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Agenda Item
ASR
Control 06-000303 |
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MEETING DATE: |
03/07/06 |
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legal entity taking action: |
Board of Supervisors |
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board of supervisors
district(s): |
All Districts |
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SUBMITTING
Agency/Department: |
Human Resources Department (Approved) |
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Department contact
person(s): |
Julie Nguyen 834-2978 |
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Patti Gilbert
834-2564 |
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Subject: Selection of Consulting Firm to Perform
Audit
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ceo Concur |
County
Counsel Review |
Clerk of the Board |
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Concur |
N/A |
Consent Calendar |
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3 Votes Board Majority |
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Budgeted: N/A |
Current Year Cost:
N/A |
Annual Cost:
N/A |
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Staffing Impact: No |
# of Positions:
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Sole Source:
N/A |
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Current Fiscal Year Revenue: N/A |
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Funding Source: N/A |
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Prior Board Action: N/A
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RECOMMENDED ACTION(S)
Select Mercer Human Resource Consulting as the primary vendor to provide Medical and Dental Claims Audit and Operational Assessment of PacifiCare Health Plan Administrators, Inc., a medical and dental third party administrator (TPA) and authorize the Human Resources Department to negotiate an agreement and return to your Board for approval of the agreement.
SUMMARY:
The Human Resources Department requests your Board's selection of Mercer Human Resource Consulting to provide Medical and Dental Claims Audit and Operational Assessment of PacifiCare Health Plan Administrators, Inc., a medical and dental third party administrator (TPA).
BACKGROUND INFORMATION:
CEO/Purchasing released Request For Proposal (RFP) # 50Z0000004 on December 2, 2005 and the County “On-Line Bid Notification System” notified approximately 311 prospective vendors of the bid opportunity. The County’s RFP was open for approximately 20 business days and consisted of a “pre-proposal questionnaires submission” wherein prospective bidders were given the opportunity to submit written questions in regards to the County’s bidding process and requirements.
As a result of this process, 24 vendors expressed interest in submitting a response to fulfill the County’s requirements and copies of the RFP were sent to each. The RFP process closed on December 29, 2005 and the County received a total of 3 responsive proposals that were reviewed by CEO/Purchasing and referred to an evaluation committee comprised of representatives from Human Resources\Employee Benefits, Internal Audit and Auditor-Controller.
The evaluation committee reviewed each proposal and rated it based upon its: background, general description and organizational structure; qualifications and experience in conducting Medical and Dental Claims Audit and Operational Assessment of TPAs for self insured health and dental plans; overall responsiveness to the Request for Proposal; degree of compliance with County model contract terms and conditions and fees. The resulting average scores, on a scale ranging from 0 to 100 were:
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CONTRACTOR |
FINAL SCORE |
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Mercer Human Resource Consulting |
87 |
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Insurance Claims Auditing & Professional Services, Inc. (ICAPS), |
69 |
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Patriot Management Care Solutions, Inc. |
45 |
Based upon the evaluations using the criteria stated above, it is the recommendation of the evaluation committee that Mercer Human Resource Consulting be selected to provide Medical and Dental Claims Audit and Operational Assessment of PacifiCare Health Plan Administrators, Inc. Mercer has well over twenty (20) years experience in auditing and evaluating health plan vendors. They have demonstrated extensive experience with conducting implementation audits of PacifiCare Health Plan Administrators, Inc. and within the last three (3) years they have conducted approximately 400 health plan vendor audits with over 95% of the audits were for self-funded health plans.
Mercer’s overall responsiveness to the RFP was rated with top scores by all panel members which is an indicator of their depth of understanding of the County’s needs in terms of the audit. Their specialized claims audit staff has claims and auditing experience, both on behalf of employers as well as internal vendor operations. Their proposed audit team includes individuals who have extensive knowledge of all aspects of the self-funded health and dental plans. Their Performance Evaluation and Audit Group, a specialty group within Mercer Health and Benefits that specializes in operations consulting, has unparalleled experience in evaluating claims administration operations. In addition, their proposed pricing alternatives and options are very competitive and they will place a portion of their fees at risk that guarantee the delivery of audit services to the County’s satisfaction. These alternatives could potentially lead to greater efficiencies within the scope of the audit by identifying additional savings opportunities and by increasing plan participant satisfaction. Outlined in its work plan and schedule, Mercer will prepare an Action Strategy Matrix to monitor PacifiCare’s progress in implementing agreed-to-actions in response to audit findings.
The Human Resources Department
requests your Board’s selection of Mercer Human Resource Consulting to provide
Medical and Dental Claims Audit and Operational Assessment of PacifiCare Health
Plan Administrators, Inc. Additionally,
the Human Resources Department requests the Board’s authorization to negotiate
an agreement with Mercer Human Resource Consulting and to return to your Board
for approval of the agreement.
FINANCIAL IMPACT:
N/A
STAFFING IMPACT:
N/A