comply with the current ICA Pharmacy Fee Schedule for
Arizona per Arizona Revised Statutes (A.R.S.) § 23-908.
2.2.10
Education Support
2.2.10.1
PBM shall provide Maricopa County with an array of educational
material and web-based tools that will help educate County employees
that require service on where to obtain prescriptions and how they are
covered (See Attachment D, Pricing Sheet). The tool(s) must also
provide suggestions for additional options for cost-effective medication
within the same therapeutic class.
SERIAL 200167-RFP
2.2.11
Network
With regard to the actual dispensing process involving the contracted providers in
PBM’s network, services will be provided to members upon the following terms
and conditions:
2.2.11.1
Pharmacy shall dispense generic equivalent drugs in lieu of prescribed
brand name drugs, if commercially available, if they meet the
requirements of the Industrial Commission Pharmaceutical Fee
Schedule Section I(C), and if they are consistent with the prescriber’s
orders and the dispensing pharmacist’s professional judgment and
current Federal and State laws and regulations.
2.2.11.2
Preferred Network
2.2.11.2.1
It is expected that PBM will propose a preferred network of
retail pharmacies where the County will receive a greater
discount than Average Wholesale Price (AWP).
2.2.11.3
Secondary Network
2.2.11.3.1
The County shall require a network that includes the
maximum number of retail pharmacies.
2.2.11.4
Specialty Drugs
2.2.11.4.1
PBM shall provide a cost-effective Specialty Pharmacy
Program with either centralized distribution or multi-channel
distribution that is national, convenient, consistent, and
flexible. Specialty pharmaceuticals are generally high-cost
medications that are usually prescribed for people with
complex or chronic medical conditions, for example,
multiple sclerosis, hemophilia, hepatitis, or rheumatoid
arthritis. Medications typically exhibit one or more of the
following characteristics: may be injected or infused,
although some may be taken orally; have unique
monitoring, storage or shipment requirements; require
additional education and support from a health care
professional; and are usually not available at retail
pharmacies.
2.2.11.4.2
The Specialty Pharmacy Program must have developed
services to meet the unique challenges of dispensing and
monitoring specialty pharmaceuticals. The Specialty
Pharmacy Program must provide cost-effective care and
promote positive patient outcomes through increased
adherence to medication regimen, as well as promote an
enhanced patient experience through the convenience of
scheduled delivery, disease management programs, and
compliance monitoring that employs a care-coordination
model. In care-coordination model, licensed clinicians (e.g.
nurses,
pharmacists,
and
physicians)
provide
comprehensive clinical management services. Clinical
professionals support patients through a plan of care that
includes education, training, and mental health support
(e.g., behavioral health, case management, or disease
management referral). The plan of care will address
education,
interventions,
compliance,
monitoring
parameters, and goals and outcomes of therapy. Non-
SERIAL 200167-RFP
adherence or non-compliance to the plan and the rationale
behind the non-adherence or non- compliance must be
communicated to the prescribing physician.
2.2.11.4.3
The Specialty Pharmacy Program must contain provisions
addressing preferred specialty medications and biosimilars.
2.2.12
Pharmaceuticals
2.2.12.1
The Pharmaceutical Fee Schedule applies to prescription medicines
(drugs) required to treat an injured employee, whether the medicine is
dispensed by a pharmacy or dispensed by a physician.
Medicines dispensed by either a pharmacy or physicians are subject
to the most recent Pharmaceutical Fee Schedule, provided on the
azica.gov website (https://www.azica.gov/2019-arizona-physicians-fee-
schedule).
2.2.12.2
Generic drugs shall be dispensed to workers' compensation claimants
when they are available and as provided in A.R.S. § 32-1963.01,
subsections A and C through L; for purposes of this section, the
definitions found in A.R.S. § 32-1963.01 apply.
2.2.12.3
Reimbursement for prescription medicines shall be based on the
medication dispensed, including a brand name drug that is
dispensed, as provided in A.R.S. § 32-1963.01.
2.2.12.4
Reimbursement for prescription medicines shall be based on the
Pharmaceutical Fee Schedule in the absence of a contractual
agreement between the pharmacy and payer governing reimbursement.
Network discounts may not be applied in the absence of a contractual
agreement with the pharmacy authorizing such discounts.
2.2.12.5
Reimbursement for injectable drugs requires a provider to identify
the injectable drug given through the use of an accepted industry
identifier, such as the applicable national drug code (NDC), to enable
the payer to make the appropriate payment.
2.2.12.6
As another cost reducing measure, the Commission is asking the
medical community to voluntarily prescribe less costly drugs whenever
possible.
2.2.12.7
Whether dispensed by a pharmacy or dispensed by a medical
practitioner or by a pharmacy not accessible to the general public, the
dispensing fee per prescription shall be $7.00 as recommended by
the ICA.
2.2.12.7.1
If a prescription or over the counter (OTC) medication is
administered by a medical practitioner, a dispensing fee is
not permitted.
2.2.13
Infusion Therapy
2.2.13.1
PBM may propose a separate Specialty Infusion Program that features
cost containment and cost avoidance to reduce and manage
inappropriate utilization of services, decrease cost drivers associated
with location of care, and identify cost-effective, convenient, coordinated
care. The Specialty Infusion Program must improve member health and
well-being by providing access to accurate, objective, and relevant
SERIAL 200167-RFP
healthcare information, improve member quality of life, and decrease
absenteeism. The Specialty Infusion Program must demonstrate,
through reports and documentation, a defined return on investment for
the County and proven positive outcomes for members.
2.2.14
Injectables
2.2.14.1
PBM may propose an Injectables Program to manage the cost of
injectable medication (including self-injectable and those administered
in a physician’s office or hospital) through the PBM. The program must
demonstrate, through reports and documentation, a defined return on
investment for the County and proven positive outcomes for members.
2.2.15
Durable Medical Equipment (DME) Distribution
2.2.15.1
PBM shall propose a DME distribution program for DME available at a
medical supply facility or retail pharmacy store where there is a defined
return on investment for the County. This program shall include
equipment, wound care, ostomy supplies, nebulizers, respiratory aids,
and incontinence supplies. This service should be processed through
the pharmacy authorization process.
SERIAL 200167-RFP
EXHIBIT B-1
VENDOR NARRATIVE
Medical Bill Review and Check Writing Services
5.7.1.1
Respondents must answer the following questions to be considered for Workers’ Compensation
Medical Bill Review and Check Writing Services (BRCWS)
5.7.1.1.1Describe the implementation process you would employ for a seamless transition of
our cost containment operations to your organization and address all aspects including
account setup, EDI development, history transfer, etc. Provide the name of your
implementation manager who will be assigned to the County and his/her related
professional experience.
As the incumbent for Bill Review services, no further implementation is required at this
time. All necessary services and procedures are already in place. However,
Contractor is open to discussing enhancements and any changes that the County is
looking to implement.
5.7.1.1.2Which office locations will perform re-pricing for our account? What is the composition
of your Medical Bill Review staff at this office (titles and number of associates per
position)?
The Phoenix, Arizona office will continue to perform re-pricing for Maricopa County:
1850 North Central Avenue
Suite 1200
Phoenix, AZ 85004
Contractor’s medical bill review staff includes the following personnel:
1 Manager
2 Senior Analysts with specialties in quality assurance
1 Senior Analyst, Professional Review Specialist and CPC
1 Senior Analyst, Provider Relations
3 Bill Review Analysts
2 Clerical Assistants
5.7.1.2
Other than reducing bills to state’s fee schedule, elaborate on other methods your firm will provide
to allow for further reductions.
Contractor saves our customers over $4 billion annually, allowing the County to achieve 65%
savings per bill in 2019. Our effective bill review process, proprietary PPO network, and
professional review service provides the most comprehensive solution for the County. Each
feature focuses on increasing processing efficiencies and maximizing savings opportunities
delivering up to 28% higher savings than leading competitors. Contractor can offer increased
savings on all medical bills due to our integrated processing via automation and advanced
technology. We offer the leading Return on Investment (ROI) in the marketplace. Depending
on the state, the ROI can be as high as 25:1.
Contractor is able to offer our customers significant increased savings due to the following
steps performed on each bill as needed:
Bill review's artificial intelligence engine- includes millions of rules, creating a
comprehensive review process that is more efficient than the traditional
manual bill review, has achieved industry leading savings results, and either
reduces or eliminates manual tasks.
Appropriate, reasonable, and customary rule - applied to all medical bills,
reducing the costs from 10-40% depending on state regulations. Updates to
SERIAL 200167-RFP
reasonable and customary rates are made in accordance with FAIR Health's
release schedule.
Professional review- employs an experienced and trained team of registered
nurses to review bills against actual medical files in order to find inconsistencies
between services provided and services billed. Our experienced review staff
has clinical backgrounds in all areas of medicine as well as medical billing and
coding to ensure an accurate, consistent and thorough review.
Negotiation services- negotiation services are applied on out-of-network bills
with penetration of over 30%, and incremental savings of 15% or greater above
and beyond normal bill review fee schedule application. Negotiations use
clinical review and multiple data sources to find the best savings. Each bill
achieves a sign-off with provider approval resulting in no balance billing issues
to the employee/insured, their family, or the client.
5.7.1.3
List any affiliated PPO providers or other providers that offer discounted programs to your
organization.
We are the only company that maintains a leased network with Blue Cross Blue Shield of
Arizona offering the most PPO savings possible. We provide an integrated managed care program
with 100% transparency to all services and transactions within our online system. In addition,
contractor offers a proprietary national PPO network comprised of over 750,000 board certified
providers and locations. We also provide more than 9,000 providers and specialties in the state
of Arizona, offering our clients local insight with national coverage.
Providers are selected from a demanding criteria based on quality, range of services, price,
and location. Each provider is thoroughly evaluated, credentialed, and re-credentialed every 3
years. Through this extensive evaluation process, contractor is able to provide significant medical
savings while maintaining high quality care. Contractor’s provider listings can be accessed via
our website at www.corvel.com or our healthcare portal, www.caremc.com, where users can
locate providers in their area, see a map, get door to door driving directions, or print a directory.
5.7.1.4
How does your company handle charges that are not covered by the approved and current fee
schedules on the ICA website? What method does your company employ to ensure the County
agency does not overpay for non-covered services? Describe your provider inquiries department
and how you address provider complaints. What specific (uniqueness) can you offer about your
handling of provider inquiries that will ensure the number of provider complaints received by the
County’s staff is minimized?
Contractor reviews all charges that are not covered by the Arizona fee schedule. We will
generally re- price based on contract language. In some cases, it will be less than what is
dictated by a fee schedule. Appropriate payment is determined from similar treatments and/or
reasonable and customary charge data. Through this process, we verify that the County will
not be overpaying for non-covered services. Contractor shall assist and support in recouping
those overpayments in a timely manner.
Contractor offers a provider portal that lets providers quickly and easily access Electronic Fund
Transfer (EFT) and check payments as well as EOR images, eliminating the need for contractor
to send paper payment statements and emails.
Features of the provider portal include:
View bill status for EFT and check transactions
View EOR images
View zero pay EORs
Export data to Excel
Upload documents and medical bills to contractor
View bundled/unbundled EFT payments
Update provider information (add or remove provider, update location, etc.)
SERIAL 200167-RFP
Provider Inquiries
Providers are able to submit disputes and inquiries on contractor’s websites (www.corvel.com)
and www.caremc.com) or by telephone to our Provider Relations team at 602-288-2020. They
are also instructed on the EOR to contact contractor with any PPO related issues. Our
provider relations representatives contact providers via email, fax or telephone within 24 hours
of the inquiry. The Arizona provider email address is southwest_pr@corvel.com.
Provider Complaints
For provider-related issues, contractor has initiated procedures to ensure open communication
with all parties. Any complaints, filed by an injured worker, provider, employer or insurer will be
treated as a grievance. The formal grievance is forwarded to the contractor Provider Relations
staff where it will be promptly be reviewed and details of the grievance will be investigated. The
appropriate parties will be contacted to discuss the situation and necessary corrective action will
be initiated. The resolution will be documented in writing to all parties.
At any time when the Provider Relations staff is unable to resolve a PPO provider grievance at
Level One, a written summary of all telephone, written, or onsite discussions will be completed
by the Provider Relations staff and forwarded, along with the initial grievance form, to the
Contractor Manager and the Provider Network Quality Assurance (QA) Committee for further
review. All parties will be notified, in writing, of the recommendations for resolving the grievance.
Three grievances submitted for any network provider within a one-year period will result in a
more in-depth review of the provider's practice patterns and referral to the QA Committee. Three
grievances submitted for any contractor customer will result in an onsite meeting with the
management/Supervisory staff of the payor/employer and referral to the QA Committee.
Providers may contest the finding of the QA Committee in writing by providing sufficient
information or proof that the findings were inappropriate. Any contest will be reviewed by the
Contractor Medical Director or the physician member of the QA Committee. The results of the
review will be communicated in writing by the physician reviewer and will include a statement
that the findings were upheld, overturned, or an alternate finding was determined with
explanation of the alternate finding.
Any provider that has been terminated from the network can apply for reinstatement after a period
of six months. Upon reapplication (including new credentialing information), the provider will be
reinstated upon approval by the QA and Credentialing Committees and after a successful interview
with the Contractor Medical Director or the physician member of the QA Committee.
5.7.1.5
Does your company use a third party to process billing? If so, what company is used? Preference
will be given to companies that do NOT use a third-party bill processor.
No, we do not use a third-party vendor to process our bills. Contractor manages Bill Review from
intake to EOR on bills that range in complexity from provider to hospital bills. Contractor’s
software, systems, and staff are direct resources of our company.
Contractor has over 200 employees located in Portland, Oregon involved in the development,
management and support of our bill review software. Payors are able to review and approve
bills online as well as access savings reports in an instant through our online system. This EDI
process is paperless proving to be cost effective and efficient with no storage or filing costs.
Our rapid turnaround time and online platform make information available in real time. For
a complete solution, contractor offers provider reimbursement, which submits payment to
providers upon client approval.
5.7.1.6
What is the process for the check writing service? Is pre-payment required? How frequently are
invoices sent?
One of the most innovative interfaces of contractor’s bill review service is our automated
issuance of provider reimbursements. We provide access to an online bill approval tool where
the County can track the status of a bill, view images and EORs, and approve or deny payment.
Once a bill is marked for approval, the EOR and the attached check is mailed to the provider within
SERIAL 200167-RFP
48 hours. An electronic payment file is then sent to our client and/or their TPA systems on a
nightly basis.
Contractor’s provider reimbursement service allows the ability to determine dollars spent,
dollars reviewed, and assist in setting reserves through charts available online. Our bill approval
tool and automated reimbursement service will allow the County to experience an increase
in savings through increased efficiencies while saving time for the Adjuster due to easy
accessibility. Contractor is able to accommodate a pre-payment process.
The County can view invoice and payment status via our online approval tool. The County will
be able to track the status of a bill, view images and EORs, and approve or deny payment.
Once a bill is marked for approval, the EOR and the attached check is mailed to the provider
within 48 hours. A 1099 report is mailed to the provider at the end of the year. An electronic
payment file is then sent to the County on a nightly basis.
Current process for Maricopa works as follows:
Once a week on Fridays, the treasury department sends an invoice and check
register for the previous week to the client
The County funds via ACH Credit
Once we receive the funds, we release the checks, which are mailed out to
providers
5.7.1.7
Provide proof that respondent has been in the Workers’ Compensation Bill Review business for
a minimum of five consecutive years (see section 2.1.4).
Contractor has been providing bill review services for 35 years.
5.7.1.7.1Provide sample reports as required in section 2.1.3.
*See electronic procurement file/vendor response.
Pharmacy Benefit Manager
5.7.1.8
Respondents must address the following in their proposal to be considered for Pharmacy Benefit
Manager (PBM) services (see section 2.2).
5.7.1.8.1Implementation plan per section 2.2.9.
Contractor offers an efficient process for pharmacy program implementation that is
handled by our Pharmacy Solutions Implementation Team. The process involves to
ensure a seamless transition for your injured workers.
Steps for implementation include:
Transfer medications and claims history of tail claims to contractor.
Develop a custom formulary to meet the County's specific program needs.
Each formulary is reviewed quarterly with contractor’s nurse, pharmacist, and
data analysis team to ensure quality and safe care.
Train Adjuster's on point of sale, prior authorization, and formulary training.
All medication
transactions are visible for maximum pharmacy spend
management.
Notify eligible injured workers via notification letter of new benefits with
pharmacy card.
Send reminder of new coverage with clear messaging including national
CorVel Pharmacy Solutions phone number.
The Pharmacy Solutions Implementation team closely monitors the first 30
days’ activity, followed by a review meeting.
SERIAL 200167-RFP
5.7.1.9
Dedicated PBM consultant to be the County’s key clinical pharmacist and strategist; provide the
name of your consultant and his/her related professional experience.
Ryan Hamm, Clinical Pharmacist, monitors pharmacy alert reports to identify and
manage “at risk” claims. He also works with treating prescribers, contractor staff, and
Adjusters to explore and recommend alternative pain solutions on a case-by-case
basis. Ryan works with the Formulary Support team and clients to define, update, and
support formularies. Kem Gentes, Pharmacy Nurse, provides clinical support to
internal and external staff as well as to the prior authorization process. Among other
tasks, she assists with targeted medication clinical interventions, provides patient-
specific drug reviews, recommendations, and serves as a drug information resource.
5.7.1.9.1Dedicated local account manager; provide the name of your dedicated local account
manager who will be assigned to the County and his/her related professional experience.
Dani Oluyeba will be the local Account Manager for the County. Dani has over 15 years
of extensive experience in Account Management and Client Relationship Management.
She has worked in the PBM and finance industries with proven success in first class
customer service.
5.7.1.9.2List of all generic drugs on your Maximum Allowable Cost (MAC) manufacture list.
Contractor provides a discount across all generic medications as we have found it to
be the best savings in the workers compensation market. We are open to discussing
a MAC list and MAC pricing option. Generic substitution is an important aspect of
reducing drug spend. Brand drugs cost 3-5 times more than their generic substitutes.
The PBM industry equates every 1% improvement in the generic dispensing rate
will correspond with a 1% savings over the entire pharmacy spend. Contractor targets
an 85% generic dispensing rate for our clients.
If a generic substitution is available, the pharmacist is required to substitute the generic
unless the
physician has indicated Dispense-as-Written (DAW). DAWs are not
dispensed automatically but are stopped at the point-of-service by a prior authorization
for all brand drugs with generic equivalents. We will then call the prescribing physician's
office to request a substitution. This drive to generics will have a significant impact on
the overall cost of the County's program. Contractor offers step therapy programs to
dispense either generic or over-the-counter options for a period of time before
dispensing the stronger, and often more costly, prescription drug.
5.7.1.9.3List of off-list price or retail price of DME.
Contractor’s DME network panel is comprised of several national industry leading
providers. To help ensure optimized savings, all services are quoted at the point of the
referral, and quotes are reviewed before service delivery. As a quoted service, we do
not have a full pricing list. However, overall savings generally ranges from 5-15% below
state workers’ compensation fee schedule or usual and customary pricing.
5.7.1.9.4List of preferred networks of retail pharmacies.
Please see Attachment F: Arizona Retail Pharmacies.
5.7.1.9.5Sample reports as required by section 2.2.6.
Contractor will provide the County with a full variety of reports to analyze our
pharmacy services, demonstrate savings, performance, generic, brand, and mail
order drug utilization, penetration, as well as additional metrics.
SERIAL 200167-RFP
Standard pharmacy reports
include:
Pharmacy savings
detail & summary
Drug specific report
Pharmacy alert report
Pharmacy detail report
Clinical modeling report
Medication review report
SERIAL # 200167-RFP
EXHIBIT C: ARIZONA RETAIL PHARMACIES
SERIAL 200167-RFP
SERIAL 200167-RFP
SERIAL 200167-RFP
SERIAL 200167-RFP
SERIAL 200167-RFP
SERIAL 200167-RFP
SERIAL 200167-RFP
SERIAL 200167-RFP
SERIAL 200167-RFP
SERIAL 200167-RFP
SERIAL 200167-RFP
SERIAL 200167-RFP
SERIAL 200167-RFP
SERIAL 200167-RFP
SERIAL 200167-RFP
SERIAL 200167-RFP
SERIAL 200167-RFP
SERIAL 200167-RFP
SERIAL 200167-RFP
CORVEL HEALTHCARE CORPORATION, PO BOX 911964, DENVER CO 80291
PRICING SHEET: NIGP CODES 94620, 27176, 94886
Terms:
NET 30
Vendor Number:
VC0000009500
Certificates of Insurance
Required
Contract Period:
To cover the period ending June 30, 2021.