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RFP DOCUMENT

for analyzing compliance of RSBY Scheme Monitoring and Empower SNA in Audit of Enrollment, Transaction and Claim in Chhattisgarh

State Nodal Agency RSBY Chhattisgarh

Department of Health and Family Welfare

Government of Chhattisgarh

Raipur

Issued / Released on 14th of September 2011

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RFP document for analyzing compliance of RSBY Scheme Monitoring and Empower SNA in Audit of Enrollment, Transaction and Claim in Chhattisgarh

of State Nodal Agency Chhattisgarh State Nodal Agency RSBY ChhattisgarhDepartment of Health and Family Welfare

Government of ChhattisgarhRaipur

Notice

Sealed bids are invited from reputed organizations having experience of implementing IT solutions for carrying out analysis of enrollment, transaction and claim in real time under Rashtriya Swasthya Bima Yojana and generation of alerts for SNA to take effective and immediate action for smooth monitoring of RSBY scheme Chhattisgarh.

The bids are invited in two parts i.e., Technical Bid and Financial bid. Insurance companies and Third Party Administrators (Health) & their allied companies and Agencies involved with DHFW Chhattisgarh are not permitted to participate in the bidding process.

The tender document for this may be downloaded from the website http://cghealth.nic.in

The technical bids and financial bids should be sealed by the bidder in a cover duly super-scribed is to be put in a bigger cover which should also be sealed and duly super-scribed.

The Technical bids will be evaluated by the Technical Bid Evaluation Committee. Financial bids of only the technically acceptable offers shall be opened before the successful bidders by the SNA for awarding of the contract. Following schedule will be observed in this regard.

Last date of submission of technical bid document: 6 PM of 21.10.2011Opening of technical bids: 22.10.2011

The completed technical Bid documents should be submitted before at the following address:-

State Nodal Agency RSBY ChhattisgarhDepartment of Health and Family Welfare

2nd Floor Directorate of Health and Family Welfare, Old Nursing Hostel, Raipur-492001Email: rsbycg@gmail.com Tel: 0771-4255948

All correspondence / communications on the scheme should be made at the above address.

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RFP DOCUMENT

RFP document for analyzing compliance of RSBY Scheme Monitoring and Empower SNA in Audit of Enrollment, Transaction and Claim in Chhattisgarh

RASHTRIYA SWASTHY A BIMA YOJANA

A number of studies have revealed that risk owing to low level of health security is endemic for informal sector workers. The vulnerability of the poor informal worker increases when they have to pay fully for their medical care with no subsidy or support. On the one hand, such a worker does not have the financial resources to bear the cost of medical treatment, on the other; the health infrastructure leaves a lot to be desired. Large numbers of people, especially those below poverty line, borrow money or sell assets to pay for the treatment in private hospitals. Thus, Health Insurance could be a way of overcoming financial handicaps, improving access to quality medical care and providing financial protection against high medical expenses. The “Rastriya Swasthya Bima Yojana” announced by the Central Government attempts to address such issues. Government of Chhattisgarh has launched this scheme in all its 18 districts.

For analyzing compliance of RSBY Scheme Monitoring and Empower SNA in Audit of Enrollment, Transaction and Claim in Chhattisgarh, Proposals are invited from the Companies / Agencies. The agencies which are in agreement with scheme and its Terms of Reference, only need to participate in the bidding and any disagreement in this regard may invite disqualification / rejection of bid at technical level. Hence all the agencies are requested to go through the scheme carefully and submit their agreement in specific format given in the bid.

Agency/Organization after qualifying the Technical bid will have to make a presentation. Finally, the study will be awarded to the Company/agency/organization that is selected by the Committee on the basis of both the Technical and Financial bid following due procedure. The selected Company/agency/organization has to start work immediately after its award, and each of the deliverables would be completed as per the time frame in the scope of work. In case the selected Company/agency/organization declines to take up this work after a notice of award has been issued, it would be barred from applying for any such work or assistance of any kind from Department of Health and Family Welfare, Raipur, Chhattisgarh for a period of 3 years from the date of award beside forfeiture of EMD

The decision of the Bids Evaluation Committee shall be final, and no enquiries, or application for review, shall be entertained.

SCOPE OF WORK

1. Supporting the state government in monitoring and reviewing RSBY activities in the StateThis shall require supporting the State Government in taking fortnightly review of activities taken up in the RSBY programme by the various selected insurance companies, TPA and hospitals. This would include supporting monitoring and analysis of

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a. Enrollment: Master Enrollment, Area wise Enrollment, Family wise Enrollment, Gender wise Enrollment, Age wise Enrollment, Card Issuance, Missing details (Card, Photo, Finger print), Zero enrollment, etc.

b. Hospital Empanelment: Hospital Profiling, Beneficiary Ratio, facilitation chart, etc.

c. Hospitalization: Zero Hospitalization, Repeat Treatment, Village having < 2% Hospitalization, Outside Hospitalization, High Treatment Variation, Disease wise Hospitalization, etc.

d. Claim: Utilization, Claim Rejected, Claim Status, Premium against claim, Demography wise Claim, etc.

e. Awareness: Campaigns, Advertisement, health camps etc.f. Grievance:

All the insurance companies will be required to be monitored and reviewed in standard formats. At least once in 15 days, a official communication on their performance would be required to be intimated for necessary action.

2. Communication Audit

With the guidance of the State Government work with the Insurance Companies in overseeing the communication activities done by the Insurers. Work with State Nodal Agency and the hospitals in ensuring organisation of health camps etc.

This will require linking with the private hospitals to conduct awareness programmes and health camps on a frequent basis to increase the claim ratio. In addition to this, it will also require liasoning with the district machinery to utilize their channels of creating awareness. Similarly, it would also require to develop a holistic awareness programme which can be implemented through various channels as stated above. All this will be required to be done under the supervision of the State Government after taking the necessary approvals.

3. RSBY Process Audit

This shall require review of all front-end activities at hospitals / nursing homes which directly impact the insured population in terms of nature and quality of healthcare services actually offered.

4. Hospital Documentation Audit

Review of the documentation maintained by hospitals / nursing homes in substantiation of treatment given to RSBY patients as per standard medical practices, though not necessarily to be sent to Insurers.

5. Transactions Audit

Review all back-end processes involving interface between hospitals and Insurers. The idea is to bring out the performance levels in terms of reimbursements of treatment charges, timelines, frequency and data transfer as compared to those envisaged in the bid document and/ or the SLA.

6. Random Concurrent Audit of claims (Live audit)

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Whilst review of historical data may lead to one set of conclusions, the ground realities come to the fore only through a review of all activities as they happen. Through a structured mechanism, districts/hospitals are to be sampled based upon the number of claims intimated on daily basis and all RSBY processes / deliverables measured live. This exercise aims at audit of processes as they happen live immediately on claim intimations.

7. Regular Audit of Claims (data-based)Monthly analyses of claims data is to be carried out and pre-agreed claims activities in the hospitals reviewed indicating out-of-the-ordinary levels. This is to be done by sifting through claims data, flagging such service providers and subjecting them to audits with a view to correcting past shortcomings and ensuring course-corrections for future.

8. Random survey for Users’ ExperienceTo conduct in-depth interviews and field surveys of the beneficiaries who have availed of treatment under RSBY. The underlying objective of this questionnaire-driven audit is to not only ascertain the nature of treatment received by them but also to highlight deficient services or malpractices, if any. The tool for the survey and sampling method will be mutually agreed upon between the State Nodal Agency and the chosen organizations.

9. Audit of Hospital Empanelment ProcessHaving mapped each district with the number of hospitals empanelled under RSBY, this exercise shall take stock of availability or otherwise of hospitals in the panel. This review shall also enquire into adherence to laid-down empanelment process.

REPORTS

Reports on each audit as and when carried out, monthly reports & analyses and annual reports shall be required to be submitted by the bidders. Following reports are essential:

1. BPL Master Data Analysis2. Enrollment Data Analysis3. Hospital empanelment ratio Analysis4. Hospitalization analysis5. Claim Analysis6. Advertisement analysis etc7. Any other report as per the requirement of the programme.

MANPOWER REQUIREMENT

During the period of the contract the successful bidder shall be required to have at least the following, verifiable manpower in its employment at all times.

Core Team: Project Coordinator – Responsible for overall monitoring and liasoning Conduct monthly

workshop with stakeholders. Liase with the stakeholders/partners (Project

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Manager having Post Graduate with experience in e-Goverance at least 7-8 years)

Data Analyst - (Minimum Two – Experience of data analysis of similar nature of at least 4 years)

Operations Specialist - (Minimum one – At least 4 years Experience of handling operations of IT infrastructure)

Network & System Admin - (Minimum one – At least 8 years Experience of handling operations of IT infrastructure)

Developer - (Minimum Six – At least 3 years Experience)

All the members of core team must have requisite Educational and Experience certificate

Terms and Conditions

Eligibility Criteria

The bidder should have an average annual turnover of at least Rs.500,00,00/- in IT / ITES sector during last three Financial Years ending on 31-Mar-2010 and must submit certified copy of the audited statement of accounts (PL Account & Balance Sheet), as a proof of annual turnover stated.

Should have implemented at least 3 (three) web based projects with minimum project cost (each without hardware & system software) of Rs. 20, 00,000/- for any Government(State/Central) / Government Autonomous Bodies / Government Corporation for building their Process Automation Systems in the last 3 years (Please attach copy of work orders).

Out of this, at least 2 (two) installations should have been successfully completed. (Please attach copy of completion certificate from the client).

The vendor should have at least 5 years relevant experience in software development, and maintenance. (Please attach copy of evidence)

The firm / company / organization should be registered as per law. (Please attach copy of evidence)

No consortium of vendors is allowed to bid for the project.

The vendor must be ISO-9001:2008 or CMM Level 3 certified at least for software development and project management consultancy (Please attach proof of the same)

Vendors should have a minimum of 100 employees in its Payroll (Please attach relevant documents as proof)

Applicants should not be under a declaration of ineligibility for corrupt and fraudulent practices issued by Government of India / State Governments. A self-declaration certificate should be enclosed.

Note:

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(a) In absence of any one of the above, the offer will be treated as non-responsive and summarily rejected.

(b) Relevant documents in support of the above criteria must be enclosed along with Pre-Qualification Bid documents failing which the bid will liable to be rejected.

(c) The technical & financial bids of the bidders, unsuccessful in pre-qualification bid shall not be considered for evaluation.

Note: The qualifying requirements data shall be enclosed with the technical bid only. The bidder who do not qualify this criterion, will be disqualified immediately and their bids will not be considered.

Contents of RFP Document

The supplier is expected to examine the RFP Document carefully. Failure to furnish all information required as per the Tender Document may result in the rejection of the Bid.No bid will be accepted after prescribed closing time for submission of the same.

The delay will not be condoned for any reason. However, if the last date of submission of tender is declared as a holiday by government, the last date of submission of tender will be extended to the next working day.

The bids may be cancelled and not evaluated if the bidder fails to:

a. Seal the envelope properly with sealing tape. b. Submit envelopes i.e. Technical Proposal and Financial proposal in another large envelope.c. Give complete bids in all respects. d. Submit financial bids not as mentioned in the tender document.

Deadline for Submission Bids / Proposals:

Complete bid documents should be submitted by 18.00 hours on 21st October 2011. Bid documents received later than the prescribed date and time will not be considered for evaluation.

IN NO CASES, RATE S SHOULD BE QUOTED ANYWHERE EXCEPT IN FINANCIAL BID

Language of Bid and Correspondence

The Bid should be prepared by the supplier in English language only. All the documents relating to the Bid (including brochures) supplied by the supplier should also be in English, and the correspondence between the supplier & SNA will be in English language only.

Bid Currencies

Prices shall be quoted in INDIAN RUPEES, inclusive of all prevailing taxes.

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Period of Validity of the Bid

For the purpose of placing the order, the Bids shall remain valid for at least 90 days after the date of bid opening.

A bid valid for a shorter period may be rejected by SNA as being non-responsive.

During the period of validity of Bids, the rates quoted shall not change.

In exceptional circumstances, SNA may ask for extension of the period of validity and such a request shall be binding on the Supplier.

SNA's request and the response to such a request by various Suppliers shall be in writing.

A supplier agreeing to such an extension will not be permitted to increase its rates.

Deadline for Submission of the BID

Bids will be received by the SNA at the specified address not later than 21.10.2011 on 6.00Hours.

SNA may, at its discretion, extend this deadline for any other administrative reasons.

Non-disclosure

The Data on all pages of the following submission constitutes a trade secret. It is furnished to the Supplier in confidence with the understanding that it will not, without the permission of SNA, be used or disclosed other than for proposal evaluation/submission purposes

Non Hiring

The Supplier will not engage the services of SNA personnel who are involved in the implementation of the proposed system for the period three years post implementation and maintenance period of the said system.Jurisdiction under Law of Chhattisgarh

The proposals and any resulting contracts shall be governed and abide by the Law of Chhattisgarh.

Any dispute or conflict arising will be settled as per the Jurisdiction under the Law of Chhattisgarh.

Payment Schedule / Terms of Payment

No payment shall be made for partial work done. Payment will be made in phases as per the following:

Milestone %age PaymentSRS Submission and Sign off 10%Software Development and Implementation 20%

Rest 70% of the payment will be paid quarterly

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EVALUATION AND AWARD PROCESS

Technical Evaluation (Total Marks – 100)

Vendors shall submit with their offer documents and/or other evidence of their ability to carry out the contract, failing which the vendor will not be considered for evaluation and award process.

Criteria, Sub- Criteria and point system for evaluation of full Technical Proposals

1) Experience of the vendor relevant to the assignment:I. Experience in web based process automation projects for Government

Departments, Corporations, PSUs, and Pvt. Sectors etc.(15 or more full points)

II. The vendors having knowledge and functional expertise in the e-Governance domain.

III. The vendors having knowledge and functional expertise in RSBY domain

IV. Experience of working with BPL data processing and cleansing.V. The vendor should be managing national and state level helplines.

(6 or more full points)

Total points for criterion 1.

2) Specifications of the vendorI. The vendor should have executed web based process automation projects of

e-Governance.(Amounting 600 Lakhs or more in the last 5 Years Full points)

II. The vendor’s employee strength.(100 or more full points)

III. The vendor should have ISO 9001:2008 or CMM Level 3 certified.

Total points for criterion 2.

3) Adequacy of the proposed methodology and work plan in responding to the Terms of Reference:

I. Project Appreciation( understanding of objectives: 4 pointsComments on ToR: 3 points)

II. Quality of MethodologySpecific approach for carrying out the Assignment

III. Work program and organization of staff(Task assignment and manning schedule: 5 pointsWork program: 3 points)

Total points for criterion 3.

4) Key professional staff qualifications and competence for the assignments

Points

5

5

5

1010

35

10

5

5

20

7

5

8

20

5

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I. Project Coordinator(Having Post Graduation with 8 years or more experience in e-governance - full points)

II. Data Analyst(5 years or more experience in data analysis - full points)

III. Operations Specialist(4 years or more experience of handling operations of IT infrastructure -full points)

IV. Network & System Admin(8 years Experience of handling operations of IT infrastructure –full points)

V. Developer (3 years Experience- full points)

Total points for criterion 4

5

5

5

5

25

TOTAL 100

NOTE: Vendors with more than 70% (70 marks out of 100) will be considered for Commercial Evaluation.

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COMMERCIAL OPENING

Commercial opening will be done and on the basis of price quoted vendors will be termed as –L1, L2, L3 and so on… as per the rank of lowest price quoted.

BID EVALUATION

If commercial bids for bidder 1, 2, 3, 4… are taken as L1, L2, L3, L4… where Lmin is the lowest bid then the weightage given to commercial bids would be:

Lmin/L1, Lmin/L2, Lmin/L3, L4/Lmin and so on...

Similarly weightage will be calculated for Technical Evaluation: T1/Tmax, T2/Tmax, T3/Tmax, T4/Tmax and so on… for bidder 1, 2, 3, 4… respectively

Each proposal would be evaluated against the 70 – 30 Criteria. This means 70% weightage will be given to Technical Proposal 30% to Financial Proposal.

AWARD

Finally the technical and commercial scores obtained by all the vendors would be summed and the vendor with highest score would be AWARDED THE BID.

The final scores of the vendors would be as given below –

Bidder 1:(T1/Tmax)*0.7 + (Lmin/L1*0.3)Bidder 2:(T2/Tmax)*0.7 + (Lmin/L2*0.3)Bidder 3:(T3/Tmax)*0.7 + (Lmin/L3*0.3)Bidder 4:(T4/Tmax)*0.7 + (Lmin/L4) *0.3The vendor with the highest marks computed above on cost and quality basis will be awarded the bid.

REJECTION

SNA reserves the right to reject any and all proposals, in whole or in part, to waive any and all informalities, and to disregard all non-confirming, non-responsive or conditional proposals.

In the event any or all proposals are rejected, in whole or in part, thereafter SNA in its sole discretion may initiate a new RFP process including all or part of the components of this Request for Proposals.

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PROPOSAL FORMATS

Tender should invariably be submitted in TWO BID SYSTEM consisting of two parts as detailed below:

PART-I: TECHNICAL BID IN ONE SEALED COVER

PART-II : COMMERCIAL BID IN ONE SEALED COVER

Then put both the sealed envelopes in one main envelope indicating “Technical/Commercial Proposal for RSBY Scheme Monitoring and Empower SNA in Audit of Enrollment, Transaction and Claim”.

PERIOD OF CONTRACT

The successful bidder shall be required to carry out the activities arising out of the scope of work as mentioned above for a period of one year from the date of agreement. A bidder shall be obligated to carry out inventorying and audit activities, maintain the manpower, and submit periodic reports during this period.

TECHNICAL BID

The Technical Bid, in the format as in Annexure-I here to, should be submitted in an envelope super scribed as “TECHNICAL BID-RSBY-PROCESS & DELIVERY AUDIT”. Each page of the bid along with annexure needs to be signed and the company’s stamp needs to be affixed on each page.

The technical bid will be evaluated first on the qualifying criteria. The qualifying criteria are as follows:

1. The agency/ company shall have a turnover of at least 50 lakhs in past three year.

2. The agency shall be working for at least 5 years since its inception.

3. The company/agency should be registered company/agency with the respective authority (No sole proprietorship agencies shall be eligible).

Agencies which fulfill the above criteria will be technically evaluated further based on the following parameters and scores shall be allotted as shown here under. For a bidder to qualify to the next round (i.e., Financial Bid), a minimum of 70 points need to be scored.

FINANCIAL BID

The Financial Bid, in the format as in Annexure-II here to, should be submitted in an envelope super scribed as “FINANCIAL BID-RSBY-PROCESS & DELIVERY AUDIT”.

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TIMELINES

The Technical Bid and the Financial Bid need to be sealed in two separate envelopes and put in another, larger envelope, super scribed “BID-RSBY-PROCESS & DELIVERY AUDIT”. The same should reach the SNA on or before 21.10. 2011 and acknowledgement obtained. The Government shall not be responsible for any kind of postal or other delays. Proposal received after due date shall be out rightly rejected.

The Technical Bids shall be opened on 22.10. 2011 at 3 pm in the presence of those bidders who wish to be present on the occasion.

The Financial Bids shall be opened on 30.10. 2011 at 3 pm in the presence of only those bidders who score 70 or more points in the Technical Bid.

NODAL OFFICER

The bids are to be submitted to and clarifications can be sought from the SNA whose details are as under.

State Nodal Agency RSBY ChhattisgarhDepartment of Health and Family Welfare

2nd Floor Directorate of Health and Family Welfare, Old Nursing Hostel, Raipur-492001Email: rsbycg@gmail.com Tel: 0771-4255948

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CHECKLISTS

Please check whether following required documents have been enclosed in the cover, namely,

1. EMD of Rs 2 Lakh enclosed in the shape of DD in favor of YES/NO Rastriya Swasthya Bima Yojana- State Nodal Agencypayable at Raipur, CG

2. Certificates/ Documents testifying the firm / company / organization is having YES/NO at least 5 years relevant experience in software development, maintenance, and hardware support.

3. Certificates/ Documents showing that the firm / company / organization YES/NOis registered as per law.

4. Work Orders showing 3 webs based government / PSU projects each having YES/NOvalue of 50 Lakhs or more in the last 3 years

5. Balance sheet showing average annual turnover of INR 50 lakhs in the preceding YES/NO three financial years

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TECHNICAL BID: ANNEXURE-I

Forming part of the Invitation of bids for Inventorying compliance of RSBY Claims Processes and Audit of Healthcare Delivery by hospitals & nursing homes in State of Chhattisgarh.

1 Name of the bidder

2. Full Postal Address of Head Office

3. Phone / Fax Number of Head Office Phone :

Fax :

4. Address of State of ___________ Representative Office

5. Website

6. Name of the Contact Person

7. Mobile phone & E-mail ID of the contact person

Mobile :

E-mail :

8. Nature of the firm ( Proprietorship/ Pvt. Ltd. / Public Ltd)

9. Date of incorporation ( attach photocopy)

10. Profile of the company Please attach separately

11. Details of experience of RSBY related work in State of ___________ or other States (attach documentary evidence)

Please attach a separate sheet giving details and also furnish documentary evidence in support)

12. Details of the Core-team ( Please mention the date of their joining the company as only full time employees shall be considered)

Please attach separate CV showing their qualifications, experience of work of similar nature, date of joining, mobile phone numbers, clientele’ handled. A maximum of four shall be considered. ( only full time employees should be included here and not consultants / advisors / part-timers)

13. Project Proposal Attach a project proposal showing therein your understanding of the assignment, details of each activities, periodicity, methodology, frequency, manpower, timelines, MIS and nature

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of reports etc. in reference to the Scope of Work

.

14. Name / details of the authorized signatory

Signature :Name :Company stamp :

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FINANCIAL BID: ANNEXURE-II ( to be submitted separately)

Forming part of the Invitation of bids for Inventorying compliance of RSBY Claims Processes and Audit of Healthcare Delivery by hospitals & nursing homes in State of Chhattisgarh

1 Name of the bidder

2. Full Postal Address of Head Office

3. Professional Fee ( including all expenses ) (both in figure and words, excluding Service Tax)

4. Service Tax ( both in figure and words)

5. Name / details of the authorized signatory

Signature :

Name :

Company stamp :

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ANY OTHER DETAIL WHICH IS RELEVANT TO THE BID CERTIFICATE

It is certified that:

1. The information given above is TRUE to the best of my knowledge. The organization shall stand liable for any information given above which is later found to be FALSE, including the forfeiture of any payment due to it.

2. The information given above is COMPLETE to the best of my knowledge and I have not willingly suppressed any material information that might lead to misjudgments while evaluating this Technical Bid.

3. The professionals, staff, equipment and all requisite infrastructural facilities mentioned in this bid shall be made available for this study in due time.

4. Our agency/organization/institution is interested to undertake the proposed evaluation.

5. I am competent to sign this Certificate.

Date: Authorized Signatory

Place: Name:

Seal of the Organization:

Designation: