Vendor Questions.doc by lovemacromastia

VIEWS: 2 PAGES: 27

									1. Business/Technical Scope Questions


       Page    Section
 Q#                        Question / Clarification                         Answer
        #        #
                         Generic/Common
1.            2          Will the Government of            As displayed on the gov.bm website, the
                         Bermuda Department of Social      dates have been extended to reflect the
                         Insurance extend the response     issues encountered with the website to
                         due date by 30 days in order      submit questions as well as the delay in
                         for vendors to prepare a          responding to the questions. The new
                         thorough response?                response date is July 30, 2007.
2.            15         Will DOSI allow questions after   Questions have been allowed beyond the
                         June 15?                          original June 15 deadline.
3.                       Is IBM, mentioned as the          Yes.
                         author of the RFP
                         requirements, precluded from
                         bidding on this solicitation?
4.            4          What is the technology now        Technology is only used for premium
                         supporting premium                administration for individual HIP policies
                         administration?                   – the technology is an in-house
                                                           developed RPG application running on
                                                           AS/400.
5.            4          Many of the business goals of     The main goal with this RFP is that of
                         HIP are what could be             claims automation, so if you think a BI
                         considered part of a Business     component is needed it should be
                         Intelligence solution for HIP.    included as part of the response. The
                          Would the Government of         primary focus of the HIP RFP to improve
                              Bermuda Department of        the processing of claims. DOSI is not
                              Social Insurance allow       willing to consider a separate solicitation
                              vendors to submit bids on    for BI at this time.
                              (1) only the BI component,
                              (2) only the claims
                              processing component, or
                              (3) both?
                          Alternatively, would DOSI be
                         willing to release a separate
                         solicitation for the BI
                         component?
6.            4.3.1      What is the “existing back        Manual, with the exception of limited
                         office system”?                   policy administration functionality to
                                                           support premium billing for individual HIP
                                                           policyholders.
7.                       The requirements document         Yes, however if it can be integrated as
                         has all the requirements for      part of less costly solution that is
                         administering insurance           acceptable too.
                         policies, including premium
                         collection. This implies the
                         current HIP individual policy
                         system will be replaced by the
                         new system. Is this the case?




32bbb6ca-3e29-4a00-8077-0886c0f60e45.doc
          Page       Section
 Q#                                   Question / Clarification                        Answer
           #           #
 8.                                If the current HIP individual      Yes.
                                   policy system is to be replaced
                                   should the proposal include
                                   conversion of the data?
 9.                 4.3.4          The RFP references the             See “General Information” on the
                                   Government of Bermuda's            Information Technology Office web site
                                   Standard Development               for more details of the standard
                                   Agreement and a Statement of       development contract and Statement of
                                   Work.                              Work) .
                                    Are there any other or
                                        more specific terms and
                                        conditions?
                                   Has the actual Development
                                   Agreement for this RFP been        The standard agreement will be used.
                                   written yet, and is it available
                                   for review?
 10.                4.3.8          What is the “single page on        The spreadsheet is available on the
                                   the Microsoft Excel                Government websites RFP section under
                                   spreadsheet” and where do we       the heading “Related Documents” for this
                                   get it?                            RFP.
 11.                5              On page 8 of the requirements      Claim volumes at this time are very
                                   document it specifies that the     difficult to determine due to the manual
                                   HIP section processes 135,000      processes. It is felt that the claim
                                   claims annually. Then in the       volumes are in the range of 90,000 to
                                   breakdown it has HIP –             135,000 which would be prorated
                                   222,000, MRF - 3,500, Subsidy      accordingly for the stated claims.
                                   - 65,000, War Veterans – 500.
                                   This is 91,000. I am guessing
                                   the 135,000 is perhaps a
                                   newer statistic but the
                                   breakdown is only older
                                   statistics. Is this correct? Is
                                   so, can I assume the
                                   proportions are ballpark the
                                   same? If not, what are the
                                   other 44,000 claims for.
 12.                               What is the membership             Yes.
                                   breakdown of the different
                                   lines of
                                   business i.e. is there any
                                   membership overlap between
                                   the different
                                   plans - do members belong to
                                   the HIP and the MFR?




Response to Vendor Questions on HIP Automaton Project RFP                                             2 of 27
          Page       Section
 Q#                                   Question / Clarification                         Answer
           #            #
 13.                13.4           This section suggests that this    Fixed price, and payments based on
                                   is a fixed price contract.         milestones and deliverables associated
                                    Is that correct and will a       with those milestones.
                                        single purchase order be
                                        issued for the entire
                                        contract amount?
                                   Will payments be based on
                                   acceptance of milestones?
 14.                               Can you provide samples of         Samples will be provided after the
                                   claims forms, reports, etc. that   contract is awarded.
                                   are currently being used by
                                   DOSI?
 15.                               Is the customer okay               Any solution will be considered and
                                   evaluating a Buy (buy existing     evaluated.
                                   COTS product and do the
                                   required customization) Vs
                                   Build Option (Build a home
                                   grown application)?
 16.                               Have any off-the-shelf or          Any solution will be considered and
                                   customized proprietary             evaluated.
                                   solutions been evaluated? Is
                                   the vendor expected or
                                   allowed to provide such a
                                   solution?
 17.                               Is there a budget that the         A high level budget has been established.
                                   customer has earmarked for
                                   the project and if so, is the
                                   customer willing to disclose the
                                   same?
 18.                               Are the timelines very rigid or    There is some degree of flexibility on the
                                   is the customer open to a          schedule and it is assumed that the
                                   flexible implementation            implementation will be a phased
                                   schedule based on the              approach.
                                   customer prioritization of
                                   requirements?
 19.                               Users of the application – Are     The users are located in Bermuda but
                                   they going to be located across    there will be times when the users of the
                                   the globe/country etc or are       system will require access globally.
                                   they going to be located at the
                                   single place?
 20.                               How is IBM involved in the HIP     IBM assisted with the approach to
                                   Automation application and its     requirements gathering. As HIP moves
                                   development?                       their automation project, they will
                                                                      continue to evaluate what assistance they
                                                                      may require from outside consultants.




Response to Vendor Questions on HIP Automaton Project RFP                                               3 of 27
          Page       Section
 Q#                                   Question / Clarification                       Answer
           #           #
 21.                4              RFP mentions “Group Policy        It is expected that the vendor will
                                   Holders are not supported by      suggest an efficient approach to
                                   technology. All the other         converting the paper based system to the
                                   processes are manually            proposed automated solution.
                                   supported by paper & excel
                                   spreadsheets” - we would want
                                   to understand more clearly
                                   with respect to moving the
                                   data in the paper based
                                   systems to the new HIP
                                   Automated System.
 22.                6.1            There is a specific requirement   HIP‟s strategy is to accept claims
                                   to submit paper claims, how       electronically when possible. HIP must
                                   we‟d achieve a completely         always be able to accept paper as one of
                                   paperless claims processing in    the input types, but after claims receipt
                                   that scenario?                    the process should be paperless.
 23.                6.2            Table 1: Scope of the HIP         Yes.
                                   Automation Project
                                   Not all the functions marked in
                                   the green in the BCM have
                                   been covered in the detailed
                                   requirements. The vendor will
                                   estimate for the functions for
                                   which the requirements have
                                   been provided.
 24.                6.2            Non-Functional requirements –     The response is expected to propose a
                                   It is our understanding that in   complete solution and the
                                   the proposal we only will         implementation of it.
                                   provide the estimates for doing
                                   the analysis and not the actual
                                   server capacity and size
                                   required for the new
                                   application. Is this correct?
 25.                6.2            In case of mismatches             Follow the spreadsheet.
                                   between the requirements in
                                   the spreadsheet and section
                                   6.2 Scope of HIP Automation
                                   Project – which one should we
                                   follow between the two?
 26.                7.1.1          Does HCS require vendor to        Ultimately, HIP is looking to satisfy all
                                   include the items marked as       requirements. The primary focus of the
                                   “Medium”/”Low” in it‟s scope      vendors should be on the high
                                   since the implementation          requirements, however, HIP is interested
                                   timeline is >2 years for those    in how the vendors may be able to satisfy
                                   requirements, whereas HCS is      all of their requirements.
                                   looking at going live by June
                                   2008? Please confirm?




Response to Vendor Questions on HIP Automaton Project RFP                                             4 of 27
          Page       Section
 Q#                                   Question / Clarification                        Answer
           #            #
 27.                8.2.5          What is the proposed               Currently the deployment environment is
                                   deployment environment?            IBM iSeries, and Wintel. Databases are
                                   Does the vendor have the           IBM iSeries DB2 and Oracle.
                                   choice to provide the
                                   deployment environment (eg
                                   IBM iSeries 2 or Oracle)?
 28.                8.2.5          What are the versions of the       Assume current versions of the software
                                   hardware/software proposed?        and hardware.
 29.                               Are there any constraints in       At this time there are no anticipated
                                   offshoring part of the             constraints.
                                   application development and
                                   delivery? In this context it
                                   might be necessary to set-up a
                                   communication and data link
                                   with the Offshore Development
                                   Center (ODC). Is DOSI ready
                                   for this arrangement?
 30.                               Will there be any data             Data from the paper based systems and
                                   migration or data conversion       data contained in the individual premium
                                   required to manage the             admin system will need to be migrated to
                                   existing data in whatever          the new automated system.
                                   format they exist?
 31.                               Please specify any mandatory       At this time within Bermuda there are no
                                   compliance requirements apart      mandatory compliance requirements. It
                                   from HIPAA (eg. SOX or             is HIP‟s intention to comply to the HIPPA
                                   government mandated                requirements where it makes sense.
                                   compliance requirements).
 32.                               Please explain your current        All claims are submitted on a paper
                                   claims submission process          format.
 33.                               Do you/private healthcare          Some of the providers currently use these
                                   providers use ICD-9, CPT-4,        codes. It is the intent of DOSI to utilize
                                   HCPCS codes, Drug codes etc        standard codes such as ICD-9, CPT-4,
                                   for billing healthcare services?   HCPCS and drug codes for all providers.
 34.                               Do you have documented rates       The majority of the healthcare services
                                   for each of the healthcare         rendered have documented rates. The
                                   services that are rendered by a    procedures that tend to be rare have yet
                                   service provider?                  to be developed. These are developed as
                                                                      the claim presents itself.
 35.                               Do you have contracts with         Yes. Informal agreements exist, but we
                                   healthcare service providers       do not have a formalised contract other
                                   (doctors and hospitals) for        than legal regulations.
                                   rendering different services?
 36.                               Is the vendor permitted to use     Yes, depending on type of software.
                                   open source software other
                                   that those mentioned in the
                                   RFP?
 37.                               Are there any batch processing     The payment processing with JDE is
                                   requirements for the HIP           batched.
                                   Automation? Or would this be
                                   finalized at time of
                                   requirements and design?


Response to Vendor Questions on HIP Automaton Project RFP                                              5 of 27
          Page       Section
 Q#                                   Question / Clarification                         Answer
           #           #
 38.                               Does DOSI have any internal        Java or Microsoft.net.
                                   standards w.r.t. to different
                                   components being developed
                                   for the HIP Automation
                                   application?
 39.                               What is the underlying             AS400 and RPG.
                                   technology framework for
                                   Premium Administration for
                                   Individual policy holders?
 40.     10         RFP            In what form of documentation      If the as-is processes are required, they
                    Section 4      will DOSI provide us with the      can be provided via paper and electronic
                                   detailed as-is business process    such as Visio and Excel spreadsheets.
                                   flows of the way health
                                   insurance is administered
                                   presently as a combination of
                                   electronic, and manual - by
                                   paper and excel spreadsheets?
 41.                               Will DOSI want to have a           Yes. It is anticipated that all key
                                   consumer driven/consumer           stakeholders such as customers,
                                   empowerment aspect to this         providers, etc will interface with the
                                   system? Interfacing with           system through the government portal –
                                   different portal interfaces for    WebSphere or through an independent
                                   different stakeholders like        site.
                                   Members, Providers, Payer,
                                   Sponsor, etc.?
 42.                               Will DOSI want to include a        What is PHR??
                                   PHR element in the member
                                   interface?
 43.     29         8.1            The evaluation process refers      The vendor may suggest either; however
                                   to a demo of the vendor‟s          a COTS is the preferred approach.
                                   product offering.                  DOSI has seen demos using both AS400
                                    Is DOSI seeking only a           and Microsoft as platforms.
                                        “COTS” solution or is DPI
                                        open to custom developed
                                        solutions for the Business
                                        Intelligence component?
                                   Has the DOSI previously seen
                                   or been demonstrated any
                                   solutions in envisioning the HIP
                                   application? If so, who were
                                   the vendors?
 44.     33         8.2.1.4        Accountability/Non-                At a minimum any transaction resulting in
                                   repudiation: On what kind of       a payment should be non-reputable.
                                   transactions do we need to         Long term the government is anticipating
                                   implement this security            rolling out certificates across all
                                   feature? Are we looking at         departments.
                                   digital certificates to be
                                   associated with parties
                                   involved in such transactions?




Response to Vendor Questions on HIP Automaton Project RFP                                              6 of 27
          Page        Section
 Q#                                   Question / Clarification                         Answer
            #            #
 45.     34         Authentic      The                                Session context may be stored on the
                    ation/Ide      „Authentication/Identification‟    client as long as it is tamper proof.
                    ntification    section says that the client
                    ;              must not be used for
                    Access         maintaining session context
                    Control        whereas the „Access Control‟
                                   section says the client could be
                                   used by the storage must be
                                   tamper proof. Which
                                   requirement should be treated
                                   as correct?
 46.     34         Authentic      Our understanding is that          The understanding is correct, and there is
                    ation/Ide      multiple directory services        no plans to consolidate the two.
                    ntification    (Active directory for internal
                                   users and Application specific
                                   for external users) are
                                   currently present. Is there a
                                   need to consolidate this under
                                   only LDAP solution by
                                   migrating existing user
                                   information in different
                                   application? If so, who is
                                   responsible for this effort
                                   (vendor or Client)?
 47.                               Is there a long term plan for      It is the intent to continue to use JDE for
                                   keeping the JDE Edwards            financial (accounting) functionality. The
                                   Accounting System? If so, are      proposed solution should be able to
                                   you looking to integrate the       interface with JDE.
                                   new claims system with the JD
                                   Edwards Accounting System?
                                   There are extensive accounting
                                   questions on the RFP matrix
                                   that would be very specific to
                                   independent accounting
                                   software functionality. The
                                   current JD Edwards accounting
                                   package you use contains
                                   much if not all, of the required
                                   functionality listed in the
                                   matrix.
 48.     35         Administr      It is mentioned that the           Primarily documents such as claims in
                    ation/Con      application should be able to      paper form or faxes.
                    figuration     handle binary data. What are
                                   the different sources of binary
                                   data for this application?
                                   Documents could be available
                                   in binary format. Are there any
                                   other sources/scenarios?




Response to Vendor Questions on HIP Automaton Project RFP                                                7 of 27
          Page       Section
 Q#                                   Question / Clarification                          Answer
            #           #
 49.     36         8.2.1.5        It is mentioned that support        In this RFP it is intended to mean
                                   for multiple product release        multiple version of the application, the
                                   levels in the same cluster must     benefit being the ability to do application
                                   be present. Does it mean            updates without service interruptions.
                                   multiple versions of application
                                   infrastructure products like
                                   application servers or is it
                                   multiple versions of the
                                   developed application? What is
                                   the benefit envisaged by the
                                   availability of this support?
 50.     37         8.2.1.4        We expect that there are going      Single sign-on would be a great benefit.
                                   multiple applications to serve
                                   the functionality. Is single sign
                                   on required in this case?
 51.     38         8.2.3          It is mentioned that the            These systems are current or anticipated
                                   architecture needs to support       government systems such as customs
                                   additional disparate systems        and immigration.
                                   for future? Can you please
                                   elaborate the nature and kind
                                   of these disparate systems so
                                   that we can ensure that the
                                   architecture supports them?
 52.     38         8.2.3          Supporting delivery channels:       Currently no other channels are
                                   As of the RFP requirement we        anticipated, however openness for adding
                                   understand that the channels        additional channels as the need arises
                                   to be supported currently are       would be a benefit.
                                   portal (web), telephone, and
                                   fax and paper documents.
                                   What are the other channels
                                   envisaged (say SMS, email
                                   etc.)? Please elaborate
 53.                8.2.5          What is the target application      Currently the government supports both
                                   framework for the project? Is it    J2EE and .NET, however it would be
                                   J2EE or .NET? Is there a need       preferable if the HIP solution used only
                                   to support both                     one framework.
 54.     42         9.4.1          Since transport modes like          Yes, as an example the government is
                                   telephone (IVR), fax, paper are     currently looking at cross departmental
                                   mentioned are we envisaging         products within the document / content
                                   specialized products in the         management area. An RFP will be issued
                                   areas of content management,        at some point, however it is at very early
                                   contact center solutions and        stages and an internal project sponsor
                                   document processing?                has not yet been identified.
 55.                 Delivery      Please specify the criteria for     Typical project management processes
                     Approac       sign offs at every stage in the     will be followed during the project
                        h          staggered process of                lifecycle. It is anticipated that formal
                                   requirement gathering and           signoffs will be required before the
                                   software development                project moves into the next phase of the
                                                                       project or milestone.




Response to Vendor Questions on HIP Automaton Project RFP                                                 8 of 27
          Page       Section
 Q#                                   Question / Clarification                        Answer
           #           #
 56.                               Do the providers use standard      Standard claim forms are used by
                                   claim forms to submit claims to    providers to submit their claims.
                                   DOSI?
 57.                               Do you use standard coding         Standard claim codes are used for
                                   systems for recording              recording diagnosis and procedures.
                                   diagnosis and procedures?
 58.                               How often does DOSI receive        Premiums are normally received monthly
                                   premiums from employers and        but other modes of premium such as
                                   individuals?                       quarterly and annual are accepted.
 59.                               In what form are the               Cash, cheques, credit card, ETF.
                                   premiums received? E.g.
                                   cheques, electronic fund
                                   transfers etc
 60.                               Our understanding is that          Yes.
                                   current claims processing
                                   function is manual. Is this
                                   correct?
 61.                               Does DOSI have contracts on        a) In Bermuda, HIP uses the Bermuda
                                   fixed charges for healthcare       Hospitals Board rates to form the basis
                                   services with external hospitals   of how much they will reimburse most
                                   and doctors?                       claims, other types of services such as
                                                                      diagnostic imaging, cardiology, surgical
                                                                      procedures and laboratory tests are set
                                                                      by the Bermuda Health Council through
                                                                      DOSI and are updated for April 1st for
                                                                      each year. Additionally, the Bermuda
                                                                      Health Council negotiates with private
                                                                      physicians and laboratories the rates for
                                                                      standard procedures on an annual basis.
                                                                      b) Outside Bermuda, DOSI currently does
                                                                      not fix charges with hospitals and
                                                                      doctors, however in the future DOSI
                                                                      hopes to negotiate such rates through a
                                                                      third party.
 62.                               Does DOSI have                     Yes.
                                   documentation of the same?
 63.                               Are there any private health       Yes, the MRF and Subsidy claims are co-
                                   insurance parties with which,      ordinated with other health insurance
                                   some of the healthcare claims      companies.
                                   need to be coordinated with?
 64.                               Please walk us through your        We have process maps documenting
                                   current claims process right       current manual processes for most claims
                                   from submission to denial or       types.
                                   payment of a claim.                However, we expect a new process
                                                                      tailored to the successful solution.
 65.                               Please explain your current        Current claims appeals are handled
                                   claims appeals process             without a formal or standard process on
                                                                      an ad hoc basis.
                                                                      We expect a new process tailored to the
                                                                      system.



Response to Vendor Questions on HIP Automaton Project RFP                                                 9 of 27
          Page       Section
 Q#                                   Question / Clarification                          Answer
           #           #
 66.                               Is development expected to be       Development, if any, can be wherever
                                   performed only at onshore           the vendor wishes.
                                   location?
 67.                               Will DOSI want separate             This is a possibility. However, the current
                                   portals with individual design      government portal can also be utilized as
                                   elements suited to different        a log-in for all stakeholders.
                                   stakeholders?
 68.                               Are there any standard formats      No.
                                   used for electronic transactions
                                   i.e. 834, 837, that are used in
                                   the US for electronic
                                   transactions?
 69.                               Is the certificate of entitlement   No. Currently, this information is stored
                                   always recorded in any one          entirely manually on index files stored at
                                   system? If so which system?         DOSI‟s offices.
                                                                       In the future, the vendor's proposed
                                                                       solution should be able to capture this
                                                                       information.
                                   Business Development (a)
 70.                7.1            Why is Product Portfolio            This was an oversight when highlighting
                                   Tracking Requirements               the requirements on the component
                                   included in the Functional          business model. Product Portfolio
                                   Business Requirements when it       Tracking is within scope of the HIP
                                   is not highlighted in green in      Automation Project.
                                   Table 1 as part of the scope of
                                   the HIP Automation Project?
 71.     a.5        a.5.1.1        Are there existing systems to       No, there are no systems to capture HIP
                                   capture products information.       products at the present time. Capturing
                                   Does the scope of the HIP           HIP products within the solution is within
                                   automation include developing       the scope of the HIP Automation Project.
                                   screens to capture products
                                   information?
 72.                a.5.1.1        Need clarification on what it       DOSI is looking to analyze the
                                   means for DOSI to analyze           performance of its products such as
                                   products. What data                 profitability, volumes, lapses, claim
                                   elements/parameters/metrics         trends, etc.
                                   need to be considered?
 73.                a.5.1.2        What are factors for                Factors to determine the cost to
                                   determining cost?                   administer products would include
                                                                       volumes, transaction types, numbers of
                                                                       transactions by type, time to process, etc.




Response to Vendor Questions on HIP Automaton Project RFP                                               10 of 27
          Page       Section
 Q#                                   Question / Clarification                          Answer
           #            #
 74.                a.5.1.2        Ability to determine the cost to   Factors to determine the cost to
                                   administer products. HIGH          administer products would include
                                   Do you have a list of what is to   volumes, transaction types, numbers of
                                   be included in the cost of         transactions by type, time to process, etc.
                                   administering the products?
                                   i.e. salaries, office space,       All DOSI‟s administrative expenses are
                                   stationary, etc.                   budgeted, recorded, amended and
                                   Are all expenses entered in        forecast in the JD Edwards system.
                                   some form via the JDE system?      However, the government pays 100% of
                                   NB: This will require a pro rata   the expenses and then obtains 50%
                                   of any details that cross          reimbursement of the expenses from HIP
                                   products, for example              and MRF. HIP and MRF have no
                                   department manager‟s salary,       automated accounting system and
                                   office space, etc.                 expenses are solely recorded in excel
                                                                      spreadsheets used to produce financial
                                                                      statements. On HIP and MRF financials,
                                                                      administrative expenses are recorded as
                                                                      a single consolidated line item.
 75.                a.5.2          Maintain claim experience          2.1 specifies electronic receipt, 2.4 the
                                   5.2.1 specifies ability to         storing of the information for historical
                                   electronically receive the         purposes. The key purpose is to calculate
                                   annual claims experience and       annual fees.
                                   is a high priority where as
                                   5.2.4 specifies ability to
                                   historically store the annual
                                   claims experience and is rated
                                   as medium.
                                   What is meant by “receive” the
                                   annual experience if this does
                                   not include storing it?

 76.                a.5.2.1        Our product can receive claims     Electronically.
                                   electronically, however in what
                                   format do you anticipated
                                   receiving claim history?
 77.                a.5.2.1        Will this requirement be           We would accept the successful vendor's
                                   implemented as a single            suggestion on the best approach to this.
                                   interface for all insurers or is   A single interface or custom interfaces
                                   their any customization            would be acceptable.
                                   required for each health
                                   insurer? In that case please       There are four major health insurers and
                                   specify the number of health       five approved schemes that would
                                   insurers DOSI is currently         interface with DOSI.
                                   working with relevance to the
                                   scope of this RFP




Response to Vendor Questions on HIP Automaton Project RFP                                              11 of 27
          Page       Section
 Q#                                   Question / Clarification                        Answer
            #           #
 78.     a.5        a.5.2.1        Will this requirement be           Same response as 77 (above).
                                   implemented as a single
                                   interface for all insurers or is
                                   their any customization
                                   required for each health
                                   insurer? In that case please
                                   specify the number of health
                                   insurers DOSI is currently
                                   working with relevance to the
                                   scope of this RFP
 79.                a.5.2.2        Does the scope include             Scope includes automating all the
                                   automating HIP alone or HIP,       programs mentioned because they are all
                                   MRF, Gov Subsidy & War             under DOSI‟s operational control and
                                   Veteran program as well            responsibility.
 80.                a.5.2.2        Our product can receive claims     Electronically.
                                   electronically, however in what
                                   format do you anticipated
                                   receiving claim history?
 81.                a.5.2.4        Historical data storage – how      This has not been determined yet.
                                   long can the historical data can   (However our manual data on file can be
                                   date back to? (Example Data        traced back to1970.) Currently there are
                                   for past 3 yrs, 5 yrs etc)         no plans to delete data.
 82.                a.8.1.17       By this we assume multiple         Yes.
                                   environments will be
                                   maintained to support QA
                                   before production roll out.
                                   Correct?
 83.     a.8        a.8            Do we need to implement            Yes, multiple versions of a product must
                                   versioning capability of the       be supported, including effective dates.
                                   product? i.e., do we need to
                                   system to store snapshots of a
                                   product before any changes
                                   are made to it?
 84.                a.8.1.1        Please clarify what is to be       All forms of data will need to be stored
                                   stored & maintained? Word          including the actual legislation and the
                                   documents? Spreadsheets?           data/rate schedules along with the dates
                                   Images? Text from the              and corresponding CPT codes. These
                                   legislation? Just the actual       could be in Word, spreadsheets or .PDF
                                   data/rate schedules along with     files.
                                   dates and corresponding CPT
                                   codes?
 85.                a.8.1.1.5      Does this mean that you would      Yes.
                                   like to roll premium amounts
                                   into one bill, then separate as
                                   a line item when posting to an
                                   account?
 86.                a.8.1.16       What is a policy reserve?          Funds put aside to pay claims.




Response to Vendor Questions on HIP Automaton Project RFP                                              12 of 27
          Page       Section
 Q#                                   Question / Clarification                       Answer
           #            #
 87.                a.8.2.1        Is Post Implementation           Will be decided based on the
                                   support (like help desk)         implementation. For the bid use training
                                   expected? If so, for how long?   for the HIP staff and general support for
                                                                    six months. You may price optional
                                                                    support if you feel that is necessary.
 88.                a.8.2.2        Not sure if this is an           There is an expectation that this
                                   expectation of the product to    requirement will be satisfied, for example
                                   be developed                     correspondence being loaded in the
                                                                    system and generated at that next billing
                                                                    cycle to inform stakeholders of product
                                                                    changes.
 89.                a.8.2.4        Please clarify what product      The production operational procedures
                                   operational procedures are       are all those procedures required to
                                   referred to here.                support the product such as new
                                                                    business acquisition, policy
                                                                    administration, claims, etc.
 90.                a.5.1.1        Are there existing systems to    There are no existing systems
                                   capture product information.     whatsoever, except the policyholder
                                   Does the scope of the HIP        database for HIP only in the form of the
                                   automation include developing    AS400 system.
                                   screens to capture product
                                   information?
                                   Policy Administration (b)
 91.                b.9.1.1        Requires clarification. Is the   Yes, the government is considering
                                   Government considering           unique IDs – the length and format has
                                   issuing unique ID‟s? If so,      not yet been decided on.
                                   what length and format?
 92.                b.9.1.2        How will an uninsured person     Most of the residents of Bermuda are
                                   acquire a user name and          eligible for one of the HIP products.
                                   password? Will they have to      Persons claiming under a HIP product will
                                   have a user name/password?       be able to acquire a user name and
                                   Would they not be able to        password. They will not be required to
                                   apply for insurance without a    have a user name / password – it is an
                                   user name/password?              optional service to the residents. Yes,
                                                                    residents would be able to apply for
                                                                    insurance without a user name.
 93.                b.9.1.5        What approved schemes?           Requirement b.9.1.5 seeks to allow DOSI
                                   Sounds like a staff training     to enter details of other insurers‟ policies
                                   issue                            in our system. This would enable DOSI
                                                                    customer representatives to quickly look-
                                                                    up benefits offered by other insurers
                                                                    when asked by members of the public
                                                                    and advise the customers accordingly.
                                                                    (DOSI receives the contracts/policy
                                                                    wordings of all insurers on an annual
                                                                    basis through the Re-licensing process.)
                                                                    For example, a useful system feature
                                                                    would be a screen or series of screens
                                                                    providing a quick way to enter and
                                                                    update other insurers‟ terms and
                                                                    conditions.


Response to Vendor Questions on HIP Automaton Project RFP                                             13 of 27
          Page       Section
 Q#                                   Question / Clarification                          Answer
           #            #
 94.                b.9.2.7        Please elaborate on the scope       Managing applications during the open
                                   of this requirement. What           enrolment period refers to being able to
                                   activities would be included as     capture the receipt of the application, the
                                   part of “managing”                  status of the application, ability to
                                   applications?                       identify where the application is in the
                                                                       process, the outstanding requirements,
                                                                       etc.
 95.                b.9.2.9        Would the medical declarations      Yes, storing scanned images.
                                   be stored in the System? If so,
                                   are we looking at storing
                                   scanned images? Please
                                   confirm?
 96.                b.9.2.1        Will web, call centre and paper     Yes, the process should be channel
                                   application process flows be        independent.
                                   integrated with the system in
                                   order to acquire applications,
                                   queries and claims?
 97.                b.9.2.1        “Acquire customer via web, call     Yes, the same web based screens should
                                   centre, paper” - Our                be used by all users..
                                   understanding is that we need
                                   to provide web based screens
                                   to acquire customers. The
                                   same web based screens
                                   will also be used by DOSI staff
                                   to acquire customers by way of
                                   call centre and paper
                                   applications. Please confirm
 98.                b.9.2.11       When a member records their         Our current manual process involves
                                   replies for the last doctor visit   DOSI staff calling the doctor and the
                                   details - what is the way to        hospital to confirm the accuracy of the
                                   validate the veritability of this   statement. Outside of this, we have no
                                   reply?                              way of verifying these statements are
                                                                       accurate. However, if it is discovered
                                                                       later that the member has incurred
                                                                       treatment prior to the policy effective
                                                                       date, the claim would be denied.
 99.                b.9.2.13       It is mentioned that “there is      It is anticipated the underwriting process
                                   minimal to no underwriting          will be enhanced as a result of the new
                                   done today” . Will the              application and re-engineering the
                                   proposed system have the            processes.
                                   same or will refine the existing
                                   underwriting logic.
 100.               B.9.2.15       Ability to calculate HIP            Flat rate with some adjustments based on
                                   premiums based on age and           age and residency status.
                                   other criteria. What other
                                   criteria is used to calculate
                                   premium rates?




Response to Vendor Questions on HIP Automaton Project RFP                                               14 of 27
          Page       Section
 Q#                                   Question / Clarification                           Answer
           #            #
 101.               b.9.4.1        As per the requirement:              Indicative of the total data.
                                   “Ability to service upto 100.000
                                   Bermuda residents “
                                   Is this indicative of the total
                                   data or are there any other
                                   NFR implied in it?
 102.               b.9.4.10       Does it need to be an                Should be automated and triggered by
                                   automated process? If so,            the customer reaching the specified
                                   should it be online triggered or     period of time for the residency
                                   as a batch process.                  requirement.
 103.               b.9.4.9        Does it need to be an                See response to question b.9.4.10.
                                   automated process? If so,
                                   should it be online triggered or
                                   as a batch process.
 104.               b.9.1.3        Will incoming data be in             Incoming data will be in specified formats
                                   specified file formats. Are we       and will be a combination of bulk data
                                   looking at bulk data upload          and individual updates.
                                   here. Please confirm.
 105.               b.9.4.2        More clarity required. Please        The ability to reinstate a policy once it
                                   elaborate on the scope of            has met the reinstatement requirements
                                   activities which are part of this    is needed. The date of the reinstatement
                                   requirement.                         and each time the policy is reinstated is
                                                                        required.
 106.               B.9.5.3        Ability to apply the bulk            Yes.
                                   premium to the policyholders
                                   premiums. What does this
                                   mean? Is the premium applied
                                   to multiple entities (member
                                   and employer group)?
 107.               b.9.5.10       Will the billing process be          Event triggered – e.g. on the customer‟s
                                   online or batch triggered.           billing date, month end.
 108.               b.9.5.12       No. of Billing Cycle is not pre-     Monthly with ability to increase frequency
                                   defined. Please clarify if it is a   at a later date.
                                   single or Multiple Billing Cycles
                                   per month?
 109.               b.9.5.13       When premiums are received           Yes.
                                   over phone it is assumed that
                                   the same UI /Interface will still
                                   be used to get the details into
                                   the system
 110.               b.9.5.13       Ability to receive employer          Credit card.
                                   monthly premiums … over the
                                   phone.
                                   How are premiums meant to
                                   be accepted over the phone?
 111.               b.9.4.15       How is b.9.4.14 different from       One relates to an instance of a bill, the
                                   b.9.4.15?                            other to the complete account.




Response to Vendor Questions on HIP Automaton Project RFP                                                 15 of 27
          Page       Section
 Q#                                   Question / Clarification                          Answer
           #            #
 112.               b.9.5.18       What is the logic use in the        The requirement is to be able to receive
                                   anti- selection process?            the MRF premiums from other insurers
                                                                       and/or approve schemes. Anti-selection
                                                                       logic is not required to satisfy this
                                                                       requirement. This mechanism of
                                                                       collecting premiums is also a legal
                                                                       requirement for DOSI.
 113.               b.9.5.19       When the frequency of               Yes.
                                   premium billing is modified,
                                   some of the functionalities
                                   could be impacted. Is it a fair
                                   assumption to say that any
                                   changes in Billing frequency
                                   will be applicable only from the
                                   subsequent billing process?
 114.               b.9.4.19       Are there national occupation       No.
                                   codes? Or do we need to track
                                   by use of pseudo codes?
 115.               b.10.1.7       Ability to generate vendor          The new provider is first encountered by
                                   number based on sequencing          the receipt of a claim in the HIP system.
                                   when a new provider is
                                   encountered for payment.
                                   As all payments are routed via
                                   JDE and must be set up in JDE
                                   to receive payment, will the
                                   JDE system not be the one
                                   that will generate the vendor
                                   number?
 116.               b.10.2.1       Integrate is a large work in this   The specific type of information to be
                                   context. What information           shared has not been defined yet. This is a
                                   would you like to share? How?       general requirement with many possible
                                   To what systems?                    examples depending on the scenario: a)
                                                                       in the claims area, this is electronic
                                                                       receipt of claims from insurers; b) in the
                                                                       re-licensing area, this is electronic receipt
                                                                       of annual statistics, standard policy
                                                                       wording and applications; c) in the
                                                                       policyholder area, this might be verifying
                                                                       a member is insured with the insurer.
 117.               b.10.2.3       Is unique Provider                  No.
                                   Identification already
                                   implemented?
 118.               b.10.2.6       What are the details of the         Must be in good standing – e.g. submit
                                   criteria for preferred providers?   claims in time.
                                   Are there any in or out of
                                   network providers and if so         No, don't have a network.
                                   what are the criteria?




Response to Vendor Questions on HIP Automaton Project RFP                                                 16 of 27
          Page       Section
 Q#                                   Question / Clarification                          Answer
           #            #
 119.               b.10.2.7       Ability to provide different       Faster payment.
                                   levels of service based on
                                   preferred status.
                                   What is meant by this in
                                   relation to providers? Could an
                                   example be provided?
 120.               b.10.2.8       Delinquent in sending claims       Yes.
                                   later than desired?
 121.               b.10.2.8       Delinquent of what?                Late submission of claims.
                                   Credentials? Claims timely
                                   filing submissions?
 122.               b.10.2.10      Please explain what a typical      E.g. ability to pay with cheque.
                                   process might be.
 123.               b.10.2.12      Circulars, is this marketing       The requirement is to send
                                   material                           correspondence to any provider regarding
                                                                      DOSI operations. Examples include, but
                                                                      are not limited to: updates on DOSI
                                                                      implementing its automated system,
                                                                      marketing material, notification of office
                                                                      closures for public holidays, notifications
                                                                      of rate changes, annual legislation
                                                                      updates, any changes to the HIP Plan,
                                                                      etc.
 124.               b.10.2.16      The claims system needs to         The requirement is to enable HIP to
                                   receive data and be able to        capture: a) which physicians are
                                   report upon that data. What        submitting claims; and b) which members
                                   are you trying to achieve here     must pay and seek reimbursement from
                                                                      DOSI directly because the physician billed
                                                                      that member directly and by-passed
                                                                      submitting the claim to DOSI. It is the
                                                                      desire within Bermuda for physicians to
                                                                      only charge the patient for the amount of
                                                                      the service that exceeds the insurers‟
                                                                      expected payment to the physician.
 125.               b.10.3.5       What is the criteria for a late    The criteria should be flexible i.e. user
                                   claim?                             defined.
 126.               b.10.3.6       What criteria should be            Accuracy, duplicate claims (potential
                                   monitored by provider?             fraud),timeliness, etc.
 127.    b.10       b.10.4.1       For electronic payments are we     All payments are handled through JDE
                                   looking at using a third party     and existing or planned ancillary
                                   Off –the shelf product for this?   applications.
 128.               b.10.4.1       Can receive input file for         No answer is applicable.
                                   checks issued/cleared.
 129.               b.10.4.2       Currently supports users in        No answer is applicable.
                                   defining a "pay file" in
                                   whatever format the recipient
                                   desires.
 130.    b.10       b.10.4.3       For electronic re-imbursements     See question 127 above.
                                   are we looking at using a third
                                   party Off –the shelf product for
                                   this?


Response to Vendor Questions on HIP Automaton Project RFP                                                17 of 27
          Page       Section
 Q#                                   Question / Clarification                         Answer
            #           #
 131.    b.10       b.10.3.4       For receiving paper claims, are    Up to vendor to suggest the effective
                                   we looking at scanning the         approach.
                                   paper claims using OMR or
                                   OCR.
 132.    b.10       b.10.3.2       For bulk loading claims, are we    Yes.
                                   looking at any standardized
                                   formats such as HIPAA
 133.    b.10       b.10.3.3       Need more information about        Will be provided at a later date.
                                   the standard HIP format
 134.               b.10.6         Would the system have to           Yes. This is envisioned as a “messaging”
                                   interface with insurers for        interface between the Government and
                                   applications, licence and other    the insurers. The insurers and schemes
                                   purposes? Is there a list of       are variable.
                                   identified insurers and
                                   approved schemes?
 135.               b.10.6.1       Where do these funds get           Not related to claims. Placed in a special
                                   applied in the claims system?      account.
                                   Is it funding for various
                                   accounts?
 136.               b.10.6.2       What licenses and for what         Health Insurance companies in Bermuda
                                   approved schemes? Data             are licensed by the Government.
                                   coming from what source?           Individual employers large enough to
                                   How? Could be a document           have their own „approved scheme‟ for
                                   management solution.               health insurance are also licensed by the
                                                                      Bermuda Government to conduct health
                                                                      insurance business. Data is in the form
                                                                      of Excel spreadsheets and Word
                                                                      documents.
 137.               b.10.6.2       If licensing applications are      Licensing applications should be received
                                   scanned and indexed, and           electronically as formatted data not
                                   delivered electronically, our      images.
                                   application integrates with
                                   imaging systems to
                                   automatically import and route
                                   such documents.
 138.               b.10.6.2       Ability to receive licensing       Licensing applications and schemas
                                   applications electronically from   should be received electronically as
                                   insurers and approved              formatted data.
                                   schemes. HIGH
                                   What is meant by this? An
                                   application could be received
                                   by email, or posted to an ftp
                                   site or is this referring to
                                   uploading applications based
                                   on an EDI format? Do the
                                   insurers generally have the
                                   facility to provide applications
                                   in EDI formats? Are there that
                                   many new insurers/approved
                                   schemes a year in Bermuda to
                                   warrant this?


Response to Vendor Questions on HIP Automaton Project RFP                                                 18 of 27
          Page       Section
 Q#                                   Question / Clarification                            Answer
           #            #
 139.               b.10.6.3       What will need to be stored,          Applications and schemes are submitted
                                   images? PDF's?                        as formatted data.
 140.               b.10.6.3       Ability to receive the financial      Financial statements and additional
                                   statements and additional             documentation should be received
                                   documentation electronically.         electronically as formatted data.
                                   HIGH
                                   As above these could be
                                   received by email, or posted to
                                   an ftp site or is this referring to
                                   uploading based on an EDI
                                   format? Do the insurers
                                   generally have the facility to
                                   provide these documents in
                                   EDI formats?
 141.    b.10       b.10.6.4       Does this involved creating a         No, should be an internal automated
                                   customized report fro annual          process.
                                   re-licensing


 142.               b.10.6.5       Please clarify                        Requires the ability to produce a pre-
                                                                         loaded, standard document / certificate
                                                                         called a „license‟ and possibly print these
                                                                         licenses.
 143.               b.10.6.6       Please clarify                        Ability for the system to automatically
                                                                         send the electronic document (license) to
                                                                         a specified person in the Ministry of
                                                                         Health (authorizing the approval of
                                                                         licenses to the insurance companies).
                                   Claims ( c )
 144.               c.1.2.2        Please provide a definition of        Metrics such as how current the
                                   the parameters that should be         administration of contractual changes
                                   monitored.                            are, how many duplicate claims are
                                                                         received, etc are required to produce
                                                                         these.
 145.               c.1.1.4        Has DOSI defined specific data        The intent is to physically share
                                   and interfaces for sharing            aggregate information, not electronically
                                   information/it uses standard          exchange detailed data.
                                   HIPAA transactions for the
                                   same? Please share any
                                   additional details with us to
                                   help us estimate the effort
                                   involved in terms of number of
                                   data elements/attributes and
                                   number of interfaces
 146.               c.1.1.5        Are we looking at “context            The context here is the adjudication
                                   sensitive help” only for Claims       process and the best way to adjudicate a
                                   module or do we need it for           claim that is not automatically processed.
                                   the other modules as well?
                                   Please confirm?




Response to Vendor Questions on HIP Automaton Project RFP                                                 19 of 27
          Page       Section
 Q#                                   Question / Clarification                          Answer
           #            #
 147.               c.1.2          Would there be a disease            Yes.
                                   management aspect to the
                                   system - as a sequel to
                                   tracking chronic
                                   diseases/hospitalizations/major
                                   procedures, etc?
 148.               c.2.1          Will the treatment histories be     Treatment history will be a combination.
                                   recorded via the claim based
                                   patient health records (PBHR)
                                   into the system/or a
                                   combination of PBHR and
                                   consumer inputs of their own
                                   health records?
 149.               c.2.8          Please define focus.                Focus is on the “patient” (all claims /
                                                                       treatments) not an individual claim.
 150.               c.1.3.6        On an average, it turns out to      Refer to the response to question 11.
                                   be 250 claims per day. How
                                   many claims are currently
                                   being handled per person/per
                                   day at HCS Bermuda?
 151.               c.3.1          What kind of Audit we're            The system should randomly select a
                                   looking at here? Is it like, we     claim for audit, that is verification that
                                   generate a report and analyze       the treatment actually took place - the
                                   it offline?                         system could also generate a report of
                                                                       randomly selected claims. We may audit
                                                                       claims to ensure that the eligibility rules
                                                                       are correct.
 152.               c.3.2 -        Are these all Reporting             There may be additional reports required
                    c.3.7          requirements? Please clarify?       once the solution is better understood.
 153.               c.3.10         Please define or forward a          The claims service standards under
                                   copy of your claim service          development and variable.
                                   standards.
 154.               c.6.1.1        How would the claims get            That would be part of the new
                                   received through website? Do        application.
                                   we have claims data entry
                                   through internet?
 155.               c.6.1.1        Claims received through Faxes       Correct, after which the adjudication and
                                   and Paper based claims would        payment process is common for all
                                   get entered into the system         channels.
                                   through the front end? Please
                                   confirm the same?
 156.               c.6.1.4        How we would be able to             Claims originating from other insurers are
                                   validate this in case if it turns   processed by them, so this is not a
                                   out to be a paper based claim?      possible situation, and other insurers are
                                                                       “trusted”.
 157.               c.6.2.3        “Minimum claim requirements”        Yes, requirements such as eligibility, and
                                   do we mean the different            claimant registered in system.
                                   validations that needs to be
                                   done before it gets into the
                                   system? Please confirm?



Response to Vendor Questions on HIP Automaton Project RFP                                                20 of 27
          Page       Section
 Q#                                   Question / Clarification                         Answer
           #            #
 158.               c.6.2.3        By 'Accepted' we mean the          Yes.
                                   claim gets into the system
                                   successfully. Please validate?
 159.               c.6.2.4        Are we looking at the proofs       Proofs could be sent electronically, or
                                   being sent electronically? Or      could be paper based, which would mean
                                   someone would update the           scanning. This would be followed by an
                                   statuses in the application        update of the claim.
                                   manually?
 160.               c.6.2.4        Are you requesting                 Yes, for paper based proof.
                                   scanning/imaging services?
 161.               c.6.2.5        Depending upon the member          Yes.
                                   to whom this claim is raised, it
                                   would get look up the
                                   corresponding policy and
                                   product (to which the member
                                   is associated with?). Please
                                   confirm the same?
 162.               c.6.2.7        What is a "Claim Processor" in     The person performing manual
                                   this context? How many             adjudication.
                                   different types of claims          The number is currently under review.
                                   processors are there?
 163.               c.6.2.7        Define business rules              An example of a business rule would be
                                                                      “If claim amount is over $1,000, a senior
                                                                      claim processor is required to adjudicate”.
 164.               c.7.1.3        “Ability to determine claim        Depending on the type of claim ensure
                                   requirements” – we mean            that all pertinent information has been
                                   validating the claims entered      received.
                                   manually/electronically
                                   received for completeness? Is
                                   our understanding
                                   appropriate?
 165.               c.7.1.3        Beyond eligibility confirmation?   Yes, depending on the type of claim
                                   Such that a specific benefit       ensure that all pertinent information has
                                   would require additional           been received.
                                   documents?
 166.               c.7.1.4        “Ability to simplify / automate”   Business rules should be externalised.
                                   – do we mean                       Business users should be able to update
                                   “parameterization” of the          the rules based policy / product
                                   validation rules? Please           information, or alternatively the
                                   confirm? If so, under what all     application handling policy / product
                                   scenarios the validation rules     administration could generate them.
                                   might potentially change?
 167.               c.7.1.5        Are we looking at sending          Yes.
                                   automated notifications to the
                                   concerned stakeholders during
                                   adjudication process
                                   requesting the additional
                                   information for processing?
                                   Please confirm?




Response to Vendor Questions on HIP Automaton Project RFP                                              21 of 27
          Page       Section
 Q#                                   Question / Clarification                            Answer
           #            #
 168.               c.7.1.10       From where the “Eligibility List”   The eligibility will lists will evolve in for
                                   is received? What is the            most products. Some lists will be
                                   frequency of the upload             received periodically to update the
                                   process?                            eligibility lists.
 169.               b.7.1.19       Ability to receive requirements     Whatever is the most efficient solution.
                                   electronically (such as letter
                                   from physician). HIGH
                                   As above, is this referring to
                                   email or uploading into the
                                   system?
 170.               c.7.2.2        What kinds of printing/mailing      Forms and letters to administer the
                                   of pre-defined forms and            products such as lapse letters, residency
                                   letters are considered here?        letters, EOB‟s, follow-up letters, etc.
 171.               c.7.3.1        Is it an automated process?         No.
                                   Please confirm?
 172.               c.7.3.5        What is the business                The claim would not be eligible.
                                   significance of determining
                                   whether the claim is >13
                                   months old?
 173.               c.7.4.2        Why do we need to record            Need to know whether the claim was
                                   decision on benefits? (Claims       approved, declined and why, or pended
                                   just look up the benefit details    and why.
                                   and get adjudicated
                                   appropriately?) Please clarify?
 174.               c.7.4.5        Please clarify benefit offer        The reimbursement amount may not be
                                                                       full the full amount of the claim and
                                                                       therefore an offer is made.
 175.               c.7.4.9        Please clarify                      The claimant may come back with an
                                                                       counter offer, HIP would need to decide
                                                                       whether or not to accept the counter
                                                                       offer and if they do record this detail.
 176.               c.7.4.15       for all claims submitted on a       Up to the provider. Long term vision is to
                                   certain day? By what criteria       have claims submitted as individual
                                   will claims be batched?             transactions (messages).
 177.               c.7.5.1        Are we looking at a generic         This is basically the ability to switch to
                                   Medical Dictionary/Directory of     another browser window with a
                                   Physicians or something             predefined url (could be a medical
                                   specific to that geography?         Dictionary).
                                   Where are these
                                   directories/dictionaries
                                   available?




Response to Vendor Questions on HIP Automaton Project RFP                                                   22 of 27
          Page       Section
 Q#                                   Question / Clarification                          Answer
           #            #
 178.               b.7.5.1        Ability to link with claims         See above.
                                   resource material for the user
                                   to search the internet for
                                   Medical Dictionary, directory of
                                   physicians. HIGH
                                   Do the Department of Social
                                   Insurance users not already
                                   have access to the internet? A
                                   link could be provided within
                                   the application but most users
                                   already have a desktop and
                                   favourites for managing this.
 179.               c.7.5.2        “Provide Online access to           Yes. This information could be on the
                                   resource materials, manuals,        internet or intranet.
                                   and protocols” – means
                                   providing quick links to
                                   frequently accessed
                                   information? Is our assumption
                                   appropriate?
 180.               c.7.5.4        Is this to be a provider search     Yes.
                                   based on criteria like specialty,
                                   location, accreditation, and
                                   other quality data?
 181.               c.7.5.5        Is this an online service to be     Should be available for both DOSI staff,
                                   created for the policyholders?      policy holders, and residents.
 182.               c.7.5.5        Please clarify how this would       Yes it would be independent of the
                                   work. It seems this would be        specific application, but would be part of
                                   independent of the system           an overall end-to-end solution.
 183.               C.7.5.5        Ability to search for all           An example could be providers of
                                   government and free                 physiotherapy.
                                   resources and counseling that
                                   policyholders may not be
                                   aware of. What
                                   does this mean - can we get
                                   an example of this scenario
 184.               c.8.1.1        Is this the same as Explanation     Yes.
                                   of Benefits (EOB) that is sent
                                   to the claimant? Please clarify?
 185.               c.8.2.1        Please clarify                      View it as special process indicator. In
                                                                       this case it is recovering the funds from
                                                                       an auto insurer.
 186.               c.10.1         related to duplicate billing?       Some other criteria: Treatment never
                                   related to billing for non-         took place (either provider or consumer) ,
                                   eligible members? What other        faked receipts, and faked accidents, etc.
                                   criteria are included for
                                   determination of fraud?
 187.               c.10.3         How is a fraudulent claim           Procedures need to be developed.
                                   settled?




Response to Vendor Questions on HIP Automaton Project RFP                                               23 of 27
          Page       Section
 Q#                                   Question / Clarification                         Answer
           #            #
 188.               C.10.5         ability to forward case to         Since this is fraud this is needed to take
                                   inspectors and or legal support    legal or other action.
                                   to manage. What does this
                                   mean and can you provide an
                                   example
                                   Financial & Risk
                                   Management (d)
 189.               d.3.1          What level of automation and       The specific requirements are elaborated
                                   what are the specific financial    in d4 – d7.
                                   processes that we are looking
                                   at
 190.               d.3.1          which processes, specifically?     As above.
 191.               d.3.2          How many such interfacing          Currently JDE is the only financial
                                   applications are we looking at     application HIP needs to interface with.
 192.               d.3.3          We were under the impression       Correct assumption.
                                   that you would be keeping JE
                                   Edwards accounting package,
                                   of which our application would
                                   have to integrate with. If this
                                   is not the case, please clarify.
 193.               d.3.4          We were under the impression       Correct assumption.
                                   that you would be keeping JE
                                   Edwards accounting package,
                                   of which our application would
                                   have to integrate with. If this
                                   is not the case, please clarify.
 194.               d.3.5          We were under the impression       Correct Assumption.
                                   that you would be keeping JE
                                   Edwards accounting package,
                                   of which our application would
                                   have to integrate with. If this
                                   is not the case, please clarify.
 195.               d.3.5          --for claims payment               For HIP.
                                   processes? For DOSI? Please
                                   provide more detail for the
                                   budgets to be managed
 196.               d.3.5          Are we looking to do this via      This would be a normal annual budget,
                                   periodic comparison reports or     and the ability to see how HIP track to it.
                                   otherwise
 197.               d.3.6          We were under the impression       Correct assumption.
                                   that you would be keeping JE
                                   Edwards accounting package,
                                   of which our application would
                                   have to integrate with. If this
                                   is not the case, please clarify.




Response to Vendor Questions on HIP Automaton Project RFP                                               24 of 27
          Page       Section
 Q#                                   Question / Clarification                        Answer
           #            #
 198.               d.4.1          How should the system            Require the ability to record the
                                   evaluate underwriting            underwriting guidelines and with the
                                   guidelines, would it have to     claim metrics and product performance
                                   compare the underwriting         metrics will be able to do the required
                                   procedures for a specific        analysis.
                                   policy, plan against the base
                                   rules set up already
 199.               d.4.8          This may refer to Incurred but   yes it is similar but in this case it is not a
                                   not received, Please clarify.    known claim.
 200.               d.5.1          What information would be        This would be access to the applications
                                   required for remote access? Or   and information through VPN connections
                                   are we looking at hosting the    from outside the government network.
                                   application on the internet to
                                   support remote accessibility
 201.               d.6.1 –        Please advise the status of JD   JDE is the government‟s financial
                    d.6.18         Ewards                           package.
 202.               d.6.4          record in what way? Separate     For a particular product, require the
                                   from opening an account?         ability to record the correct account that
                                                                    the claim should be debited against.
 203.               d.6.7          please provide more detail       This will be based on business rules as to
                                                                    whether the system can authorize the
                                                                    payment or an individual is required to
                                                                    authorize.
 204.               d.6.11         what details would be the        To be determined at the time of
                                   focus of the evaluation?         evaluation.
 205.               d.7.12 –       Is this a function of the JD     Some are, some are not. Any decisions
                    d.7.22         Ewards software, or does this    should be done within the HIP system.
                                   need to be qualified with
                                   Microsoft Dynamics Accounting
                                   software
 206.               d.7.15         apply a refund payment to a      This is a normal payment.
                                   claim?
 207.               d.7.25 –       Is this a function of the JD     Some are, some are not. Any decisions
                    d.7.28         Ewards software, or does this    should be done within the HIP system.
                                   need to be qualified with
                                   Microsoft Dynamics Accounting
                                   software
 208.               d.7.20         for any other payments than      Yes.
                                   claim payments?
 209.               d.7.22         please provide more detail       The requirement is to be able define the
                                                                    process for payments.
 210.               d.7.30 –       Is this a function of the JD     Some are, some are not. Any decisions
                    d.7.32         Ewards software, or does this    should be done within the HIP system.
                                   need to be qualified with
                                   Microsoft Dynamics Accounting
                                   software
 211.               d.7.30         what investments are referred    In error, not a requirement.
                                   to here?
 212.               d.8            How many reports in total in     This will be decided during the next
                                   envisions at present             phase of the Automation project.



Response to Vendor Questions on HIP Automaton Project RFP                                               25 of 27
          Page       Section
 Q#                                   Question / Clarification                          Answer
           #            #
 213.               d.8.1.2        Are we missing something            This is an oversight. Please ignore this
                                   here?                              requirement.
 214.               d.8.1.14       In what way this is different      Are we really talking meta data here???
                                   from d.8.1.8.Can we assume         (both cases).
                                   the y both mean the same
 215.               d.8.1.15       What are the key indicators?       These are business process performance
                                   Although they are referred to      indicators, such as time to process a
                                   in the non-functional              claim, number of claims received,
                                   requirements they are not          approved, etc.
                                   defined specifically
 216.               d.8.1.15       Ability to define and maintain     See above.
                                   key performance indicators.
                                   HIGH
                                    Could you provide examples?
 217.               d.8.1.16       Ability to support business        Forecasting items like anticipated claim
                                   forecasting. HIGH                  volumes or claim payments.
                                    Could you provide examples?
 218.               d.8.1.17       How many such interfaces are       Will be determined during design.
                                   we talking about and do the
                                   interfaces need to be custom
                                   built for each f the interfacing
                                   source systems
 219.                              d.8.2 Sample reports – Reports     The information contained in the report is
                                   to include but not inclusive.      not necessarily maintained by the HIP
                                   HIGH                               system. E.g. HR related information
                                   Unsure what “to include but        would come from the HR system, and
                                   not inclusive” means. If this      asset related information would come
                                   means all reports listed may       from inventory systems.
                                   not have to be included then
                                   the following questions may
                                   not be applicable. If it means
                                   not an exhaustive list then
                                   they are applicable.
                                   d.8.2.7
                                   Operational/administrative
                                   activities (such as staff,
                                   payroll, staffing expenses such
                                   as pensions, tax, efficiency
                                   ratios)
                                   If reporting on these details
                                   the system must capture them.
                                   Is the new system meant to
                                   track all of this information?
                                   d.8.2.8 Facilities, maintenance,
                                   assets (such as building,
                                   vehicles, IT, hardware
                                   as above, is the new system
                                   meant to track all of this?
 220.               d.8.2.8        Is this report relevant here       This is part of the overall cost picture for
                                                                      HIP.



Response to Vendor Questions on HIP Automaton Project RFP                                                26 of 27
          Page       Section
 Q#                                   Question / Clarification                        Answer
           #           #
                                   Access, Security & Privacy
                                   Management (e)
 221.               e.10.2.26      Please provide more detail on     This requirement refers to being able to
                                   the contents of this worksheet.   make notes on the claim regarding
                                                                     decisions being made such that other
                                                                     users can pick the claim up and easily
                                                                     understand where the claim is in the
                                                                     process.
 222.               e.10.2.45      Ability to personalize the        Yes.
                                   elements on the interface
                                   according to personal
                                   preferences?
                                   Application Function Model
 223.                              Would you please provide          .jpg files are available on the RFP web
                                   separate images (.jpg, .tif or    site.
                                   .bmp will do, or native
                                   document format) of Figures 5
                                   (page labelled 55 of 78) and 6
                                   (page labelled 56 of 78) from
                                   the Application Function Model,
                                   since they appear cut-off on
                                   the right hand side in the PDF
                                   formatted RFP template.
                                   Conceptual Nodes
 224.                              Table 4 “Conceptual Nodes”        Table 4 is part of the RFP PDF file – try
                                   did not appear in our             downloading again.
                                   document. Please provide.
 225.               12.4           Conceptual Nodes states “Most     The following nodes exists in some form:
                                   of the Nodes required to          Application Node, Authentication Node,
                                   support the HIP applications      Backup Node, Call Centre Node,
                                   and data already exist in the     Collaboration Node, Data Warehouse,
                                   Government‟s IT                   Database Node, Directory Node, Fax, File
                                   environment”.                     Server, Firewall, Informational Node,
                                   Could you please confirm          Internet Client, Intranet Client, Load
                                   which Nodes of the ones listed    Balancing Node, Mail Node, Malicious
                                   already exist and which ones      Threat Detection, Portal Node, Proxy,
                                   do not exist for the HIP          Reverse Proxy, Security Management
                                   project?                          Node, Systems Management Node,
                                                                     Scanner, VPN Client, Web Application
                                                                     Node.




Response to Vendor Questions on HIP Automaton Project RFP                                              27 of 27

								
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