Ambulance Billing and Collection Services · Ambulance Billing and Collection ... • Billing...
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RFP Number: FB 15-01 Date Issued: January 7, 2015
Ambulance Billing and Collection
Submittal Date and Time: February 11, 2015 at 3:00 p.m. Alaska Prevailing Time
Pre-Proposal Conference Date and Time: January 28, 2015 at 3:30 p.m. Alaska Prevailing Time
Location: City of Fairbanks City Hall, Council Chambers
800 Cushman Street, Fairbanks, Alaska
Submit Responses To: CITY OF FAIRBANKS
CITY CLERKS OFFICE ATTN: SHANNON KUMPULA, PURCHASING AGENT
800 CUSHMAN STREET FAIRBANKS, ALASKA 99701
CITY OF FAIRBANKS REQUEST FOR PROPOSALS
AMBULANCE BILLING AND COLLECTION SERVICES FB 15-01
Qualified entities are invited to submit a proposal to furnish Ambulance billings and collections services for the City of Fairbanks, Alaska. The RFP documents may be obtained at the City of Fairbanks City Hall, Office of the City Clerk, 800 Cushman Street, Fairbanks, Alaska or online at www.fairbanksalaska.us by selecting See Invitations to Bid. A pre-proposal conference is planned on Wednesday, January 28, 2015 at 3:30 p.m. Alaska Prevailing Time. The conference will be held at City of Fairbanks City Hall, Council Chambers, 800 Cushman Street, Fairbanks, Alaska. You may also attend by calling our conference line at 907-459-6769. Proposals must be submitted by 3:00 p.m. Alaska Prevailing Time on Wednesday, February 11, 2015 and must contain one (1) original and five (5) printed copies with supporting materials. The proposal must be sent to:
City of Fairbanks City Clerks Office ATTN: Shannon Kumpula, Purchasing Agent
800 Cushman Street Fairbanks, AK 99701
Telephone: 907-459-6767 Proposals must be submitted in a separate, sealed envelope plainly marked with the opening date and time and clearly marked as follows: SEALED PROPOSAL Ambulance billing and collection services FB 15-01. The City reserves the right to waive informalities not inconsistent with the law and to reject any or all proposals. Publish: Fairbanks Daily News-Miner, January 7th, 11th & 18th, 2015
TABLE OF CONTENTS
Section I ... Schedule
Section II ... Background Information
Section III .. Scope of Work
Section IV . Proposal Format and Content
Section V . Evaluation Criteria and Award
Section VI .. Proposal Terms and Condition
Section VII . Attachments
SECTION I SCHEDULE The schedule represents the Citys best estimate that will be followed:
Issue RFP on January 7, 2015
Proposers submit questions by 5:00 p.m. Alaska Prevailing Time, on January 23, 2015
Pre-proposal Conference held at 3:30 p.m. Alaska Prevailing Time, on January 28, 2015
Proposals due on February 11, 2015 at 3:00 p.m. Alaska Prevailing Time
Evaluation Committee completes evaluation by February 24, 2015
City issues Notice of Intent to Award a Contract by March 1, 2015
Finalize Contract Terms and Conditions by March 6, 2015
Mayor or City Council approve contract by March 9, 2015
Implementation begins by March 15, 2015
Implementation complete and contract begins on April 1, 2015. A pre-proposal conference is planned on the date listed above. The conference will be held at City of Fairbanks City Hall, Council Chambers, 800 Cushman Street, Fairbanks, Alaska. All questions regarding the RFP should be directed by submitting a Pre-Proposal Conference Questionnaire (Attachment A) no later than 5:00 p.m., Alaska Prevailing Time, on January 23, 2015. Questions received after this date and time will not be accepted. Send questions to:
Shannon Kumpula, Purchasing Agent City of Fairbanks
800 Cushman Street Fairbanks, AK 99701
[email protected] Phone 907-459-6767 Fax: 907-459-6722
Responses to submitted questions will be provided at the Pre-Proposal Conference. Verbal requests for information will not be accepted. Questions or requests for clarification directed to any employee or elected official of the City other than the Purchasing Agent may be grounds for disqualification from the process.
Proposers must submit the original and five (5) printed copies of their Proposal and supporting materials by 3:00 p.m., Alaska Prevailing Time, on February 11, 2015 to:
City of Fairbanks City Clerks Office Shannon Kumpula, Purchasing Agent
[email protected] 800 Cushman Street
Fairbanks, AK 99701 Phone: 907-459-6767 Fax: 907-459-6722
Proposals must be submitted in a separate, sealed envelope plainly marked with the opening date and time and clearly marked as follows: SEALED PROPOSAL Ambulance billing and collection services FB 15-01
SECTION II BACKGROUND INFORMATION INTRODUCTION The City of Fairbanks (City) was incorporated in 1903 and is located in Alaskas interior. It is located some 360 road miles north of Anchorage and 120 miles south of the Arctic Circle. The City has a land area of 33.8 square miles and a population of approximately 31,535. The City levies a property tax on real property located within its boundaries. The City is a home rule City under the laws of the State of Alaska. Home rule municipalities in Alaska have a broad range of local autonomy as defined by the City Charter. Since 1995, Fairbanks is a Council-Mayor form of government. Policymaking and legislative authority are vested in the seven-member City Council, of which the Mayor is a member. The Council is elected at large on a non-partisan basis. Council members and the Mayor are elected to three-year terms and cannot serve more than two consecutive terms. The City provides a variety of local government services, including public safety (police, fire suppression and prevention, emergency dispatch and emergency medical services), street construction and maintenance, garbage collection, public improvements, building and fire code enforcement, storm drain management, and general administrative services. The City of Fairbanks operates under a total budget of $34,108,629 and employs 197 full time paid staff members and 10-15 part time paid employees during busier months. The City of Fairbanks receives revenue from many different sources. The principal sources of revenue are property taxes and revenue received from the State of Alaska. Additional Information: Copies of the following documents are available at the following site: http://www.fairbanksalaska.us/annual-financial-reports/
Comprehensive Annual Fiscal Report for 2013 Comprehensive Annual Fiscal Report for 2012 Comprehensive Annual Fiscal Report for 2011
SECTION III SCOPE OF WORK GENERAL The City of Fairbanks (City) is soliciting proposals from qualified entities to provide ambulance billing and collection services. Below is an activity history of the Advanced Life Support (ALS) and Basic Life Support (BLS) EMS calls for the years 2009 through 2013 and the 2014 activity through 6/30/14. City Residents are charged $800 per ALS call and $600 for BLS call. Non-residents are charged $1,000 for ALS calls and $800 for BLS calls. Mileage at $0.12 (twelve cents) per mile is also charged.
Successful Bidders Fee for Services Provided: The City desires an all-inclusive rate for performing the billing and collection services. The successful bidders fee for services to be provided will be a flat rate calculated on actual collections received and shall cover all costs including but not limited to telephone and postage expenses, office supplies, and any other overhead expenses or administrative support. For example, if the fee for services is 1% and you collect $75,000 of the $100,000 billed the fee will be $750 ($75,000 X 1%). The Fee for Services should be submitted using Attachment C. Fees shall remain fixed throughout the term of the contract. The contract period will be for five years, with an option to extend another five years. ELIGIBILITY REQUIREMENTS Proposers must meet the following minimum requirements:
Each respondent shall be licensed to provide services in the State of Alaska and City of Fairbanks (if applicable) and provide copy of such license(s)
Billing system must be able to receive data files electronically from ImageTrend Inc. and/or the State of Alaska Aurora System, and maintain NEMSIS compliance (if applicable)
Entity must provide current copies of insurance coverage, including workers
compensation, general liability, professional liability and auto coverage (if applicable). Entity must provide a letter of intent to sign the Business Associate Agreement-HIPPA
(Attachment D) Entity must provide a listing of current Ambulance/EMS and medical billing customers
with contact information (names and phone numbers) Entity must assign sufficient experienced qualified personnel to conduct the services in
an efficient and professional manner Entity must have experience filing claims with governmental programs such as Medicare
and Medicaid as well as health insurance programs (HMOs and PPOs) Entity must submit a proposed Scope of Service statement with the RFP response
Entity must submit a description of their billing software system
Entity must submit a system disaster recovery plan, as well as, a full description of system backup and recovery plans
A proposers failure to meet these minimum requirements shall cause their proposal to be considered non-responsive and their proposal will be eliminated from further consideration. Late proposals will not be considered, regardless of the reason. RESPONSIBILITIES City Responsibilities:
The City will generate all billable and non-billable claims on electronic software. The claims will go through an in-house Quality Management review to make sure all pertinent information is contained in the reports before they are released to the billing agency. In addition, the EMS staff will make a reasonable effort to gather any additional information, such as the responsible insurance company information, general demographics of the patient and any other information which may assist in the billing process
The City will pay the successful bidder within thirty (30) days of receiving its monthly invoice for EMS billing services for the prior month at the agreed upon rates listed in the contract
The City will provide at least two contacts for the purpose of day to day billing operations to be able to answer questions and obtain requested information that may be required from the successful bidder. The City normal business hours will be Monday-Friday 8am-5pm, excluding holidays
The City shall maintain a Lockbox to facilitate receipt and deposit of all payments on customers accounts. The successful bidder shall have inquiry access to the account and will receive copies of all payment documents necessary to post collections to customers accounts. The City will pay all cost associated with the Lockbox Account
Successful Bidders Responsibilities:
Facilitate billing from reports generated by emergency services personnel, which includes electronic run reports, ancillary documents, hospital face sheet from the receiving hospitals
Receive, process, and store all documents on a secure server Demonstrate a minimum track record of five (5) years of billing insurance companies,
including Medicare, Medicaid, Third Party Insurances and HMOs, Commercial Insurances, Auto Insurances, Workers Compensation and patients directly Billing, filing, storing (both on and off-site), and receiving Medicare and Medicaid
claims and payments electronically Transmit/receive Medicare claims via the required national format, or any future
standard Medicare or Medicaid may require Filing electronic claims with all Commercial Insurance Carriers that accept electronic
claims Maintain an office that operates, at a minimum, during normal business hours of 8:00 am
to 5:00 pm Monday through Friday, excluding holidays, and have a toll free number for billing inquiries
Interact with the receiving medical facility to obtain additional data to complete the billing process
Promptly address issues that may arise in connection with this agreement and/or day to day billing questions from City staff
Possess and maintain the necessary equipment to perform billing and collection services Maintain necessary credentialing contracts with insurance providers. All credentialing
contracts will be approved and signed by the City Finance Director Services to be Performed: Successful bidders shall provide the following services:
Mail an invoice to each individual transported, at the rates established by the City for EMS transportation services within 10 days of receiving the data
File all insurance claim forms for all patients based upon information received from the patient or obtained from successful bidders research done at referring and/or receiving health care facilities to obtain payment
Comply with attorney requests for billing charges in a timely manner.
Any claim denials for medically necessary transports shall be resubmitted properly and within the time frame provided and additional information provided within the resubmission to show validity of the claim for maximum benefit.
Follow-up on electronically submitted and mailed claims for which payment has not been received at thirty (30), sixty (60), and ninety (90) days following initial submittal. Follow-up efforts and results must be documented and available to the City for review.
Record customer payments and refunds in a timely manner. Payments deposited to the lockbox bank account must be recorded on the customer's account within two (2) days of posting by the bank
Provide the City with necessary refund request including all pertinent information relating to refund payments to patients and/or insurance companies, indicating the refund payees name, address and reason for refund
Refunds (checks drawn) will be sent for approval and signature by the City Finance Director and Mayor, or their designee
When a billed account has become past due (an account older than the date of transport plus one hundred twenty days (120), that has a balance larger than zero), provide the City Fire Department with a listing of these past due accounts including all pertinent facts regarding attempted collection efforts. Remaining balances will be written off once approved by the City Finance Director or Mayor
Any other services as agreed by the parties in order to effectively collect transport fees
Reports: Within ten (10) days of the end of the prior month, the successful bidders shall submit the following reports:
Distribution of Charges and Collections This report will track the charges, payments and financial class mix of all patients for a given month or other specified period
Ages Receivable Report This report will have outstanding invoices sorted by date or account for thirty (30), sixty (60), ninety (90), one-hundred twenty (120), and over one hundred twenty days (121+) days. This report will also provide totals for these categories
Patient Alpha Listing This report lists all patients alphabetically by patient last name
Monthly Payment Listing This report lists payments, required charge offs (contractual adjustments), and refunds posted to each patients account
Overpayment (refund) Report This report lists all patients due refunds as a result of overpayment on account
Bank account reconciliation that ties to the Monthly Payment Listing and the Overpayment (refund) Report, a listing of Non-sufficient Funds (NSFs) and other bank fees and adjustments
SECTION IV PROPOSAL FORMAT AND CONTENT FORMAT AND CONTENT The City discourages overly lengthy and costly proposals. In order for the City to evaluate proposals fairly and completely, proposers must follow the format set out herein and provide all of the information requested. Proposals must include the complete name and address of the company and the name, mailing address, and telephone number of the person the City should contact regarding the proposal.
SUBMITTAL REQUIREMENT Proposers are required to submit their proposals in accordance with the maximum number of pages and content requirements indicated in the following table. Proposals shall not be written in a font size smaller than 12 point in any portion of the document. Each section of the proposal shall be identified and assembled in the order listed in the Proposal Content Requirements below. Failure to provide a proposal in conformance with these requirements may cause a proposal to be declared non-responsive and eliminated from further consideration. Maximum Number of
Pages Proposal Content Requirements
1 Item 1: Proposal Transmittal Form-with original signatures (Attachment B)1 Item 2: Fee Schedule (Attachment C)
15 Item 3: Eligibility Requirements (include attachments)1 Letter of Intent to sign Business Associate Agreement -HIPPA (Attachment D)5 Current copies of insurance and bonding certifications2 Item 4: Responsibilities
25 MAXIMUM TOTAL PAGES FOR RFP SUBMITTAL Proposal Transmittal Form The Proposers must include a fully completed and signed Proposal Transmittal Form as the cover sheet to the RFP (Attachment B). Failure to include this form fully completed and including an original signature shall cause the proposal to be declared non-responsive and eliminated from further consideration. Minimum Requirements Proposers must indicate how they meet each of the minimum requirements, if any, listed in Section III of this RFP. SECTION V EVALUATION CRITERIA AND AWARD INITIAL EVALUATION Initially, all proposals will be reviewed by the City Purchasing Manager to determine if they are administratively responsive to the RFP. Those proposals that are administratively responsive will be distributed to the evaluation committee. The committee will determine if the proposal meets all of the minimum requirements. This is a pass/fail evaluation. The proposals that pass the minimum requirements evaluation will be evaluated based on the evaluation criteria
described below. EVALUATION CRITERIA A Selection Committee will review proposals that are received. Proposals that are nonresponsive to the requirements shall not be included for evaluation. Proposal Complies with the RFP Requirements. YES____ NO____ If No, indicate the manner in which the proposal is non-conforming. Non-conforming proposals will not be considered: Responsive proposals will be evaluated under the criteria set forth below. For each criterion, the proposal will receive a number of points within the available range for that criterion.
1. Cost 50 Points 2. Minimum Requirements 30 Points 3. Responsibilities 30 Points 4. References 40 Points
Total Points Possible 150 Points Each Selection committee member shall determine which of the following descriptions applies to each of the foregoing proposal evaluation criteria: EXCELLENT (1.0): Of the highest or finest quality; exceptional; superior; superb; exquisite. Proposer provided information for a given criteria that satisfied the requirements and described specifically how and what will be accomplished in such a manner that exhibited and exceptional degree of understanding, skill and competency, both qualitatively and quantitatively. Demonstrated the Proposer's ability to perform and deliver far and beyond expectation. VERY GOOD (0.8): To a high degree; better than or above competent. Proposer provided information for a given criteria that satisfied the requirements and described specifically how and what will be accomplished in such a manner that exhibited a very high degree of understanding, skill and competency, both qualitatively and quantitatively. Demonstrated the Proposers ability to perform and deliver beyond expectation.
GOOD (0.6): Having positive or desirable qualities; competent; skilled; above average. Proposer provided information for a given criteria that satisfied the requirements and described specifically how and what will be accomplished in such a manner that exhibited a skillful degree of understanding, skill and competency, both qualitatively and quantitatively. Demonstrated the Proposer's ability to perform and deliver at the expected level. FAIR (0.4): Average; moderate; mediocre; adequate; sufficient; satisfactory; standard. Proposer provided information for a given criteria that satisfied the requirements and described sufficiently how and what will be accomplished in a manner that exhibited adequate and average degree of understanding, skill and competency, both qualitatively and quantitatively. Demonstrated the Proposer's ability to perform and deliver at a level slightly below expectation. POOR (0.2): Inadequate; lacking; inferior quality; of little or less merit; substandard; marginal. Proposer provided information for a given criteria that did not satisfy the requirements and described in an inadequate manner how and what will be accomplished. Demonstrated the Proposer's ability to perform and deliver at a substandard and inferior level. UNACCEPTABLE (0.0): Proposer failed to provide any information for a given criteria, provided information that could not be understood, or did not provide the information for a given category as requested. After the Selection Committee member has determined the description applicable to the Proposal evaluation criteria, the number of points available for each criterion shall be multiplied by the factor associated with the applicable description (e.g. member classifies the Cost criterion as Very Good, 50 available points X 0.8 applicable description multiplier = 40). In the event of multiple agencies with high scores the City may form a Competitive Range and establish a short list of proposers. Those proposers will have the opportunity to elaborate on their proposal and answer specific questions regarding their proposal. The interview process will be scored separately and utilize the same criteria as outlined above. AWARD Award shall be made to the responsive proposer whose proposal conforms to the solicitation and is determined in writing to be the most advantageous to the City taking into consideration cost/price and the evaluation factors set forth in the Request for Proposals.
SECTION VI PROPOSAL TERMS AND CONDITIONS Terms of Contract The initial contract term shall be for an initial five (5) year term. Fees quoted shall remain fixed for the initial five (5) year term Stipulations The Proposer shall hold the City free and harmless for all claims, liability and losses caused by the actions or failures to act on the part of the billing service, and the Proposer shall fully indemnify the City for all such claims, liability and losses should they occur. The City shall be named as an additional insured on a certificate of insurance issued and maintained during the term of the contract between the City and the ambulance billing provider. The Proposer shall have Workers Compensation Insurance in accordance with the state law in which the entity operates. The Proposer shall furnish City with evidence of this coverage before the execution of the contract. Termination This agreement may be terminated by either party at any time upon ninety (90) days written notice of termination to the other party. Upon termination of the agreement, for whatever reason, the Proposer shall deliver all records and pertinent correspondence concerning the accounts and collection activities thereto to the City, and the billing service will otherwise cooperate with the City or their assignees to affect an orderly transfer of the collection of the Citys accounts receivable. If either party should terminate this agreement, the billing service shall be entitled to receive from the City, any and all payments due to the billing service up to and including the actual date of termination and transfer of accounts receivable. The billing service must turn over all records and have them delivered to a location designated by the City upon termination of the contract. Examination of Proposals Proposers should carefully examine the entire RFP and any addenda thereto, and all related materials and data referenced in the RFP. Proposers should become fully aware of the nature of the work and the conditions likely to be encountered in performing the work. Request for Proposal Format Proposals must be made in strict accordance with the format provided herein. Bulletins and Addenda Any bulletins or addenda to the proposal specifications issued during the period between issuance of the RFP and receipt of proposals are to be considered covered in the proposal and in awarding a contract they will become a part thereof. Receipt of bulletins or addenda shall be
acknowledged by proposals in their cover letter. False or Misleading Statements If, our opinion, a proposal contains false or misleading statements or references that do not support a function, attribute, capability, or condition as contended, the entire proposal shall be rejected. Clarification of Proposal We reserve the right to obtain clarification of any point in a proposers proposal or to obtain additional information necessary to properly evaluate a particular proposal. Failure of a proposer to respond to such a request for additional information or clarification may result in rejection of the proposal. Responsiveness The proposal should respond to all requirements of this RFP to the maximum extent possible. Proposers are asked to clearly identify any limitations or exceptions to the requirements inherent in the proposed system. Alternative approaches will be given consideration, if the approach clearly offers us increased benefits. Rejection of Proposal Proposals that are not prepared in accordance with the instructions to proposers may be rejected or disqualified. If not rejected, the City of Fairbanks may demand correction of any deficiency and accept the corrected proposal upon compliance with these instructions to proposing proposers. Proposal Modifications Any bidder may modify their proposal in writing, which may be hand delivered or sent by certified mail up to two days prior to the closing time. The written communication should not reveal the price as this will not be known until the sealed bid is opened. Modifications will be accepted by the City, and binding upon the responding entity, where the modification:
Is received by the City at the place designated for submission of RFP responses prior to the deadline.
Clearly states FB 15-01 City of Fairbanks Ambulance Billing and Collection Services and the name of the responding entity.
Is signed by the same individual who signed the original submittal. The modification document shall include a photocopy of each page of the original submittal which the responding entity seeks to modify, with the modification and the respondents signature clearly set out in ink on each page. Facsimile modification documents will be accepted within a sealed envelope provided that the Proposers signature is clearly legible. Should there be more than one submittal modification from a responding entity, the last
modification received prior to the deadline shall be opened and applied to the submittal. All earlier modifications shall be returned to the responding entity unopened. Any modification, which fails to meet any requirement of this section, shall be rejected and the submittal shall be considered as if no modification has been attempted. Oral Change/Interpretation No oral change or interpretation of any provision contained in this RFP is valid whether issued at a pre-proposal conference or otherwise. Written addenda will be issued when changes, clarifications, or amendments to proposal documents are deemed necessary by the City. Late Submissions Regardless of cause, late qualifications will not be accepted and will automatically be disqualified from further consideration. It shall be the proposers sole risk to assure delivery at the designated office by the designated time. Late qualifications will not be opened and may be returned to the proposer at the expense of the proposer or destroyed if requested. Withdrawal of Proposals At any time prior to the scheduled closing time for receipt of RFP submittals, any responding entity may withdraw their submittal, either personally or by written request. However, a proposal may not be withdrawn after opening without the written consent of the City. Acceptance of Proposals The contents of the proposal of the successful proposer will become, at our option, a contractual obligation if a contract ensues. Failure of the successful proposal to accept this obligation may result in cancellation of the award. Proposals submitted are offers only and the decision to accept or reject is a function of quality, reliability, capability, reputation, and expertise of the proposing proposers. The City of Fairbanks reserves the right to terminate the selection process at any time and to reject any or all proposals. The City of Fairbanks reserves the right to accept the Proposal that is, in its judgment, the best and most favorable to the interests of the City of Fairbanks and to the public; to reject the low price Proposal; to accept any item of any Proposal; to reject any and all Proposals; and to waive irregularities and informalities in any Proposal submitted or in the Request for Proposal process, provided; however, the waiver of any prior defect or informality shall not be considered a waiver of any future or similar defect or informality. Proposers should not rely upon or anticipate such waivers in submitting their proposals. Proposal Acceptance Period Award of this proposal is anticipated to be announced within ten (10) calendar days after proposals are due, although all offers must be complete and irrevocable for ninety (90) days
following submission date. Dispositions of Proposals All materials submitted in response to this RFP will become the property of the City of Fairbanks. One copy shall be retained for the official files of the Purchasing Office and will become public record after award of the Contract. Confidentiality The content of all proposals will be kept confidential until the selection of the Contractor is announced. At that time, the selected proposal is open for review by the competing proposers, excluding any tabulations and evaluations thereof. After the award of the Contract, all proposals, tabulations and evaluations will then become public information. Confidential/Proprietary Information After award of the contract, proposals shall become public information except for proprietary information. If a proposer wishes individual pages, which contain actual business, proprietary information held confidential, each page must be marked and an explanation furnished of its proprietary nature. In addition to marking individual pages, the Proposals Cover will also be annotated with the words THIS PROPOSAL CONTAINS PROPRIETARY INFORMATION. Confidential and Proprietary information is not meant to include any information which, at the time of disclosure, is generally known by the public and/or competitors. News Releases News releases pertaining to the award resulting from the RFPs shall not be made without prior written approval of the Citys Purchasing Manager. Choice of Law and Jurisdiction The laws of the City of Fairbanks and State of Alaska shall govern this RFP, and any legal action brought therein shall be filed in the Fourth District at Fairbanks, Alaska. Conflicts of Interest No member of the governing body of the City of Fairbanks or other officer, employee or agent of the City of Fairbanks who exercises any functions or responsibilities in connection with the carrying out of the project shall have any personal interests, direct or indirect, in any ensuing contract as a result of this RFP. The contractor for itself and its principal employees, officers, agents, directors, or shareholders covenants that neither the contractor nor any of the listed classes of individuals has nor shall acquire any interest, direct or indirect, in the project, direct or indirect, to which the contract pertains which would conflict in any manner or degree with the performance of its work hereunder. The successful proposer further covenants that in its performance of the contract no person having such interest shall be employed, without first disclosing his/hers potential conflict.
Insurance Successful proposer shall maintain throughout the period of this contract, insurance in the following minimum requirements:
Commercial General Liability Insurance: The Contractor is required to provide Commercial General Liability (CGL) insurance on an occurrence form with limits not less than $500,000 Combined Single Limit per Occurrence and $1,000,000 in the Aggregate not excluding premise operations, independent contractors, products and completed operations, broad form property damage, blanket contractual, collapse, and underground hazards.
Comprehensive Automobile Liability Insurance: The Contractor shall cover all owned, hired, and non-owned vehicles with coverage limits not less than $100,000 single limit per occurrence for bodily injury and property damage.
Workers Compensation and Employers Liability Insurance: Statutory requirements by the applicable state law or regulation. Employers Liability insurance shall be $100,000 each accident for bodily injury, $500,000 policy limits for bodily injury by disease, $100,000 per employee for bodily injury by disease.
Professional Liability, including Valuable Papers Coverage: In the amount of $500,000, or the contract ceiling price, whichever shall be greater.
Without limiting its indemnification, the Contractor shall maintain, until acceptance of the project by the Owner, all insurance specified and minimum limits set forth.
Owners Responsibilities The City will provide a project manager from the Finance Department to assist the consultant, coordinate the work and administer the contract. Statutory Requirements The consultant chosen will be expected to comply with all Federal, State, Borough and City laws and statutes. Sections from State of Alaska Statutes and City of Fairbanks Code of Ordinances are listed, for your reference, because of their particular applicability to this project.
Alaska Professional Registration Requirements AS 08.48 City of Fairbanks Purchasing Ordinance, Particularly Fairbanks General Code Section
54-201 through 54-208: Competitive Sealed Proposals The proposer chosen must comply with all Federal non-discrimination and affirmative
action requirements, including Title VII of the Civil Rights Act of 1964 and 1992; Equal Employment Opportunity (EEO) provisions contained in 41 CFR Part 60
Proposers certify, by the submission of their proposal that they comply with applicable portions of the Federal Civil Rights Act of 1964, the Equal Employment Opportunity Act, Alaska Statute 18.80.010 18.80-300, and regulations issued under these acts by the state and federal governments. Proposers not in compliance with these requirements will be declared non-responsive
Selected entity will maintain compliance with the Public Laws, Acts, and Codes of Federal Regulations (CFR) contained in the Business Associate Agreement-HIPPA (Attachment D)
Tax Compliance The City of Fairbanks requires the successful proposal to be in compliance with tax provisions. No contract will be awarded to any business found to be in violation of the Fairbanks General Code of Ordinances in several areas of taxation. Licensing Requirements Section 43.70.020 of the Alaska State Statutes requires that all businesses, wishing to engage in business in Alaska, obtain a license. Fairbanks General Code 14-601states that every person and other legal entity required to obtain a state business license shall obtain an annual city business license, in addition to any other license required by this code, if the person or legal entity maintains business premises within the City limits, delivers goods or provides services within the City limits or otherwise does business in the City limits. Prior to award of any contract, the successful proposer will be required to provide the City with a copy of a current Alaska and City Business Licenses. Selection Process The City of Fairbanks, through a selection committee, will review the submitted proposal using the evaluation criteria. Contract negotiations will begin with the most qualified and suitable entity to determine whether an agreement can be reached. If an agreement cannot be reached, then the City may negotiate with the next most qualified and suitable entity. The final contract will be submitted to the Mayor for approval. Award of Contract A contract may be awarded to the responsible and responsive entity whose proposal is determined to be the most advantageous to the City, taking into consideration price and the evaluation factors set out in the request for proposals. Right to Reject and Not Award The City may accept or reject any and all proposals or waive irregularities, and reserves the right not to award the contract when it is in the best interest of the City. SECTION VII ATTACHMENTS
A - PRE-PROSAL CONFERENCE QUESTIONNAIRE B - PROPOSAL TRANSMITTAL FORM C - FEE SCHEDULE D - BUSINESS ASSOCIATE AGREEMENT-HIPPA
ATTACHMENT A PRE-PROPOSAL CONFERENCE QUESTIONNAIRE
This page must be returned via fax (907-459-6722) or email ([email protected]) by 5:00 p.m. on January 23, 2015 The pre-proposal conference will be held in the Council Chambers at 800 Cushman Street, in Fairbanks, Alaska. It will begin at 3:30 pm on January 28, 2015 and continue until all questions have been addressed. If your entity cannot be there in person you may call (907) 459-6769 to participate. Entity: _____________________
______ Yes, a representative will be attending the pre-proposal conference. Our questions regarding the RFP are listed below (or attached).
______ No, a representative will not be attending the pre-proposal conference; our questions regarding the RFP are listed below.
Please list any questions you would like addressed below:
ATTACHMENT B PROPOSAL TRANSMITTAL FORM
This form is to be completed in full, signed and submitted as the cover sheet of the proposal.
I certify that I am a duly authorized representative of the entity listed below and that information and materials enclosed with this proposal accurately represent the capabilities of the office listed below for providing the services indicated and comply with all provisions in this RFP. In addition, I certify that I am a company officer empowered to bind the company to the requirements of this RFP and to our proposal. The City is hereby authorized to request anyone identified in this proposal to furnish any pertinent information deemed necessary to verify information provided or regarding reputation and capabilities of the entity.
A. Amendments The proposer represents to the City that it has relied upon no oral representations from the City in the preparation of this proposal. If any amendments are issued to this RFP, proposer must acknowledge the receipt of such amendments in the space provided on the line below or by signing the amendment and submitting it before the submittal deadline, unless the amendment states otherwise. Proposals that fail to acknowledge receipt of amendments may be considered non-responsive and be eliminated from further consideration. The proposer acknowledges receipt of the following Amendments:
B. Original Signature This Transmittal Form must include an original signature. A proposal shall be considered non-responsive and eliminated from further consideration if an original signature is not included. Signature of Representative Office Address for which this submittal is
made: Date: Street: Name: PO Box: Title: City State Zip: Entity: Phone: _ Email address: __________________________ Fax: _____________________________ Alaska Business License No.: _______________ City Business License No: ____________
AMBULANCE BILLING AND COLLECTION SERVICES
Price Proposal Sheet RFP responses must be completed as described in the RFP, indicate an understanding of the scope of services to be provided, and include sufficient documentation to verify vendor past history and competency in providing like services as well as the intent to continue doing the same in the foreseeable future. Compensation proposal to be a flat rate (%) of collections deposited into the lockbox: ___________ Percent fee Date _________________________________________
Name of Entity _________________________________________
Entity Address _________________________________________
City, State, Zip _________________________________________
Phone Number _________________________________________
Fax Number _________________________________________
Web Site _________________________________________
Attachment D Business Associate Agreement-HIPPA
Between The City of Fairbanks Fire Department and ________________________________
This Business Associate Agreement (Agreement) between The City of Fairbanks Fire Department and ________________________ is executed to ensure that ________________ will appropriately safeguard protected health information (PHI) that is created, received, maintained, or transmitted on behalf of The City of Fairbanks Fire Department in compliance with the applicable provisions of Public Law 104-191 of August 21, 1996, known as the Health Insurance Portability and Accountability Act of 1996, Subtitle F Administrative Simplification, Sections 261, et seq., as amended ("HIPAA"), and with Public Law 111-5 of February 17, 2009, known as the American Recovery and Reinvestment Act of 2009, Title XII, Subtitle D Privacy, Sections 13400, et seq., the Health Information Technology and Clinical Health Act, as amended (the HITECH Act).
A. General Provisions
1. Meaning of Terms. The terms used in this Agreement shall have the same meaning as those terms defined in HIPAA.
2. Regulatory References. Any reference in this Agreement to a regulatory section means the section currently in effect or as amended.
3. Interpretation. Any ambiguity in this Agreement shall be interpreted to permit compliance with HIPAA.
B. Obligations of Business Associate _________________________ agrees that it will:
1. Not use or further disclose PHI other than as permitted or required by this Agreement or as required by law;
2. Use appropriate safeguards and comply, where applicable, with the HIPAA Security Rule with respect to electronic protected health information (e-PHI) and implement appropriate physical, technical and administrative safeguards to prevent use or disclosure of PHI other than as provided for by this Agreement;
3. Report to The City of Fairbanks Fire Department any use or disclosure of PHI not provided for by this Agreement of which it becomes aware, including any security incident (as defined in the HIPAA Security Rule) and any breaches of unsecured PHI as required by 45 CFR 164.410. Breaches of unsecured PHI shall be reported to The City of Fairbanks Fire Department without unreasonable delay but in no case later than 60 days after discovery of the breach;
4. In accordance with 45 CFR 164.502(e)(1)(ii) and 45 CFR 164.308(b)(2), ensure that any subcontractors that create, receive, maintain, or transmit PHI on behalf of ____________________agree to the same restrictions, conditions, and requirements that apply to ___________________with respect to such information;
5. Make PHI in a designated record set available to The City of Fairbanks Fire Department and to an individual who has a right of access in a manner that satisfies The City of Fairbanks Fire Departments obligations to provide access to PHI in accordance with 45 CFR 164.524 within 30 days of a request;
6. Make any amendment(s) to PHI in a designated record set as directed by The City of Fairbanks Fire Department, or take other measures necessary to satisfy The City of Fairbanks Fire Departments obligations under 45 CFR 164.526;
7. Maintain and make available information required to provide an accounting of disclosures to The City of Fairbanks Fire Department or an individual who has a right to an accounting within 60 days and as necessary to satisfy The City of Fairbanks Fire Departments obligations under 45 CFR 164.528;
8. To the extent that ______________________ is to carry out any of The City of Fairbanks Fire Departments obligations under the HIPAA Privacy Rule, __________________ shall comply with the requirements of the Privacy Rule that apply to The City of Fairbanks Fire Department when it carries out that obligation;
9. Make its internal practices, books, and records relating to the use and disclosure of PHI received from, or created or received by _______________________ on behalf of The City of Fairbanks Fire Department, available to the Secretary of the Department of Health and Human Services for purposes of determining ______________________________ and The City of Fairbanks Fire Departments compliance with HIPAA and the HITECH Act;
10. Restrict the use or disclosure of PHI if The City of Fairbanks Fire Department notifies ______________________________ of any restriction on the use or disclosure of PHI that The City of Fairbanks Fire Department has agreed to or is required to abide by under 45 CFR 164.522; and
If The City of Fairbanks Fire Department is subject to the Red Flags Rule (found at 16 CFR 681.1 et seq.), ______________________________ agrees to assist The City of Fairbanks Fire Department in complying with its Red Flags Rule obligations by: (a) implementing policies and procedures to detect relevant Red Flags (as defined under 16 CFR 681.2); (b) taking all steps necessary to comply with the policies and procedures of The City of Fairbanks Fire Departments Identity Theft Prevention Program; (c) ensuring that any agent or third party who performs services on its behalf in connection with covered accounts of The City of Fairbanks Fire Department agrees to implement reasonable policies and procedures designed to detect, prevent, and mitigate the risk of identity theft; and (d) alerting The City of Fairbanks Fire Department of any Red Flag incident (as defined by the Red Flag Rules) of which it becomes aware, the steps it has taken to mitigate any potential harm that may have occurred, and provide a report to The City of Fairbanks Fire Department of any threat of identity theft as a result of the incident.
C. Permitted Uses and Disclosures by Business Associate The specific uses and disclosures of PHI that may be made by _______________________ on behalf of The City of Fairbanks Fire Department include:
1. The preparation of invoices to patients, carriers, insurers and others responsible for payment or reimbursement of the services provided by The City of Fairbanks Fire Department to its patients;
2. Preparation of reminder notices and documents pertaining to collections of overdue accounts;
3. The submission of supporting documentation to carriers, insurers and other payers to substantiate the healthcare services provided by The City of Fairbanks Fire Department to its patients or to appeal denials of payment for the same; and
4. Other uses or disclosures of PHI as permitted by HIPAA necessary to perform the services that ______________________________ has been engaged to perform on behalf of The City of Fairbanks Fire Department.
1. The City of Fairbanks Fire Department may terminate this Agreement if The City of Fairbanks Fire Department determines that ______________________________ has violated a material term of the Agreement.
2. If either party knows of a pattern of activity or practice of the other party that constitutes a material breach or violation of the other partys obligations under this Agreement, that party shall take reasonable steps to cure the breach or end the violation, as applicable, and, if such steps are unsuccessful, terminate the Agreement if feasible.
3. Upon termination of this Agreement for any reason, ______________________________ shall return to The City of Fairbanks Fire Department or destroy all PHI received from The City of Fairbanks Fire Department, or created, maintained, or received by ______________________________ on behalf of The City of Fairbanks Fire Department that ______________________________ still maintains in any form. ________________________ shall retain no copies of the PHI. If return or destruction is infeasible, the protections of this Agreement will extend to such PHI.
Agreed to this ____ day of _____, 2015
The City of Fairbanks Fire Department
Signature:__________________________ Signature: ___________________________ Title: Warren B Cummings, Fire Chief Title: _______________________________ Date: ____________________ Date: _______________________________
A - PRE-PROSAL CONFERENCE QUESTIONNAIREB - Proposal Transmittal FormATTACHMENT APRE-Proposal conference QUESTIONNAIREATTACHMENT BProposal Transmittal FormA. AmendmentsB. Original SignatureATTACHMENT C
This Business Associate Agreement (Agreement) between The City of Fairbanks Fire Department and ________________________ is executed to ensure that ________________ will appropriately safeguard protected health information (PHI) that is created, r...A. General Provisions1. Meaning of Terms. The terms used in this Agreement shall have the same meaning as those terms defined in HIPAA.2. Regulatory References. Any reference in this Agreement to a regulatory section means the section currently in effect or as amended.3. Interpretation. Any ambiguity in this Agreement shall be interpreted to permit compliance with HIPAA.B. Obligations of Business Associate_________________________ agrees that it will:1. Not use or further disclose PHI other than as permitted or required by this Agreement or as required by law;2. Use appropriate safeguards and comply, where applicable, with the HIPAA Security Rule with respect to electronic protected health information (e-PHI) and implement appropriate physical, technical and administrative safeguards to prevent use or di...3. Report to The City of Fairbanks Fire Department any use or disclosure of PHI not provided for by this Agreement of which it becomes aware, including any security incident (as defined in the HIPAA Security Rule) and any breaches of unsecured PHI as ...4. In accordance with 45 CFR 164.502(e)(1)(ii) and 45 CFR 164.308(b)(2), ensure that any subcontractors that create, receive, maintain, or transmit PHI on behalf of ____________________agree to the same restrictions, conditions, and requirements t...5. Make PHI in a designated record set available to The City of Fairbanks Fire Department and to an individual who has a right of access in a manner that satisfies The City of Fairbanks Fire Departments obligations to provide access to PHI in accorda...6. Make any amendment(s) to PHI in a designated record set as directed by The City of Fairbanks Fire Department, or take other measures necessary to satisfy The City of Fairbanks Fire Departments obligations under 45 CFR 164.526;7. Maintain and make available information required to provide an accounting of disclosures to The City of Fairbanks Fire Department or an individual who has a right to an accounting within 60 days and as necessary to satisfy The City of Fairbanks Fir...8. To the extent that ______________________ is to carry out any of The City of Fairbanks Fire Departments obligations under the HIPAA Privacy Rule, __________________ shall comply with the requirements of the Privacy Rule that appl...9. Make its internal practices, books, and records relating to the use and disclosure of PHI received from, or created or received by _______________________ on behalf of The City of Fairbanks Fire Department, available to the Secretary o...10. Restrict the use or disclosure of PHI if The City of Fairbanks Fire Department notifies ______________________________ of any restriction on the use or disclosure of PHI that The City of Fairbanks Fire Department has agreed to or is required to a...If The City of Fairbanks Fire Department is subject to the Red Flags Rule (found at 16 CFR 681.1 et seq.), ______________________________ agrees to assist The City of Fairbanks Fire Department in complying with its Red Flags Rule obligations by: (a) ...C. Permitted Uses and Disclosures by Business AssociateThe specific uses and disclosures of PHI that may be made by _______________________ on behalf of The City of Fairbanks Fire Department include:1. The preparation of invoices to patients, carriers, insurers and others responsible for payment or reimbursement of the services provided by The City of Fairbanks Fire Department to its patients;2. Preparation of reminder notices and documents pertaining to collections of overdue accounts;3. The submission of supporting documentation to carriers, insurers and other payers to substantiate the healthcare services provided by The City of Fairbanks Fire Department to its patients or to appeal denials of payment for the same; and4. Other uses or disclosures of PHI as permitted by HIPAA necessary to perform the services that ______________________________ has been engaged to perform on behalf of The City of Fairbanks Fire Department.D. Termination1. The City of Fairbanks Fire Department may terminate this Agreement if The City of Fairbanks Fire Department determines that ______________________________ has violated a material term of the Agreement.2. If either party knows of a pattern of activity or practice of the other party that constitutes a material breach or violation of the other partys obligations under this Agreement, that party shall take reasonable steps to cure the breach or end ...3. Upon termination of this Agreement for any reason, ______________________________ shall return to The City of Fairbanks Fire Department or destroy all PHI received from The City of Fairbanks Fire Department, or created, maintained, or received by _...