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									                      Request for Proposals - No. SEHA-G-RFP-05-2011
                             Management Service Agreement
                               Central Business Office (CBO)


                                 Issue date: 25 January, 2011


                                     Submit Proposals to:
                          Attn: Procurement and Services Manager
                         Abu Dhabi Health Services Company (SEHA)
                                  Hazza Bin Zayed 1st Street
                                       P.O.Box 109090
                                       Abu Dhabi, UAE
                                    Tel: +971-2-410-2000


                                    Closing date and time:
        Proposals must be received by SEHA Procurement and Services Department
                          No later than 10:00 AM on 13 March, 2011


                      All inquiries related to this RFP should be sent to:
                            Ms. Noha Kaddoura – Purchasing Assistant

                           Tel: 00-971-2-410-2503 E-mail: rfp@seha.ae

      Note: kindly mention the tender no. (SEHA-G/RFP/05/2011) in the subject of your email.




SEHA-G-RFP-05-2011                                                                             Page 1
                                                             Table of Contents
I.         Schedule of Events ................................................................................................................................ 4
II.        Definitions ............................................................................................................................................. 5
III.            Background ....................................................................................................................................... 5
      A.        Emirate of Abu Dhabi ....................................................................................................................... 5
      B.        Healthcare Sector in Abu Dhabi ........................................................................................................ 6
      D.        Revenue Cycle Management at SEHA Facilities ................................................................................ 8
      E.        Delineation of RCM Activities between the Corporate Office and the Facilities .............................. 9
      F.        Information Technology Status and Future Roadmap ...................................................................... 9
IV.             Scope of Services............................................................................................................................... 9
V.         The Management Service Agreement (MSA) ..................................................................................... 11
VI.             Personnel ........................................................................................................................................ 11
VII.            Contract Term ................................................................................................................................. 13
VIII.           Transition Period ............................................................................................................................. 13
IX.             Management Fees .......................................................................................................................... 14
A.         Base Fee .............................................................................................................................................. 14
B.         Performance Fee ................................................................................................................................. 14
C.         Key Personnel Fee ............................................................................................................................... 14
D.         Incentive Bonus................................................................................................................................... 14
X.         Project Timeline .................................................................................................................................. 15
XI.             Project Management & Communication ........................................................................................ 15
XII.            Qualified Bidders............................................................................................................................. 15
XIII.           Proposal Preparation and Submission ............................................................................................ 16
      A.        Technical Proposal .......................................................................................................................... 16
           1.      General Requirements ................................................................................................................ 16
           2.      Technical Criteria ........................................................................................................................ 17
           a)      Criterion 1 – Bidder’s Qualifications and Experience ................................................................. 17
           b)      Criterion 2 – Resources capabilities to be deployed or made available to SEHA ....................... 17
           c)      Criterion 3 – The Bidder’s proposed approach to setting up and managing the CBO................ 18
           d)      Criterion 4 – Evidence of successful performance ...................................................................... 18
           e)      Criterion 5 – Bidder’s comments on the MSA ............................................................................ 19
           3.      Financial Proposal ....................................................................................................................... 19

SEHA-G-RFP-05-2011                                                                                                                                         Page 2
          a)      Annual Base Fee .......................................................................................................................... 19
          b)      Man-month Key Personnel Fee - Category 1 .............................................................................. 19
          c)      man-month Key Personnel Fee – Category 2 ............................................................................. 19
XXVI.             Evaluation Criteria and Process .................................................................................................. 20
XXVII.            RFP General Terms and Conditions............................................................................................. 20
A.        Award .................................................................................................................................................. 21
B.        Proposal Preparation Costs ................................................................................................................. 21
C.        Closing Date and Time ........................................................................................................................ 21
D.        Delivery of Proposals .......................................................................................................................... 21
E.        Late Proposals ..................................................................................................................................... 21
F.        Unsolicited Proposals .......................................................................................................................... 21
G.        Irrevocability of Proposal .................................................................................................................... 21
H.        Validity of Proposal ............................................................................................................................. 21
I.        Currency and Taxes ............................................................................................................................. 21
J.        SEHA’s Rights and Options .................................................................................................................. 21
XXVIII.           RFP Follow-up Communications & Pre-bid Conference ............................................................. 22
     A.        Questions and Answers................................................................................................................... 22
     B.        Pre-bid Conference ......................................................................................................................... 22
     C.        Site Visits ......................................................................................................................................... 23
Attachment (1) - Management Service Agreement (MSA)......................................................................... 24
Attachment (2) - List of SEHA Facilities ....................................................................................................... 25
Attachment (3) - SEHA Business Entities .................................................................................................... 28
Attachment (4) - Health Insurance Law Healthcare Insurance Regulatory Environment .......................... 29
Attachment (5) - RCM Staffing and Volumes by Facility ............................................................................. 34
Attachment (6) - Current Delineation of RCM Activities ............................................................................ 40
Attachment (7) - RCM Information Technology Roadmap ......................................................................... 43
Attachment (8) – Proposed Delineation of RCM Activities......................................................................... 45
Attachment (9) - Suggested Revenue Cycle Key Performance Metrics ...................................................... 47




SEHA-G-RFP-05-2011                                                                                                                                          Page 3
I.         Schedule of Events
                         Event                                                   Time                      Date
 Public Notice of RFP                                                                                  Jan 25, 2011
 Submit intent to attend pre-bid conference and
                                                                       3:00 PM                        Feb 12, 2011
 list of attendees by
 Site Visits (please see related section in the RFP)                                              Feb 13 - Feb 24
                                                                       By Appointment
                                                                                                    (Sun - Thu)
 Pre-Bid Conference (Agenda and location will be
                                                    8:00 AM – 5:00 PM                                 Feb 14, 2011
 posted on SEHA website under “tenders” )
 Deadline for Receipt of Written Questions          3:00 PM                                           Feb 22, 2011
 Response to Written Questions to be posted on
                                                    3:00 PM                                           Feb 27, 2011
 SEHA website
 Closing date & start of proposal evaluation        10:00 AM                                      March 13, 2011
 Begin MSA negotiations with shortlisted bidders
                                                                                                      April 3, 2011
 by
 Award, Signing of MSA and start of mobilization                                                          June 5
 Anticipated contract start date                                                                       July 3, 2011
All requests and submissions should be sent to (rfp@seha.ae)
                    January                                 February                                   March
     S    M    T      W       T    F    S    S    M    T       W       T    F     S     S    M    T      W     T    F    S
                                         1              1       2       3    4     5               1      2     3    4    5
      2    3    4      5       6    7    8    6    7    8       9      10   11    12     6    7    8      9    10   11   12
      9   10   11     12      13   14   15   13   14   15      16      17   18    19    13   14   15     16    17   18   19
     16   17   18     19      20   21   22   20   21   22      23      24   25    26    20   21   22     23    24   25   26
     23   24   25     26      27   28   29   27   28                                    27   28   29     30    31
     30   31

                     April                                    May                                       June
     S    M    T      W       T    F    S    S    M    T       W       T    F     S     S    M    T      W     T    F    S
                                    1    2    1    2    3       4       5    6     7                      1     2    3    4
      3    4    5      6       7    8    9    8    9   10      11      12   13    14     5    6    7      8     9   10   11
     10   11   12     13      14   15   16   15   16   17      18      19   20    21    12   13   14     15    16   17   18
     17   18   19     20      21   22   23   22   23   24      25      26   27    28    19   20   21     22    23   24   25
     24   25   26     27      28   29   30   29   30   31                               26   27   28     29    30



                     July                                   August                                 September
     S    M    T      W       T    F    S    S    M    T       W       T    F     S     S    M    T      W     T    F    S
                                    1    2         1    2       3       4    5     6                            1    2    3
      3    4    5      6       7    8    9    7    8    9      10      11   12    13     4    5    6      7     8    9   10
     10   11   12     13      14   15   16   14   15   16      17      18   19    20    11   12   13     14    15   16   17
     17   18   19     20      21   22   23   21   22   23      24      25   26    27    18   19   20     21    22   23   24
     24   25   26     27      28   29   30   28   29   30      31                       25   26   27     28    29   30
     31




SEHA-G-RFP-05-2011                                                                                                  Page 4
II.     Definitions
For the purpose of this RFP, the terms below have the following meanings:
Authority means the Health Authority - Abu Dhabi used synonymously with HAAD.
Business Entity means a business owned by SEHA and established as a separate profit centre
for accounting and operational purposes and includes the SEHA hospitals and Ambulatory
Healthcare Services Division.
CBO means Central Business Office.
Emiratization is an initiative by the government of the United Arab Emirates to employ its
citizens in a meaningful and efficient manner in the public and private sector.
Facilities means the hospitals owned by SEHA.
Government means the Government of Abu Dhabi.
Manager means the firm or company engaged by SEHA to perform the services described in
this RFP.
Project means the work specified in this RFP.
RCM means revenue cycle management.
MSA, Management Services Agreement or Contract means the Management Services
Agreement to be entered into between SEHA and the selected Manager to perform the services
described in this RFP, the proposed version of which is included in Attachment (1).
SEHA means Abu Dhabi Health Services Company P.J.S.C.
SEHA Corporate Office or Corporate Office means the head office of SEHA which oversees and
controls the Business Entities.
Additional terms pertaining to this RFP are defined herein or included in the MSA.
III.    Background
A.     Emirate of Abu Dhabi
The Emirate of Abu Dhabi is the largest of the seven Emirates constituting the Gulf State
known as the UAE (United Arab Emirates). It covers an area of 67,340 Km 2, which represents
approximately 87% of the total area of the UAE. The Emirate of Abu Dhabi currently has a
population of about 1.6 million, constituting about 30% of the population of the UAE as a
whole. Approximately 20% of the residents are UAE nationals while fewer than 80% are
expatriates, of which the largest numbers originate from Pakistan and India. The population is
young by international comparison and the birth-rate is considerably high. Life expectancy at
birth for males is roughly 76 years, while for women it is currently about 79 years.
The Emirate has a tolerant and open society, essentially governed by the well-functioning
monarchy, supported by an appointed Executive Council of Ministers. Building on impressive
national revenue largely originating from the Emirate’s substantial oil fields, the government
has set itself highly ambitious targets for the development and upgrading of its infrastructure

SEHA-G-RFP-05-2011                                                                      Page 5
and social services, including the health and education systems. The Government of Abu Dhabi’s
Plan 2030 sets out extensive and detailed plans for the development of the Emirate, intended to
grow the population, attract visitors and diversify the income sources of the Emirate from
natural resources. Included in the Plan 2030 are plans for the development of world-class
resorts, hotels, golf courses and several internationally recognized projects such as the Abu
Dhabi Grand Prix Formula 1 racing event, the Louvre Abu Dhabi museum (a venture with the
French government) and the Guggenheim Abu Dhabi (a venture with the Guggenheim
Foundation in New York to be designed by internationally renowned architect Frank Gehry).
For more information about Abu Dhabi, please visit http://www.abudhabi.ae.
B.   Healthcare Sector in Abu Dhabi
The health care infrastructure of the Emirate is dominated by healthcare facilities owned by the
public provider, SEHA. However, the Emirate has a rapidly growing private sector with more
than 25 hospitals (total of 581 beds), as well as many outpatient clinics. Some of the facilities
are owned and operated by large oil or construction companies for their employees, while
the majority are owned and operated by locally or regionally owned small or medium-sized
private businesses (SMEs).
The health system in Abu Dhabi is largely regulated by the local health authority, Health
Authority - Abu Dhabi (HAAD). The Federal Ministry of Health also regulates to a lesser extent
health care services in the Emirate.
In 2005, Abu Dhabi government established the first mandatory health insurance law in the
county (Law No. 23 of 2005 and the Executive Regulations). All Nationals and Expatriates living in
the Emirate of Abu Dhabi must be enrolled in an insurance plan. There are over 30 licensed
insurance carriers in the Emirate. Daman is the largest health insurance carrier in Abu Dhabi.
The establishment of SEHA and reorganization of the governmental health regulator in 2007
(discussed below) were components of the healthcare sector reform initiatives of the
Government of Abu Dhabi, which also included the establishment of a national health insurance
provider (The National Health Insurance Company, or Daman) and the implementation of
healthcare insurance for nationals and non-national residents.
C.   Abu Dhabi Health Services Company (SEHA)
Prior to 2007, government owned health care facilities in the Emirate of Abu Dhabi were
managed by the General Authority for Health Services (GAHS). In 2007, the Abu Dhabi
Government issued two laws concerning the restructuring of GAHS and the healthcare system.
Law No. 1 of 2007 regarding the establishment of Health Authority – Abu Dhabi (HAAD) and Law
No. 10 of 2007 regarding the establishment of Abu Dhabi Health Services Company PJSC (Public
Joint Stock Company).
The Abu Dhabi Health Services Company PJSC (whose marketing identity is SEHA, meaning
"health" in Arabic) is an independent, public joint stock company (PJSC) established to operate
and manage the public healthcare system in Abu Dhabi. While SEHA is owned by the government,
it has an independent board of directors (consisting of government, business and industry
representatives) providing leadership and strategic direction with predominantly private-sector

SEHA-G-RFP-05-2011                                                                         Page 6
objectives and is governed by the Commercial Companies Law, the federal legislation applicable
to private and publicly-owned (listed) corporations.
The company owns and operates all of the public hospitals and clinics in the Emirate of Abu
Dhabi. The SEHA Health-System consists of 12 hospitals with 2,644 beds, 62 ambulatory care,
family care and urgent care centers and 2 blood banks. SEHA is one of the largest integrated
healthcare providers in the Middle East employing over 16,000 doctors, nurses, ancillary care and
administrative personnel. Attachment (2) contains a list of SEHA owned facilities.
SEHA has created a mission and vision consistent with the Government’s goals for the Abu Dhabi
healthcare system which is to continuously improve patient care to recognized international
standards (SEHA vision) and to provide our patients and communities with world-class healthcare
(SEHA mission). An annually updated five-year strategic plan containing specific strategic
objectives, targets and initiatives has been developed by executives of SEHA (including the senior
management of its healthcare facilities) to achieve this mission and vision.
SEHA has partnered with internationally recognized hospital managers to assist it in achieving its
goals of providing world-class healthcare. These include Johns Hopkins Medicine (through its
international development company Johns Hopkins Medicine International), The Cleveland Clinic
Foundation (along with its international corporation Cleveland Clinic Global Solutions, LLC)
VAMED Management and Vienna Medical University International (consortium) and Bumrungrad
International Ltd. Attachment (3) contains a list of the international managers and SEHA facilities
they manage.
The operational relationship between SEHA and the international partner is established
through a management services agreement. Under this arrangement, the manager assumes
significant control of the facility's operations. However, SEHA (through its corporate office)
maintains control and oversight of selected corporate shared services. These services include
(among others):
    1. Planning and rollout of Information Systems and Technologies
           a. Cerner Health Information System
           b. Oracle ERP for Finance, Human Resources and Materials Management
           c. Great Plains, ProFit and Concuity systems for Revenue Cycle Management and
              other related components including contract management solution
           d. Enterprise Integration and other infrastructure related systems
    2. Managed care contract negotiations
    3. Certain HR functions as mandated by law (e.g. civil service requirements and
       emiratization initiatives)
    4. Group procurement contracts
    5. Budget submission to the Government of Abu Dhabi (done on behalf of the facilities)
    6. Facilities Planning and Construction
Other coordination and control mechanisms and structures are in place (through contractual
SEHA-G-RFP-05-2011                                                                          Page 7
obligations in the management services agreement or otherwise) such as reporting lines, joint
management meetings and hospital manager - business entity performance reviews.
For more information about SEHA, please visit: http://www.seha.ae.
D.   Revenue Cycle Management at SEHA Facilities
Until 2006, none of the public facilities had an established patient financial services unit. The
facilities were considered public entities and were not required to bill for the vast majority of
their services. In 2005, the Emirate of Abu Dhabi issued the private health insurance law (Law
No. 23 of 2005). Attachment (4) contains the English version of the insurance law and a
summary of the health insurance regulatory environment in Abu Dhabi. The law mandated the
enrollment of all residents (Emirati nationals and expatriates) of Abu Dhabi in the health
insurance program.
Starting in 2006, all expatriates living in Abu Dhabi were required to enroll in selected insurance
plans. The health insurance law established the minimum coverage for any insurance policy
sold in Abu Dhabi. The government of Abu Dhabi also subsidized a low income insurance
policy, known as the Basic Plan. All other insurance policies are referred to as "Enhanced
Plans". By mid-2008, Nationals began to enroll in the health insurance program. The health
insurance program of the Nationals (called Thiqa) is fully subsidized by the government of Abu
Dhabi.
In 2006, the General Authority for Health Services (now SEHA for these purposes) entered into
an exclusive 5 year agreement with the National Health Insurance Company - Daman (a
corporation owned jointly by the Government of Abu Dhabi and Munich Re), the largest health
insurance company in Abu Dhabi. Gradually, GAHS (now SEHA) facilities began to establish in-
house billing capabilities. Challenges faced by SEHA facilities in establishing revenue cycle
operations included implementation of billing IT infrastructure, employment of qualified staff,
organization of work processes and strategic direction.
In 2008, SEHA management also began the process of centralizing and coordinating revenue
cycle operations through centralized decision-making processes and support of the individual
facilities. Strong emphasis was placed on upgrading the in-house billing system and charting
the roadmap for a more comprehensive IT solution. In addition, SEHA engaged a revenue cycle
consultant to work with five of the business entities to restructure revenue cycle operations at
these entities. Externally, SEHA continued its negotiations with HAAD and Daman to improve
the billing structure and adopt international standards such as the CPT coding methodology.
Patient revenue collection by SEHA since the establishment of SEHA and the Government’s
reform of the health sector increased from AED 350M in 2007 to over AED 2.5B in 2010.
Projected patient revenue collection for 2011 is AED 4.4B and AED 5.4B for 2012.
Two major events took place during the last two years consistent with the Government’s
continuing healthcare reform. First, Daman - in agreement with HAAD and SEHA - removed the
exclusivity clause from the SEHA - Daman contract (along with the related health insurance law
requirement) which required that SEHA enter into direct billing arrangements on behalf of
patients only with Daman. This allows SEHA to contract with other health insurance carriers in
order to provide direct billing with such insurance companies. SEHA is currently working with a

SEHA-G-RFP-05-2011                                                                          Page 8
number of insurance carriers to finalize these contracts. The second event was the introduction
by HAAD of Prospective Payment System (PPS) for inpatient care by providers. The new PPS
utilizes the IR-DRG methodology. So far, the PPS has been applied to the government
subsidized Basic health insurance plan since August 2010.
Although significant progress in revenue cycle operations has been achieved, SEHA has planned
several on-going initiatives. The following is a list of areas which are planned to be addressed
by such initiatives (through SEHA corporate and its business entities):
           Increasing efficiency of charge capture
           Increasing coding resources
           Improving claims denial rates
           Enhancing training of RCM staff
           Addressing rapidly changing environment in the areas of regulatory requirements and
            payment systems
           Migrating from a single payer to a multi-payer environment
           Increasing efficiency of business processes and workflow
           Increasing standardization across the facilities
           Improving customer services
A description of RCM staffing and volumes at SEHA facilities is included in Attachment (5).

E.        Delineation of RCM Activities between the Corporate Office and the Facilities
As noted above, SEHA Corporate Office has centralized certain functions within its health-
system. A breakdown of the RCM activities between the Corporate Office and the Business
Entities is outlined in Attachment (6).
F.        Information Technology Status and Future Roadmap
Cerner Health Information System (HIS) has been implemented in the majority of SEHA
facilities. The remaining facilities are expected to go live with Cerner HIS before the end of
2011. The backbone of SEHA's billing system has been an in-house modified version of the
Microsoft GreatPlains. SEHA plans to migrate to Cerner ProFit by the end of 2011. Most
facilities have already integrated GreatPlains with Cerner HIS. Currently, GreatPlains is set up to
handle a multi-payer environment as well as new payment schemes such as the IR-DRG. A full
description of SEHA's IT status and future roadmap is presented in Attachment (7).
IV.         Scope of Services
SEHA intends to separate revenue cycle operations from the facilities and consolidate the
operations into a Central Business Office (CBO) which will be operated as a Business Entity.
Some RCM functions may remain under the control of the facilities (e.g. case management and
scheduling) while the majority of the functions will be managed by the new Business Entity. A
proposed delineation of RCM tasks between the Corporate Office, the CBO, and the facilities is
presented in Attachment (8). The newly established entity will provide RCM services to SEHA
facilities on a fee-for-service basis representing a fair allocation of the cost to SEHA of such
services. These arrangements will be implemented through a Services Agreement between the
CBO and the Business Entities. Leveraging the resources of the selected Manager, the CBO may

SEHA-G-RFP-05-2011                                                                            Page 9
be able to sell additional premium services (e.g. training) to the facilities. While not part of the
current arrangement, it is envisioned that the CBO may be able to market its services (excluding
IT solutions and other services contracted exclusively for SEHA use only) to clients outside of
the SEHA health-system. The CBO services fee structure will be developed by SEHA Corporate
Office in collaboration with the Business Entities and the Manager.
SEHA is seeking proposals from well established providers of comprehensive medical billing and
revenue cycle management solutions to assist SEHA in:
      Establishing a centralized consolidated revenue cycle solution using existing and
       planned SEHA infrastructure (e.g. IT infrastructure and resources).
      Enhancing the productivity of RCM staff and transforming the CBO into a lean and
       efficient function.
      Assisting SEHA in implementing its billing strategy and IT roadmap.
      Managing the CBO in accordance with the agreed Management Service Agreement
       (MSA).
      Providing training to RCM staff as well as clinicians and others involved in the revenue
       cycle processes.
      Pursuing robust front end and back office solutions.
      Promoting a culture of revenue cycle excellence.
      Undertaking process improvement activities to streamline business processes and
       simplify workflow.
      Focusing on customer care through training and establishment of a call center.
      Standardizing processes across SEHA facilities.
      Entering into Service Agreements with SEHA business entities to offer RCM services.
The selected Manager will enter into a Management Service Agreement (MSA) with SEHA to
manage the CBO. Full management of the CBO will be preceded by a transition period, during
which the manager will work with SEHA on establishing the RCM function as a separate
Business Entity and planning for and implementing the infrastructure for the new operation.
This includes staff and resources (e.g. IT equipment and furniture). It is anticipated that the
Manager will be permitted a transition period of up to six months. The Manager will be paid a
transition fee for its dedication of resources during the transition period based on achievement
of transition KPIs (see attached MSA for further details regarding the proposed transition
arrangements).
Upon the completion of the transition period, the Manager will assume full responsibility for
managing the CBO. SEHA will provide the Manager with a space for central office operations.
RCM staff currently working at the facilities will continue to be stationed at the facilities.
Initially, SEHA Corporate Office will provide the CBO with administrative support (e.g. Human
Resources, Procurement, General services, etc.). By the end of the transition period, the CBO
should have fully operational administrative functions. As part of the Service Agreements with
SEHA-G-RFP-05-2011                                                                          Page 10
the Business Entities, the Manager may negotiate appropriate space and resources to be
provided by the Business Entity for any on-site functions which are necessary.
In addition to the services described in the MSA, SEHA may invite the Manager to submit
proposals for additional value added services (e.g. software solutions or CDM build). If the
Manager is recommended to provide such services, SEHA will negotiate the delivery of the
services at a reasonable market rate.
V.         The Management Service Agreement (MSA)
The Manager and SEHA will enter into a Management Services Agreement setting out the terms
of the arrangement for the management of the CBO and the provision of the RCM services.
Attachment (1) contains the MSA. As part of its proposal, the Manager is requested to provide
its comments on the MSA through submission of a mark-up of comments. Following the short-
listing of bidders (which will in part be based upon the bidders’ acceptance of the proposed
terms of the MSA) SEHA will negotiate the MSA with each short-listed bidder based on the
bidder’s submitted mark-up and a final determination and award made. The parties will
immediately thereafter execute the final MSA.
In general, the key terms of the MSA include:
          Services to be provided by the Manager
          Term (proposed as 6 years)
          Termination rights of the Parties
          Minimum contractual standards and performance obligations
          Fee structure (base fee, key personnel fee, performance fee, transition fee)
          Amount of fees (as proposed by bidders in financial response to the RFP)
          Manager information and reporting obligations
          Transition obligations and KPIs
          Performance regime, including determination of KPIs, KPI targets and KPI review and
           award (Joint Services Review including manager representatives)
          Governance structure (steering committee including manager representatives)
          Manager resources required to perform services (key personnel, seconded personnel)
          Manager exit obligations
Please carefully review the MSA attached to this RFP for further information on these material
and other proposed terms.

VI.        Personnel
A.        Overview



SEHA-G-RFP-05-2011                                                                        Page 11
The CBO personnel will consist of SEHA employees and the key personnel appointed by the
Manager in accordance with the MSA. The CBO, on behalf of SEHA, will be responsible for the
salaries and benefits of the SEHA employees and the Manager will be responsible for all
expenses related to the employment of the key personnel (including salary, taxes, housing,
airfare, insurance, dependents' benefits, pension, and educational allowance). The key
personnel fee paid by SEHA to the manager is expected to compensate the manager for its key
personnel employment expenses.
To the extent possible, SEHA will assist the Manager in securing work and residency permits for
its key personnel by providing the necessary documents to the Manager for processing such
permits at UAE government offices. Employment activities within the SEHA system are subject
to applicable local labor and civil service laws as well as Emiritization initiatives.
The Manager appointed staff are expected to work full time in a similar capacity to that of SEHA
employees. This includes workdays, holiday schedule, shift hours, and allowed leave and sick
time. All appointed staff will be expected to utilize SEHA's time and attendance system to
record their attendance. The appointed staff are also expected to comply with SEHA's and
Business Entity policies and procedures and all applicable laws and regulations.
B.       Manager Key Personnel
The MSA will include responsibilities and experience and educational requirements for the
agreed key personnel (please see Schedule 4 of the MSA). For the purposes of its response to
the RFP, the Manager is requested to appoint two categories of key personnel on full time
basis. Category 1 personnel will include 4-6 senior management positions in the CBO, excluding
the Chief Financial Officer and the Chief Human Resources Officer positions which, for
governance and control reasons, will continue to be SEHA employees.
Suggested key personnel positions in this category may include:
         Chief Revenue Officer
         Director Of Business Office Operations
         Director of Training
         Director of IT services
         Director of Revenue Integrity
         Director of Decision Support
         Director of Patient Access
         Reimbursement Manager
         Coding Manager
General requirements for Category 1 candidates include, at minimum:
         Bachelors or master's degree in a related field.
         At least five years experience in the same or a similar role.
         Demonstrated leadership and management successes.
         At least two years experience working for the Manager.



SEHA-G-RFP-05-2011                                                                      Page 12
Category 2 personnel will include managerial staff who will be assigned to the Business Entities
to manage the onsite RCM activities, liaise with personnel from the facility, and manage the
Service Agreement between the CBO and the Business Entity. The Manager is expected to
assign one staff per Business Entity. For Business Entities covering large geographic areas, the
Manager may assign more than one staff in accordance with the Business Entity needs. It is
contemplate that initially the Manager will appoint 12-16 managers dedicated to particular
Business Entities.
General requirements for Category 2 candidates include, at minimum:
          Bachelor's or Master's degree in a related field.
          At least five years experience in the same or a similar role.
          Demonstrated leadership and management successes.
          Preference to have the majority of the candidates with at least two years experience
           working for the Manager.
The Manager may, subject to SEHA approval, consider recruiting a limited number of category 2
key personnel from within the UAE.
The appointment and replacement of the key personnel must be approved by SEHA.
In addition to the key personnel who are permanent employees dedicated to the CBO, the
Manager may from time to time allocate a limited number of seconded employees of the
Manager to the CBO for a term of one to three years at the cost of SEHA in accordance with the
terms of the MSA. The seconded employees may fill particular employment needs which have
been identified by the Manager in accordance with the CBO's business and strategic plans and
operational requirements.
VII.       Contract Term
The proposed initial contract term is six (6) years from the completion of the transition period.
The contract may be renewed based on mutual agreement between SEHA and the Manager.
VIII.      Transition Period
Prior to the beginning of operation of the contract (operations date), there will be a transition
period of up to six (6) months. The purpose of this transition period is to establish the CBO as a
Business Entity and to develop and establish business and operating plans for the CBO. During
this period, the Manager is expected to:
              Assess the RCM operations at SEHA Corporate Office and the Business Entities.
              Establish the main CBO office with all RCM and administrative functions.
              Develop organizational charts for the main office and the facilities.
              Appoint staff according to the newly developed organizational charts.
              Enter into a standardized Service Agreement with the Business Entities.
              Finalize the agreed KPIs and KPI targets for the first contract year.


SEHA-G-RFP-05-2011                                                                         Page 13
The Manager may, at its discretion and cost, bring additional experts to help with the transition.
SEHA will pay a transition fee to the Manager based on the completion of agreed transition
period KPIs. The transition fee must be proposed by the Manager in its financial proposal.
IX.     Management Fees
Management fees will be paid to the Manager by SEHA for the performance of the services to
SEHA and the CBO as described in this section.
A.    Base Fee
The base fee is fixed fee calculated on annual basis and represents compensation for the
partnership between SEHA and the Manager. As part of the base fee, the Manager grants SEHA
the rights to use the Manager's brand name at the CBO and SEHA as well as access to the
Manager's resources available at the Manager's Corporate Offices and facilities. The base fee
also covers additional obligations as agreed in the final MSA document.
B.    Performance Fee
An amount of 50% of the base fee is fixed and guaranteed. The other 50% of the base fee will
be awarded based on achievement of KPIs. The KPIs are set by SEHA in consultation with the
Manager on an annual basis with quarterly targets.
In setting the KPIs for the contract, SEHA will utilize financial and non-financial KPIs. Revenue
cycle KPIs will be driven from internationally accepted metrics. Attachment (9) contains a list
of commonly used KPIs (as published by the Healthcare Financial Management Association)
which SEHA considers to be acceptable performance metrics for the purposes of the
performance fee.
During the transition period, the full base fee will be paid based on achieving agreed targets for
the transition period.
C.    Key Personnel Fee
The key personnel fee is based on the number of assigned key personnel. The fees are paid
based on man-month basis. Manager has the option of setting an annual fee for each key
personnel or has a lump sum fee for all key personnel. In the latter option, the fee is assumed
to be divided equally between the key personnel for pro-ration purposes. Different rates
should be set for Category 1 and Category 2 personnel. The fee is inclusive of all key personnel
expenses as well as any administrative fees incurred by the Manager. The key personnel are
deemed Manager's staff and they are fully compensated by the Manager without any
additional obligations from SEHA.
D.    Incentive Bonus
The incentive bonus will be awarded based on the profitability of the CBO as a business entity.
The Manager can earn up to 30% of the full Base Fee. The formula for calculating the bonus will
be negotiated with the awarded manager.
Base and Key Personnel Fees are adjusted annually for inflation in accordance with the official
inflation figures issued by the UAE government. The Base and Key Personnel Fees are paid on

SEHA-G-RFP-05-2011                                                                        Page 14
quarterly basis. The incentive bonus is paid on annual basis after closing the books and
finalization of annual audit.
The above fee structure will be applied in respect of the first three years of the contract in
order to permit the Manager to become familiar with the operating environment of the RCM
Services Business. It is expected that beginning in the fourth year of the contract (or earlier if
agreed), the manager will assume greater risks in terms of the base fees and the incentive
bonus (based on, for example, collected revenue) and that this will be negotiated by the parties
based on the change procedure set forth in the MSA.


X.         Project Timeline
The bid timeline is described in the Schedule of Events. Updates (if any) to the schedule of
events will be communicated to prospective bidders who have submitted their intent to bid.
XI.        Project Management & Communication
The governance structure of the arrangement is set forth in the MSA. Below is an outline of the
major governance components:
          Steering Committee – membership from SEHA and Manager: provides oversight and
           makes key decisions regarding the operations of the facility.
          Joint Service Review committee – membership from SEHA and Manager: has a
           performance based role, and is responsible for the implementation and review of the
           achievement of the KPIs and Performance Fees.
          Contract Management Unit – SEHA unit responsible for contract management and for
           appointing Contract Manager to work with key personnel
          SEHA Audit Department
          Collaboration and reporting between CBO administrative and operational departments
           and their counterparts at SEHA Corporate Office.
XII.       Qualified Bidders
This RFP has been published in local newspapers for full and open competition and provided to
pre-selected firms believed by SEHA to be providing world-class RCM services. SEHA will
consider proposals only from qualified bidders. Qualified bidders shall:
          Have demonstrated expertise and experience in providing revenue cycle services to
           healthcare facilities (which may include the management of a CBO) for a minimum of
           ten (10) years for clients with similar size to that of SEHA.
          Have extensive experience in working with DRG systems and other bundled
           reimbursement options.
          Have reputable business record (to be confirmed through reference checks and other
           due diligence activities).


SEHA-G-RFP-05-2011                                                                        Page 15
            Be willing to grant SEHA the use of Manager’s trademarks and logos at no additional
             cost.
            Be willing to grant SEHA access to the Manager's resources at its Corporate Office and
             facilities for training, best practices, and knowledge transfer.
            Be capable of assigning the qualified key personnel as described in the RFP and the MSA
             to work in the UAE for the duration of the MSA contract period.
            Be able to submit a bid and subsequently sign a contract with SEHA directly without
             having to go through an intermediary or an agent.
            Indicate its willingness to agree exclusivity for the services provided under the MSA in
             the GCC region (or provide a counterproposal thereto)
            Be able to declare “no conflict of interest” in performing any activities awarded as part
             of this RFP.
            Be able to legally operate in the UAE.
XIII.        Proposal Preparation and Submission
Interested bidders shall submit their technical and financial proposals in two (2) separate sealed
envelopes or packages. The language of the proposal shall be English. The contents of the two
proposals shall be prepared and submitted in accordance with the following outline:
A.       Technical Proposal
The technical proposal packet shall include one (1) original hardcopy, eight (8) printed copies,
and one (1) electronic copy on a CD. The technical proposal should contain the following
information with no pricing details:
        1.    General Requirements
             a) Cover Sheet
             b) Table of Contents
             c) Bidder’s information sheet.
              (1)     Official Name
              (2)     Address
              (3)     Authorized staff
              (4)     Contact information
             d) Letter of intent highlighting the Manager’s capabilities and expertise as well as:
              (1)     a statement indicating acceptance of RFP’s terms and conditions,
              (2)     a statement indicating accepting the MSA as the basis for contract
                      negotiations, based on the Bidder’s comments provided in its MSA mark-up
                      (see criterion 5),


SEHA-G-RFP-05-2011                                                                              Page 16
         (3)    a statement declaring no conflict of interest in submitting the proposal or
                performing any of the tasks specified in this RFP or the MSA, and
         (4)    a statement addressing the requirements listed under the section labeled
                "Qualified Bidders".
         The letter must be printed on the company’s letterhead signed by the authorized
         bidder’s representative.
        e) Executive Summary of the proposal (3 pages max).
        f) Copy of the Manager’s Trade License (UAE or Manager’s Country License); where
           applicable.
        g) Copies of Manager’s audited Financial Statements for the past three years (bidders
           may submit the statements on Compact Disk or any other electronic media).
   2.    Technical Criteria
        a) Criterion 1 – Bidder’s Qualifications and Experience
         The purpose of this section is to determine the ability of the Bidder to respond to this
         RFP. Bidders must describe their ability to meet the requirements set forth in this RFP.
         The description shall at minimum contain:
         (1)    Description of the organization including brief history, mission/vision/values,
                core values, legal structure, scope, location(s), and ownership type.
         (2)    Experience in delivering revenue cycle solutions and managing CBOs.
         (3)    Description of the business model (e.g. how the organization offers its CBO and
                other revenue cycle services to other clients).
         (4)    Description of premium services sold or offered to clients.
         (5)    Description of current client base.
         (6)    Report of performance on key revenue cycle metrics over the past three years
                (one or more locations).
         (7)    Governance model including organizational charts; where applicable.
         (8)    Organization’s approach to strategic planning and marketing.
        b) Criterion 2 – Resources capabilities to be deployed or made available to SEHA
         The purpose of this section is to describe the core services and resources that the
         Bidder will make available to the SEHA as part of the expected MSA. The Bidder
         should, at minimum, address services and resources in the following areas:
         (1)    Enhancement to the existing information technology tools and solutions
         (2)    Training resources
         (3)    Policies and procedures

SEHA-G-RFP-05-2011                                                                        Page 17
       (4)    Business process improvement
       (5)    Benchmarks and performance metrics
       (6)    Deployment of additional experts other than the key personnel to work on
              specific short term tasks (e.g. special training, IT setup…etc.)
      c) Criterion 3 – The Bidder’s proposed approach to setting up and managing the CBO
       The purpose of this section is to demonstrate high level understanding of the
       requirements set in the RFP and the scope of the planned CBO. While SEHA has
       established (or is in the process of establishing) several Business Entities, it would be
       helpful to obtain the views of the Bidder on this aspect. At minimum, the Bidder
       should address the following areas in describing its proposed approach to establishing
       and managing the CBO:
       (1)    Approach to the six (6) months transition period identifying key activities and
              major deliverables.
       (2)    Separating RCM operations from the facilities. Bidders are requested to review
              the proposed delineation of functions between SEHA Corporate Office, the CBO
              and the Business Entities (Attachment 8) and submit their recommendations as
              part of this section.
       (3)    Establishment of the CBO scope based on the proposed delineation of tasks as
              described in Attachment (8). The final agreed scope based on SEHA proposed
              delineation of tasks and bidder’s approach will be added in schedule (2) of the
              MSA.
       (4)    Assessment of current RCM operations
       (5)    Providing input into the contractual arrangements between the CBO and the
              Bes, particularly the financial aspects
       (6)    Setting up strategies and performance metrics
       (7)    Setting up CBO’s organization structure
       (8)    Recommended staffing. Detailed staffing levels per department are not
              required. Staffing ratios and/or projected hours per patient day or similar
              measure will suffice
       (9)    Approach to excellence in customer service
       (10)   Approach to performance management and business process re-engineering
       (11)   Approach to training
      d) Criterion 4 – Evidence of successful performance
       The purpose of this section is for the Bidder to describe their ability to deliver similar
       services. The Bidder is requested to present three (3) or more success stories
       demonstrating the Bidder’s exemplary work in delivering revenue cycle services in an
SEHA-G-RFP-05-2011                                                                         Page 18
         efficient and responsible manner. Success stories should reflect one or more of the
         following:
         (1)       Evidence of successful performance improvement and innovations
         (2)       Achievements in customer care
         (3)       Demonstrated use of benchmarks and metrics to induce improvements and
                   efficiencies
         Bidders are encouraged to present the stories in brief (5 pages max per story).
        e) Criterion 5 – Bidder’s comments on the MSA
        SEHA expects bidders to substantially accept the terms and conditions in the MSA.
        Bidders should submit an electronic redline markup version of their comments on the
        MSA as part of the technical proposal. The purpose of this activity is to assess and score
        the legal and commercial terms and relative value of the arrangement to SEHA.
   The original technical proposal should be submitted in one volume and should be limited to
   the above content. Bidders wishing to supplement their proposal with additional
   documents may include such documents separately. The supplemental information will be
   considered at the discretion of the evaluation panel.
   3.    Financial Proposal
   The financial proposal packet shall include one (1) original hardcopy and one (1) copy in a
   separate [from the technical proposal] sealed envelope. The proposal shall include the
   following components:
        a) Annual Base Fee
        b) Man-month Key Personnel Fee - Category 1
        (Along with number of proposed staff)
        c) man-month Key Personnel Fee – Category 2
        (Along with number of proposed staff)

                        Fee               Number                  Fee                       Total
        Base Fee
        1. Fixed and Guaranteed Portion       1        = 50% of total base fee
        2. Performance based portion          1        = 50% of total base fee
        Key Personnel
        3. Category 1                     # of Staff   Man month sum lump fee    # of staff X Fee X 12
        4. Category 2                     # of Staff   Man month sum lump fee    # of staff X Fee X 12
        Total                                                                    Add 1 thru 4


SEHA-G-RFP-05-2011                                                                                  Page 19
    The proposed fees shall be inclusive of all taxes, imposts, duties, withholding taxes, charges
    or other assessments of whatsoever nature, whether levied by the Government of Abu
    Dhabi or the UAE, or any other Government elsewhere.
Bidders submitting their proposals via mail or couriers may place the two separately sealed
proposals in the same mailing package provided that the technical and financial submissions are
sealed in separate envelopes.
XXVI. Evaluation Criteria and Process
SEHA will conduct a comprehensive evaluation of all complete proposals in accordance with the
criteria set forth below. Proposal evaluation will be conducted by a SEHA appointed team based
on the requirements stated in this RFP. The team will shortlist bidders based on the technical
merits and costs of their proposals. Contract negotiations will be initiated with shortlisted
bidders as soon as the technical and financial evaluations are completed. As part of the
evaluation process; SEHA, at its own discretion, may:
          Invite short listed bidders to present their proposals to the evaluation panel,
          Request a site visit to the bidder’s operation sites, and/or
          Request the shortlisted bidders to submit best and final offers (BAFOs).
The contract will be awarded to the most responsive bidder (technically and financially) in the
sole discretion of SEHA. The criteria/factors for evaluating each proposal, including the overall
weighted average score of each, are:

                                           Criteria                                          Score
  Mandatory Criteria
            Evidence of meeting the criteria listed under the section labelled
             “Qualified Bidders”.                                                            Pass or
            Demonstrated financial stability as evidenced in the audited financial           Fail
             statements.
            Acceptance of minimum threshold of
  Criterion 1 – Bidder’s Qualifications and Experience                                        15%
  Criterion 2 – Resources capabilities to be deployed or made available to SEHA               15%
  Criterion 3 – Bidder's proposed approach to setting up and managing the CBO                 20%
  Criterion 4 – Evidence of successful performance                                             5%
  Criterion 5 – Bidder’s comments on the MSA                                                  15%
  Cost Proposal (based on Base fee and man month cost per key personnel)                      30%
  Total                                                                                      100%

XXVII. RFP General Terms and Conditions


SEHA-G-RFP-05-2011                                                                             Page 20
A.   Award
This project will be awarded through a formal contractual agreement based on the attached
MSA document.
B.   Proposal Preparation Costs
Bidders are solely responsible for their own expenses in preparing proposals and/or for
subsequent negotiations with SEHA, if any. This also includes any Bidder’s third party fees and
travel costs. If SEHA elects to reject all proposals, SEHA will not be liable to pay and/or
reimburse any bidder for any claims, whether for costs or damages incurred by the Bidder with
respect to the preparation, submission and/or evaluation of the proposal.
C.   Closing Date and Time
The proposal must be submitted by the closing date and time specified on the Schedule of
Events table.
D.   Delivery of Proposals
All proposals must be delivered or mailed to the address specified on the cover page of the RFP.
Proposals sent by facsimile or e-mail will not be accepted. SEHA working hours are Sunday
through Thursday (7:00 AM - 3:00 PM).
E.   Late Proposals
Proposals will only be considered if they are received by the closing date and time as stated
within the RFP. Late proposals will not be accepted and will be returned un-opened to Bidders.
F.   Unsolicited Proposals
Unsolicited proposals outside the scope described in this RFP will not be accepted.
G.   Irrevocability of Proposal
By submission of a clear and detailed written notice, the bidder may amend or withdraw its
proposal prior to the closing date and time. However, upon the elapse of the closing date and
time, all proposals become irrevocable. By submission of a proposal, the Bidder agrees that
should his/her proposal be selected, the Bidder will enter into a contract with SEHA.
H.   Validity of Proposal
Proposals shall remain valid for a period of 120 calendar days from the RFP’s closing date.
I.   Currency and Taxes
Prices quoted must be in United Arab Emirates’ Dirham ; inclusive of tariffs and/or taxes, where
applicable.
J.   SEHA’s Rights and Options
SEHA expressly reserves the right to:

SEHA-G-RFP-05-2011                                                                       Page 21
             Modify, amend, or substitute the RFP at any time.
             Cancel the RFP.
             Issue additional instructions or requests to prospective bidders.
             Conduct investigations about the qualifications and experience of responsive
              bidders.
             Request additional information from selected bidders if deemed necessary for
              the proposal evaluation or award selection. This may include asking bidders to
              present their proposals to SEHA Management.
             Waive any irregularities in received proposals.
             Discuss or negotiate with selected bidders proposal’s terms and conditions.
             Accept or reject any or all proposals, including awarding all or part of the
              required services without issuing further solicitations.
             Procure services specified in the RFP by any other means.
             Accept other than the lowest fee proposal and shall not be bound to give any
              reasons for non-acceptance of any proposal it may receive.
             Have and retain all copies of proposals or information submitted to support a
              proposal.
             Require the selected Bidder to participate in negotiations on the terms and
              conditions of a contract and to submit revisions, including price revisions that
              may result from such negotiations.
The proposal, once evaluated, shall be considered a public record except for the material that
the Bidder specifically requests to be considered a “trade secret”.
XXVIII. RFP Follow-up Communications & Pre-bid Conference
In addition to the RFP document, SEHA will provide prospective bidders equal access to
additional information about SEHA and RCM through a number of channels. To keep up with
RFP related updates, prospective bidders are encouraged to submit their intent to bid as soon
as possible.
A.   Questions and Answers
All inquiries and/or communications regarding this RFP shall be channelled through the
assigned contact specified on the front page of the RFP. Amendments, changes, and
clarifications to the RFP will be published on SEHA's website. Questions regarding this RFP must
be submitted electronically by the deadline specified in the Schedule of Events. Questions must
reference the exact RFP page(s). SEHA will disseminate responses to submitted questions to all
responsive bidders electronically. SEHA reserves the right to determine at its sole discretion,
the appropriate and adequate response to all comments.
B.   Pre-bid Conference
To assist interested bidders in obtaining more information about SEHA and to formally discuss
this RFP document, SEHA will hold a pre-bid conference before the closing date of the RFP. The
date and time of the pre-bid conference is presented in the Schedule of Events. The pre-bid
conference will provide an opportunity for interested bidders to meet SEHA team members.

SEHA-G-RFP-05-2011                                                                      Page 22
Discussions and clarifications offered during the pre-bid conference shall not be considered as
part of the RFP documents; unless disseminated through official written addenda to the RFP.
Interested bidders are requested to submit their intent to attend the conference including the
names of the attendees by the date specified in the Schedule of Events.
C.    Site Visits
SEHA will also offer the opportunity to prospective bidders to visit SEHA facilities and take a
close look at revenue cycle operations. SEHA revenue cycle, information technology, and
operations staff will be available to meet bidder representatives. Interested bidders should
notify the RFP contact person of their intent to conduct site visits along with intended visit
dates and names of attendees. Visits will be arranged on first come first serve basis.
In addition to the above, prospective bidders are encouraged to perform their due diligence
about the work environment and living in Abu Dhabi. This includes understanding the
regulatory structure and health insurance practice. The Health Authority - Abu Dhabi (HAAD) is
the health insurance regulator in Abu Dhabi (www.haad.ae). Specific information about data
transmission requirements, coding, and licensing can be accessed at HAAD website
(www.haad.ae/datadictionary). Information about the National Health Insurance Company
(Daman) is available at www.damanhealth.ae.
Prospective bidders should refrain from trying to collect information about this RFP from
unauthorized sources including SEHA staff other those identified in the RFP document.
     *************************************************************************
          *************** Next Section Contains RFP Attachments ***************
     *************************************************************************




SEHA-G-RFP-05-2011                                                                     Page 23
                Attachment (1) - Management Service Agreement (MSA)


                          Presented in a separate document.




SEHA-G-RFP-05-2011                                                    Page 24
      Attachment (2) - List of SEHA Facilities

  Business Entity            Category                                  Facility     Beds
                     Hospitals                   Sheikh Khalifa Medical City        568
                                                 Abu Dhabi Rehabilitation Center     70
                                                 Behavioral Science Pavilion        125
                     Medical Centers             Al Bateen
                                                 Al Ittihad
                                                 Al Khaleej
                                                 Khalidiyah Urgent Care Center
                                                 Al Madina
                                                 Al Manhal
      SKMC
                                                 Al Mushrif
                                                 Al Rodha
                                                 Al Zafranah
                     Dental Clinics              Abu Dhabi Dental Clinic
                                                 Al Dhafra Dental Clinic
                     Blood Banks                 Abu Dhabi Blood Bank
                     DPSC                        None
                     Renal Dialysis              Two Units
                     Home Care                   Yes
                     Hospitals                   Tawam Hospital                      432
                                                 Al Wagan Hospital                    15
                     Medical Centers             Al Jahli
                                                 Neima
     Tawam           Dental Clinics              Tawam Dental Services
                     Blood Banks                 Al Ain Blood Bank
                     DPSC                        None
                     Renal Dialysis              One Unit
                     Home Care                   Yes
                     Hospitals                   Al Mafraq Hospital                  368
                     Medical Centers             Al Nahda
                                                 Baniyas
                     Dental Clinics              None
     Mafraq
                     Blood Banks                 None
                     DPSC                        None
                     Renal Dialysis              One Unit
                     Home Care                   None
                     Hospitals                   Al Rahba Hospital                   119
                     Medical Centers             None
                     Dental Clinics              None
    Al-Rahba         Blood Banks                 None
                     DPSC                        None
                     Renal Dialysis              One Unit
                     Home Care                   None
                     Hospitals                   Corniche Hospital                   285
     Corniche        Medical Centers             Women's Health Center
                     Dental Clinics              None

SEHA-G-RFP-05-2011                                                                 Page 25
   Business Entity             Category                        Facility                   Beds
                       Blood Banks        None
                       DPSC               None
                       Renal Dialysis     None
                       Home Care          None
                       Hospitals          Delma Hospital                                    23
                                          Ghayathi Hospital                                 34
                                          Liwa Hospital (Open for Outpatient Services)       0
                                          Madinat Zayed Hospital                           132
                                          Al Mirfaa Hospital                                28
                                          Al Sila Hospital                                  36
                       Medical Centers    Abu Al-Abyad
       WMR                                Beda Al Mutawa
                                          Sir Baniyas
                                          Al Dhafra
                       Dental Clinics     None
                       Blood Banks        None
                       DPSC               None
                       Renal Dialysis     10 Stations
                       Home Care          None
                       Hospitals          Al Ain Hospital                                  375
                       Medical Centers    Al Khabisi
                                          Al Masoudi
                                          Oud Al Touba
       Al-Ain          Dental Clinics     None
                       Blood Banks        None
                       DPSC               None
                       Renal Dialysis     None
                       Home Care          None
                       Hospitals          None
                       Medical Centers    Al Faqa
                                          Al Hayer
                                          Hili
                                          Al Khatim
                                          Al Khazna
                                          Al Maqam
                                          Al Muweiji
                                          Niyadat
    Ambulatory
                                          Al Qua'a
 Healthcare Services
                                          Shueib
                                          Al Yahar
                                          Bain Al Jesreen
                                          Khalifa A
                                          Mezyad
                                          Mussafah
                                          Remah
                                          Samha
                                          Shahama

SEHA-G-RFP-05-2011                                                                       Page 26
   Business Entity           Category                           Facility    Beds
                                           Sweihan
                                           Zakher
                                           Mobile Clinic 1
                                           Mobile Clinic 2
                                           Abu Dhabi Airport Clinic
                                           Al Ain Airport Clinic
                     Dental Clinics        Al Mafraq
                     Blood Banks           None
                     DPSC                  Madinat Zayed
                                           Delma
                                           Mussafah
                                           Sila
                                           Ghiathy
                                           Abu Dhabi
                                           Al Ain
                     Renal Dialysis        None
                     Home Care             None
DPSC = Disease prevention and Screening Center




SEHA-G-RFP-05-2011                                                         Page 27
        Attachment (3) - SEHA Business Entities

                                                                    Medical   Dental   Diagnostic     Blood
        Business Entity             Managed By           Hospital
                                                                    Center    Center     Center       Bank
Al-Ain Hospital                    Vamed and MUV            1         4
Al-Corniche Hospital           Johns Hopkins Medicine       1         1
                                     International
Al-Rahba Hospital              Johns Hopkins Medicine       1
                                     International
Ambulatory Health Services               SEHA                         22        1          5
Al-Mafraq Hospital            Bumrungrad International      1          2
Sheikh Khalifa Medical City         Cleveland Clinic        3          8        2                      1
                                       Foundtion
Tawam Hospital                 Johns Hopkins Medicine       2         2         1                      1
                                     International
Western Medical Region                   SEHA               6         5
Dialysis Center (under            Under Negotiation
development)
Abu Dhabi Rehabilitation         Under Negotiation          1
Center (Under Development)




SEHA-G-RFP-05-2011                                                                          Page 28
        Attachment (4) - Health Insurance Law Healthcare Insurance Regulatory Environment


The English Translation of the Health Insurance Law is presented in a separate document. In addition,
the following is a summary of the regulatory environment of healthcare insurance in Abu Dhabi.

Overview

In 2006 Abu Dhabi Government introduced new Health Insurance Law, No. 23 and its Executive
Regulations. By this law, the Health Authority of Abu Dhabi “HAAD” is responsible for the
implementation, monitoring and ensuring compliance with the health insurance law and its regulations.
The law was implemented in stages, and has applied to all expatriates living or residing in the Emirate of
Abu Dhabi since January 2007. The Health insurance law and its regulations (the “Health Insurance
Scheme”) not only deal with the provision of financing for healthcare, but regulate all aspects of
healthcare for expatriates in the Emirate of Abu Dhabi.

As part of the implementation of the Health Insurance Scheme in May 2008 the Government of Abu
Dhabi launched the insurance program that grants all UAE Nationals and those of similar status
healthcare coverage through a comprehensive network of healthcare providers. The program has been
named Thiqa.

Area of regulation

A legal duty has been imposed on sponsors and employers of resident expatriates to ensure that those
on their sponsorship, or in their employ, have valid health insurance in place. The Health Insurance
Scheme specifically covers expatriates and their families who are residents of Abu Dhabi and it is
considered obligatory.

This Health Insurance Scheme also includes health coverage for an employee's wife and up to three
children below 18 years of age. The employer/sponsor is required to cover the expenses of providing
health coverage to the employee; passing this burden to the employee or dependents is considered a
violation of the law. To enforce compliance by sponsors and employers, the Health Insurance Scheme
provides fines for sponsors and employers that fail to ensure that insurance is in place and provides that
they will be responsible for the cost of healthcare services provided to uninsured persons in their
employ or under their sponsorship. Expats are not given resident permits and are not able to renew
existing permits if they are not subscribed to this Health Insurance Scheme.

As such, all persons entering the UAE on a visit visa should be covered by health insurance provided by
their sponsor. In cases of emergency, the sponsor is entitled to cover the health care fees plus a financial
penalty if the visitor is not covered. For persons entering the UAE on a tourist visa without the need of a
sponsor, insurance in not needed and in case of emergency they are obliged to cover the health care
fees.

Exemptions

The Health Insurance Scheme is mandatory for expatriates residing in UAE however exemptions are
provided in respect of the following categories of persons: UAE Nationals, GCC nationals who are


SEHA-G-RFP-05-2011                                                                                 Page 29
residents of the Emirate of Abu Dhabi, a non-national wife of a UAE national, the children of a national
mother married to a non-national, UAE passport holders who are residents of the Emirate of Abu Dhabi,
everyone who is exempted from the Health Insurance Scheme after the acceptance of HAAD and the
Executive Council.

The Heath Insurance Scheme does not cover claims related to road accidents a. An authorized provider
may recover the costs of the medical emergency from the car insurance provider.

Coverage

The basic coverage under this scheme is comprehensive and includes the following: medical
examination, treatment, primary health care, laboratory tests and x-rays, in-patient stay and treatments
in hospitals, medications required for treatment, and even accommodation for one escort in critical
cases. In case of an emergency an authorised provider shall provide health care to any insured party,
whether or not their insurance covers the treatment in the case of a medical emergency. The authorised
provider may then recover the costs of the medical emergency from any authorised insurer. In
circumstances where the injured person would not normally be covered due to the nature of the
medical emergency, the sponsor of the injured should pay the applicable fees.

Employers are required to provide either of these three basic policies: Basic Product Policy, which is for
people with a monthly salary of over or equal to 3000 AED (Dirham) plus housing allowance of about
4000 AED. The annual limit is 250,000 AED per individual/dependent; Enhanced Policy, which applies to
everyone who does not fall within the other two categories; Emergency Policy, for visitors or those with
visit visas and provided by their corresponding sponsors. All policies with the exception to Emergency
policy are valid for at least 1 (one) year and should be renewed accordingly and the insured is not
entitled to claim back the premium.

Separately, National Health Insurance Company – Daman was assigned to manage Thiqa Policy.
Enrolling under the Thiqa scheme is free of charge and there is no age restriction. Thiqa members are
eligible to receive: Outpatient Coverage, Day treatment, Inpatient Coverage (private room with one
bed).

Product Beneficiaries Payer Premium Paid by Reach
 Product         Beneficiaries    Payer               Premium           Paid by           Reach
 Basic           Lower income     DAMAN               Standard          Employer          Abu Dhabi
 Product         expats           (plus               (600 AED                            (plus UAE
                                  government          p.a.)                               emergency)
                                  subsidies)

 Enhanced         Higher income     Approx  30 Risk - adjusted          Employer          Varying
 Product(s)       expats            insurers   (largely
                                               group
                                               business)
 thiqa            UAE Nationals AD Finance     Free                     Free              UAE (plus
                  and     similar (DAMAN is                                               worldwide
                  categories      TPA)                                                    emergency)



SEHA-G-RFP-05-2011                                                                               Page 30
Insurance Companies and Providers requirements

The regulations set out requirements that all participants in the broader healthcare sector in Abu Dhabi
including, healthcare providers, insurers, third party administrators (“TPAs”) and insurance
intermediaries, have to comply with if they wish to offer healthcare services to expatriates. All insurance
companies and intermediaries who wish to sell health insurance are required to be registered by HAAD.
The Health Authority also requires these entities to have established a place of business in Abu
Dhabi. Healthcare service providers including doctors, clinics, rehabilitation centres and pharmacies are
also required to register with HAAD, if they wish to provide healthcare services to persons insured under
the Health Insurance Scheme. Further information on licensing can be found on www.haad.com.

In order to monitor the implementation and compliance with the Health Insurance Scheme, the
implementing regulations provide that HAAD is allowed to apply to the Ministry of Justice to appoint
“authorised officers” to investigate complaints and violations of the Health Insurance Scheme.
Authorised officers report to HAAD’s Grievances & Appeals Unit. All disputes arising from the
interpretation, implementation or termination of the Health Insurance Scheme shall be submitted to the
Grievances & Appeals Unit for an amicable settlement, and any other dispute resolution procedures
shall be of no force and effect unless and until the complaints procedure set out in HAAD has been
exhausted.

Functions of the Grievances & Appeals Unit is: - To receive and process complaints, - To conduct
investigations into complaints, - To refer investigations to Authorized Officers and review the reports of
Authorized Officers, - To issue written recommendations on behalf of the Authority to the plaintiff and
other parties involved, - To make recommendations to the Authority to take specific action in relation to
the complaint against any of the parties involved including the issue of Infringement Notices, - Any other
functions that are incidental to the performance of any of the preceding functions.

Standard Providers Contract

Starting from January, 1st 2011 HAAD has made compulsory the standard form of contract (“SPA”), to be
used between Insurance Companies and TPAs (“Payers”) and the Healthcare Providers (HAAD’s
Periodical 40, August, 2010). The contract provisions are effective, as of 1st of January 2011, to all
contracting entered or renewed on/after the above date. Starting from 1st of March, HAAD will start
auditing all contracts concluded or renewed per the standard contract and have emphasized that any
contracting that is in contradiction with standard contract provisions, will be void and null.

Provisions of the SPA are set by HAAD and determine the legal and (to a large extent) the commercial
elements of the relationship such as payment terms, timely submission and penalties for late submission
and termination. The SPA provides Payers with the right to establish quality criteria for measuring a
provider’s performance. Those criteria have to be agreed upon signing the SPA and are applicable as
KPIs for the payment approval process through-out the contract validity. Providers and Payers are
permitted to negotiate the reimbursement prices up to a maximum of three times the HAAD-set
mandatory tariff. Payment may be made only for medically necessary services and no payment will be
made for claims in which there is a determination of medical malpractice.

Direct billing and E Claims


SEHA-G-RFP-05-2011                                                                                Page 31
In 2008 HAAD has issued a number of standards (“Standards”) regulating direct billing and claims
process. Systems adopted are mainly based on US Medicare/RVU system. Rules are implying that the
common language and code standards defined in www.haad.ae/DataDictionary need to be used in any
data exchange between healthcare entities, to the exclusion of alternative conventions. Any licensed
healthcare entity is in a position to require purely electronic claims (“eClaims”) and remittance
transactions and healthcare entities with more than 20´000 annual encounters must use purely
electronic. Claims and remittance transactions that DAMAN’s Thiqa plan requires use of purely
electronic claims and remittance transactions. Exceptions to this rule have to be individually negotiated
with HAAD.

In regards to the eClaims, Abu Dhabi Government has implemented the policy of Union Law 1/2006 on
Electronic Transactions and Commerce (ETCL), implying that to place information stored or exchanged
electronically on the same legal footing as information stored or exchanged by traditional means (ETCL
Article 4 (1). There is no published UAE official guidance regarding records management but as a
minimum, entities need to implement systems and processes that meet currently recognized industry
best practices for electronic information record keeping.

Standards as well imply that healthcare entities are obliged to apply the internationally recognized
standards ISO 27001 and ISO 27002 (formally known as ISO/IEC 17799:2005) (the International
Standards). The International Standards establishes guidelines, specifications and general principles for
initiating, implementing, maintaining and improving information security management in an
organization. They contain best practices of control objectives and controls in a number of areas relating
to information security management.

Pricing

Health Insurance Scheme defines that service prices are set according to the type of policies. HAAD
regulates mandatory prices for Basic Product and Thiqa Policy and set the limits for the parties
negotiations in regards to the Enhanced Policy.

Further Standards establish and mandate the diagnosis related groupings system (DRG), definitions and
rules for the management and monitoring of health insurance claims by healthcare providers and Payers
under the Health Insurance Scheme of Abu Dhabi. DRG standard applies to all inpatient healthcare
services – except for long-term care services, as defined by the HAAD Standard for the provision of long-
term care, and dental inpatient cases – provided by all HAAD licensed healthcare providers and Payers
operating in the emirate of Abu Dhabi. Inpatient healthcare services are defined according to the Clinical
Coding Steering Committee’s (CCSC) criteria.

DRG payments are applicable to all inpatient encounters as defined by the Clinical Coding Steering
Committee. DRGs must be used for payment for the Basic Product from service date 1 August 2010, and
31 December 2011 for all other products. The HAAD Grouper (currently provided by 3M) prevails in case
of conflict between the parties.

Payment for a DRG consists of a Base Payment plus, if applicable, an outlier payment. The outlier
payment is applicable if it is >0.

Claims Adjudication Standard


SEHA-G-RFP-05-2011                                                                               Page 32
Claims adjudication is the determination of the Payers financial responsibility, after the member's
insurance benefits are applied to a medical claim, beyond those set out in the Standard Provider
Contract. Payers must have a documented claims adjudication process which comprises the
development, application and review of Edits Adjudication Guidelines and Audits.

Adjudication guidelines are applied by Payers during their adjudication process, and must be published
or accessible by contracted providers through website or providers’ portals, and be governed by the
Standard Contract requirements.

By December 31st, 2011 Payers, adjudicating medical claims, must have access to at least one
internationally certified coder “Expert”, as per the recognition guidelines of the Clinical Coding Steering
Committee. After this date, HAAD may, at its sole discretion, enforce this requirement and monitor
compliance with it accordingly.




SEHA-G-RFP-05-2011                                                                                Page 33
              Attachment (5) - RCM Staffing and Volumes by Facility

                                                                RCM Staffing by Facility




                                                                                                                                                                                                                   Utilization Review
                                                                                                                                                                                                                    Management &
                                                                                                 Patient Access




                                                                                                                                                                         Office/Billing
                                                                                                                                                     Counselors
                                                                      Scheduling




                                                                                                                                                      Financial
                                                                                                                                Cashiers




                                                                                                                                                                                                  Coding




                                                                                                                                                                                                                                                   Total
                                                                                                                                                                             Back
                                                          RCM




                                                                                                                                                                                                                           Case
  BE                         Provider




                                                                                                                                                                                                                                        Facility
                                                                                   Staff




                                                                                                                  Staff




                                                                                                                                           Staff




                                                                                                                                                             Staff




                                                                                                                                                                                    Staff




                                                                                                                                                                                                           Staff




                                                                                                                                                                                                                                Staff
                                                          Sup

                                                                Sup




                                                                                           Sup




                                                                                                                          Sup




                                                                                                                                                   Sup




                                                                                                                                                                     Sup




                                                                                                                                                                                            Sup




                                                                                                                                                                                                                   Sup




                                                                                                                                                                                                                                                       BE
           CORNICHE HOSPITAL                              1                        6       6                      36                       7                  1      1              11      1              6                            76
Corniche                                                                                                                                                                                                                                                   81
           Women's Center                                                          5                                                                                                                                                     5
Al-Rahba   AL RAHBA HOSPITAL                                    1                  3       3                      35      1                7                  1      1              11      1              6                            70                 70
           Main Office                                    4                                                                                                                          8                     2                            14
           BAIN AL GESREEN HEALTH CENTER                                                                                  1                15                                                              3                            19
           AL KHATIM HEALTH CENTER                                                                                        1                 4                                                                                            5
           MUSSAFAH HEALTH CENTER                                                                                                                                                                                                        0
           SHAHAMA HEALTH CENTER                                                                                          1                12                                                              2                            15
           KHALIFA HEALTH CENTER                                                                                          1                19                                                              5                            25
           SAMHA HEALTH CENTER                                                                                            1                10                                                              1                            12
           DPSC - Abu Dhabi                                                                                                                57                                                                                           57
           DPSC - Mussafah                                                                                                                 20                                                                                           20
  AHS      DPSC - Al Ain                                                                                                                   41                                                                                           41             339
           AL HILI PHC                                                                                                    1                 5                                                              1                             7
           SWEIHAN PHC                                                                                                    1                 3                                                                                            4
           AL MUWEIJI PHC                                                                                                 1                15                                                              1                            17
           ZAKHER PHC                                                                                                     1                 6                                                                                            7
           AL KHAZNAH PHC                                                                                                 1                 3                                                                                            4
           AL NIYADAT PHC                                                                                                 1                 5                                                              1                             7
           AL MAQAM PHC                                                                                                   1                13                                                              2                            16
           AL FAQA PHC                                                                                                                      4                                                                                            4
           AL SHUEIB PHC                                                                                                                    4                                                                                            4

        SEHA-G-RFP-05-2011                                                                                                                                                                                                     Page 34
                                                                                                                                                                                                      Utilization Review
                                                                                                                                                                                                       Management &
                                                                                  Patient Access




                                                                                                                                                            Office/Billing
                                                                                                                                        Counselors
                                                       Scheduling




                                                                                                                                         Financial
                                                                                                                 Cashiers




                                                                                                                                                                                     Coding




                                                                                                                                                                                                                                      Total
                                                                                                                                                                Back
                                           RCM




                                                                                                                                                                                                              Case
  BE                        Provider




                                                                                                                                                                                                                           Facility
                                                                    Staff




                                                                                                   Staff




                                                                                                                            Staff




                                                                                                                                                Staff




                                                                                                                                                                       Staff




                                                                                                                                                                                              Staff




                                                                                                                                                                                                                   Staff
                                           Sup

                                                 Sup




                                                                            Sup




                                                                                                           Sup




                                                                                                                                    Sup




                                                                                                                                                        Sup




                                                                                                                                                                               Sup




                                                                                                                                                                                                      Sup




                                                                                                                                                                                                                                          BE
          AL HAYER PHC                                                                                                       6                                                                                               6
          REMAH PHC                                                                                        1                 3                                                                                               4
          AL YAHAR PHC                                                                                     1                14                                                                1                             16
          MEZYAD PHC                                                                                       1                12                                                                1                             14
          AL QUAA PHC                                                                                      1                 9                                                                                              10
          Mobile Clinics                                                                                                                                                                                                     0
          AL MAFRAQ DENTAL CENTER                                                                          1                9                                                                 1                             11
          Main Office                      1                                                                                                                                                                                 1
          AL MAFRAQ HOSPITAL                                        8        1                     48                       13      1           11      1              24                     19      1           12       139
Mafraq                                                                                                                                                                                                                                    173
          BANIYAS HEALTH CENTER                                              2                     25                                                                                                                       27
          AL NAHDA HEALTH CENTER                                             1                     5                                                                                                                         6
          Main Office                      1                                 2                     8                                                    4              20                                                   35
          AL JAHLI MEDICAL CENTER                                            1                     14      1                1                           1               1                                                   19
          TAWAM HOSPITAL                                                    17                     69      1                5       2           19      2               9      2              24                    4      154
Tawam                                                                                                                                                                                                                                     292
          TAWAM HOSPITAL DENTAL SERVICES                                     1                     20      1                1                           1               7                                                   31
          AL WAGAN HOSPITAL                                                  1                     16      1                1                                           3                                                   22
          NEIMA PHC                                                          1                     25      1                1                           1               2                                                   31
          Main Office                      1                                                       6                                                    5               5      1                                            18
          MARFA HOSPITAL                                                                           12                                                   2                                     1                             15
          LIWA HOSPITAL                                                     1                      7                                                    1                                     1                             10
          BIDA MUTAWA PPHC                                                                         1                                                                                                                         1
Madinat
          DELMA HOSPITAL                                                                           5                                                                                                                         5            117
 Zayed
          ABU AL-ABYAD PHC                                                                                                                                                                                                   0
          SEER BANIYAS PHC                                                                                                                                                                                                   0
          SILA HOSPITAL                                                                            9                                                                                          1                             10
          GHIATHY HOSPITAL                                                                         8                                                    1                                     2                             11

       SEHA-G-RFP-05-2011                                                                                                                                                                                         Page 35
                                                                                                                                                                                                        Utilization Review
                                                                                                                                                                                                         Management &
                                                                                      Patient Access




                                                                                                                                                              Office/Billing
                                                                                                                                          Counselors
                                                           Scheduling




                                                                                                                                           Financial
                                                                                                                     Cashiers




                                                                                                                                                                                       Coding




                                                                                                                                                                                                                                        Total
                                                                                                                                                                  Back
                                               RCM




                                                                                                                                                                                                                Case
    BE                        Provider




                                                                                                                                                                                                                             Facility
                                                                        Staff




                                                                                                       Staff




                                                                                                                                Staff




                                                                                                                                                  Staff




                                                                                                                                                                         Staff




                                                                                                                                                                                                Staff




                                                                                                                                                                                                                     Staff
                                               Sup

                                                     Sup




                                                                                Sup




                                                                                                               Sup




                                                                                                                                        Sup




                                                                                                                                                          Sup




                                                                                                                                                                                 Sup




                                                                                                                                                                                                        Sup




                                                                                                                                                                                                                                            BE
            Dhafra Clinic                                                       1                      8                                                                                                                       9
            MADINAT ZAYED HOSPITAL                                              1                      28                                          1      1               2                     5                             38
            Main Office                        1                                                                                 3                        3              20                                                   27
            SHEIKH KHALIFA MEDICAL CITY              1                  11      11                     73                       12                 8                                            12                    1      129
            BEHAVIORAL SCIENCES PAVILION                                                                                                                                                                                       0
            ABU DHABI REHABILITATION CENTER                                                                                                                                                                                    0
            KHALIDIYA URGENT CARE CENTER                                        1                      12                                                                                                                     13
            ABU DHABI DENTAL CLINIC                                             1                      8                                                                                                                       9
            DHAFRA DENTAL CLINIC                                                                       7                                                                                                                       7
  SKMC      BATEEN PHC                                                          1                      11                                                                                                                     12            240
            ETTEHAD PHC                                                         1                      12                                                                                                                     13
            KHALEEJ PHC                                                         1                      7                                                                                                                       8
            MADINA PHC                                                                                                                                                                                                         0
            MANHAL PHC                                                          1                      3                                                                                                                       4
            MUSHRIF PHC                                                         1                      4                                                                                                                       5
            ROWDA PRIMARY HEATLH CARE CENTER                                    1                      4                                                                                                                       5
            ZAFARANAH PHC                                                       1                      7                                                                                                                       8
            Main Office                                                                                                                                                                                                        0
            AL AIN HOSPITAL                    1                                4                      85                       5                  1      1              33      1              35      1             4      171
 VAMED      AL MASOUDI PHC                                                                             12                                                                                                                     12            206
            OUD AL TOBA PHC                                                     1                      10                                                                                                                     11
            AL KHABISI PHC                                                                             12                                                                                                                     12
Total                                          10     2                 33      64 652                         23 345                    3        42      26 156                  6 133                    2         21                    1518




         SEHA-G-RFP-05-2011                                                                                                                                                                                         Page 36
                                          Daman Claims and Gross Amounts per Facility/BE

      Region                                    Facility                                   No. of Claims         Claims Amount AED
    Al-Corniche      CORNICHE HOSPITAL.                                                                147,512             102,787,928
     Al-Rahba        AL RAHBA HOSPITAL                                                                 234,060              77,020,653
                     BAIN AL GESREEN HEALTH CENTER                                                     149,195              28,524,653
                     AL KHATIM HEALTH CENTER                                                            28,951               3,179,462
                     MUSSAFAH HEALTH CENTER                                                             14,817               1,408,675
                     SHAHAMA HEALTH CENTER                                                             191,496              21,156,107
                     KHALIFA HEALTH CENTER                                                             180,163              31,704,654
                     SAMHA HEALTH CENTER                                                                70,345               9,467,606
                     DISEASE PREVENTION AND SCREENING CENTER - Abu Dhabi                                 3,691                 760,077
                     DISEASE PREVENTION AND SCREENING CENTER-ALAIN                                       1,529                 307,350
                     AL HILI PRIMARY HEALTH CARE CENTER                                                 72,087               8,010,284
                     SWEIHAN PRIMARY HEALTH CARE CENTER                                                 38,156               3,895,737
                     AL MUWEIJI PRIMARY HEALTH CARE CENTER                                             106,885              21,128,089
 Ambualtory Health   ZAKHER PRIMARY HEALTH CARE CENTER                                                  47,731               4,452,344
     Services        AL KHAZNAH PRIMARY HEALTH CARE CENTER                                              18,736               1,841,036
                     AL NIYADAT PRIMARY HEALTH CARE CENTER                                              68,189               8,452,742
                     AL MAQAM PRIMARY HEALTH CARE CENTER                                               143,834              15,572,935
                     AL FAQA PRIMARY HEALTH CARE CENTER                                                 12,413               1,332,875
                     AL SHUEIB PRIMARY HEALTH CARE CENTER                                               19,384               1,811,886
                     AL HAYER PRIMARY HEALTH CARE CENTER                                                40,499               3,756,876
                     REMAH PRIMARY HEALTH CARE CENTER                                                   32,039               3,581,141
                     AL YAHAR PRIMARY HEALTH CARE CENTER                                               175,173              18,495,955
                     MEZYAD PRIMARY HEALTH CARE CENTER                                                 190,600              19,804,174
                     AL QUAA PRIMARY HEALTH CARE CENTER                                                 69,344               6,799,097
                     AL MAFRAQ DENTAL CENTER                                                            36,608              24,772,950
                     Total                                                                           1,711,865             240,216,707
                     AL MAFRAQ HOSPITAL                                                                426,324             284,680,648
      Mafraq
                     BANIYAS HEALTH CENTER MANAGED BY AL MAFRAQ HOSPITAL                               341,192              52,265,559


SEHA-G-RFP-05-2011                                                                                                          Page 37
       Region                                   Facility                       No. of Claims         Claims Amount AED
                        AL NAHDA HEALTH CENTER MANAGED BY AL MAFRAQ HOSPITAL                74,561               8,820,385
                        All                                                                842,077             345,766,592
                        AL JAHLI MEDICAL CENTER                                            136,103              29,799,914
                        TAWAM HOSPITAL                                                     581,541             482,545,893
                        TAWAM HOSPITAL DENTAL SERVICES                                      60,943              40,135,128
       Tawam
                        AL WAGAN HOSPITAL                                                   60,951              11,338,892
                        NEIMA PRIMARY HEALTH CARE CENTER                                   143,484              23,937,479
                        Total                                                              983,022             587,757,307
                        MARFA HOSPITAL                                                      72,631              11,909,009
                        LIWA HOSPITAL                                                       33,064               3,706,315
                        BIDA MUTAWA PRIMARY HEALTH CARE CENTER                               3,011                 290,774
                        DELMA HOSPITAL                                                      41,567               6,386,328
                        ABU AL-ABYAD PHC                                                       973                  84,812
WesternMedical Region   SEER BANIYAS PRIMARY HEALTH CARE CENTER                                647                  51,259
                        SILA HOSPITAL                                                       46,821               6,895,815
                        GHIATHY HOSPITAL                                                   106,954              17,630,768
                        MADINAT ZAYED HOSPITAL                                             251,826              60,014,944
                        ALDHAFRA CENTER (New)                                                  131                  15,027
                        Total                                                              557,625             106,985,051
                        SHEIKH KHALIFA MEDICAL CITY                                        532,326             460,677,218
                        BEHAVIORAL SCIENCES PAVILION                                        17,284              21,056,626
                        ABU DHABI REHABILITATION CENTER                                      2,000              10,272,632
                        KHALIDIYA URGENT CARE CENTER                                        37,628               2,555,452
                        ABU DHABI DENTAL CLINIC                                             45,044              26,637,397
       SKMC             DHAFRA DENTAL CLINIC                                                22,111               9,049,111
                        BATEEN PRIMARY HEALTH CARE CENTER                                  138,500              26,848,830
                        ETTEHAD PRIMARY HEALTH CARE CENTER                                  49,457               4,299,466
                        KHALEEJ PRIMARY HEALTH CARE CENTER                                  60,147               9,975,942
                        MADINA PRIMARY HEALTH CARE CENTER                                   35,909               2,886,362
                        MANHAL PRIMARY HEALTH CARE CENTER                                   41,883               6,541,564

SEHA-G-RFP-05-2011                                                                                              Page 38
        Region                                   Facility                                 No. of Claims            Claims Amount AED
                         MUSHRIF PRIMARY HEALTH CARE CENTER                                            33,673                     5,386,882
                         ROWDA PRIMARY HEATLH CARE CENTER                                              49,156                     8,435,204
                         ZAFARANAH PRIMARY HEALTH CARE CENTER                                          84,675                    12,214,241
                         Total                                                                      1,149,793                   606,836,926
                         AL AIN HOSPITAL                                                              478,468                   232,167,756
                         AL MASOUDI PRIMARY HEALTH CARE CENTER                                        104,953                    11,661,876
         Al-Ain          OUD AL TOBA PRIMARY HEALTH CARE CENTER                                        35,822                     4,255,378
                         AL KHABISI PRIMARY HEALTH CARE CENTER                                         79,666                     9,645,663
                         Total                                                                        698,909                   257,730,673
Total - All BEs                                                                      12,649,726                 2,325,101,837
 Based on submitted claims to Daman for 12 months: November 2009 Through October 2010.




 SEHA-G-RFP-05-2011                                                                                                              Page 39
        Attachment (6) - Current Delineation of RCM Activities

                                                               Primary Responsibility       Support Responsibility
   No.                       Function                                   Corporate                    Corporate
                                                            BE                           BE
                                                                   Ops     IT      RCM         Ops      IT      RCM
          Define & Communicate RCM Structure for all
          SEHA facilities to Ensure Compliance with
    1
          Regulatory Requirements & Optimization of
          Revenues                                                                 X             X
    2     Payer contract negotiations:
           Single BE specific                                X                                   X              X
           System Wide                                                             X             X
          Define and establish protocol for the
    3
          implementation of Third Party Contracts                                  X             X      X
          Administration of Contract Management
    4
          Government & Private Payers                                              X                    X
          Administer 2005 Law 23 Including Circulars &
    5
          Mandates                                                                 X                    X
    6     IT Systems readiness / stability                                 X             X       X              X
    7     Corporate RCM Policies & Procedures & Forms                              X             X
          Maintain & Administer all Plan Codes Per
    8
          Statement of Benefits                                                    X                    X
    9     Maintain Billing Rules                                                   X     X              X
   10     Price Management / Approval                                              X     X       X      X
          Coordination & Communications with HAAD on
   11
          All Matters                                                              X             X      X
          HAAD Data Standards - System Implementation
   12
          Requirements                                                             X                    X
          HAAD/Daman policies and regulations related
   13
          to RCM                                                                   X     X              X
          Development & Management of A Unified
   14
          Charge Description Master                                                X     X       X      X


SEHA-G-RFP-05-2011                                                                                                  Page 40
                                                             Primary Responsibility       Support Responsibility
   No.                     Function                                   Corporate                    Corporate
                                                          BE                           BE
                                                                 Ops     IT      RCM         Ops      IT      RCM
         Oversight & Management of the Charge
   15
         Services Processes                                                      X     X       X      X
   16    Provider licensing / credentials                 X                                    X              X
   17    Scheduling & Authorizations                      X                                    X              X
   18    Patient Access (Admissions/Registration)         X                                    X              X
   19    Financial Counseling & Collections of Deposits   X                                    X              X
   20    Claims Management and Processing                 X                                    X              X
   21    Insurance Claims Adjudication                    X                                    X              X
         AR Management (Cash receipts, posting and
   22
         follow-up & Write-offs)                          X                                    X      X       X
         Management of claims denial and
   23
         resubmission                                     X                                    X      X       X
         Case Management & Utilization Review
         Develop case management and UR protocol at
    1    the facility level and communicate process to
         facilities                                                              X     X       X
         Development of case management and
    2    utilization review corporate policies and
         Position Descriptions                                                   X             X
         Annual assessment of case management
    3
         processes at the facility level                                         X             X              X
    4    Initiate & Head up a CM &UR Committee                                   X
         Implement & Maintain an Effective Case
    5
         Management Program at the Facility Level         X                                                   X
         HIM & Coding
         Represent RCM on Clinical Coding Steering
    1
         Committee, REG/HIM Council, HIM IUC group                               X     X
         Development of and Maintenance of Facility
    2
         Coding Review Program                                                   X     X


SEHA-G-RFP-05-2011                                                                                                Page 41
                                                         Primary Responsibility       Support Responsibility
   No.                      Function                              Corporate                    Corporate
                                                      BE                           BE
                                                             Ops     IT      RCM         Ops      IT      RCM
         Periodic Assessment (at least annually) of
    3
         Facilities Coding Performance                                       X     X       X
         Documentation & Coding of All Patient
    4
         Encounters                                   X
    5    Development of Corporate Coding Polices                             X             X
Ops = Operations Division




SEHA-G-RFP-05-2011                                                                                         Page 42
       Attachment (7) - RCM Information Technology Roadmap
Upper Part - Cerner HIS implementation at the remaining SEHA facilities
Lower Part - RCM solutions implementation




SEHA-G-RFP-05-2011                                                        Page 43
SEHA-G-RFP-05-2011   Page 44
       Attachment (8) – Proposed Delineation of RCM Activities
(‘P’=Primary Responsibility and ‘S’=Secondary Responsibility)

                                                                                               Corporate
 No.                                              Function                                                 CBO   BE
                                                                                                 RCM
        Define & Communicate RCM Structure for all SEHA facilities to Ensure Compliance with
  1
        Regulatory Requirements & Optimization of Revenues                                        P
  2     Payer contract negotiations:
         Single BE specific                                                                       P
         System Wide                                                                              P
  3     Define and establish protocol for the implementation of Third Party Contracts             P
  4     Administration of Contract Management Government & Private Payers                         P
  5     Administer 2005 Law 23 Including Circulars & Mandates                                     P
  6     IT Systems readiness / stability                                                          P         S
  7     Corporate RCM Policies & Procedures & Forms                                               P         S
  8     Maintain & Administer all Plan Codes Per Statement of Benefits                            P         S
  9     Maintain Billing Rules                                                                    P
  10    Price Management / Approval                                                               P
  11    Coordination & Communications with HAAD on All Matters                                    P         S
  12    HAAD Data Standards - System Implementation Requirements                                  P         S
  13    HAAD/Daman policies and regulations related to RCM                                        P
  14    Development & Management of A Unified Charge Description Master                           P         S
  15    Oversight & Management of the Charge Services Processes                                   P         S
  16    Provider licensing / credentials                                                                         P
  17    Scheduling                                                                                               P
  18    Authorization                                                                                       P
  19    Patient Access (Admissions/Registration)                                                            P
  20    Financial Counseling & Collections of Deposits                                                      P
  21    Claims Management and Processing                                                                    P
  22    Insurance Claims Adjudication                                                                       P
  23    AR Management (Cash receipts, posting and follow-up & Write-offs)                                   P


SEHA-G-RFP-05-2011                                                                                               Page 45
                                                                                               Corporate
 No.                                          Function                                                     CBO   BE
                                                                                                 RCM
 24    Management of claims denial and resubmission                                                         P
       Case Management & Utilization Review
       Develop case management and UR protocol at the facility level and communicate process
  1
       to facilities                                                                              P
       Development of case management and utilization review corporate policies and Position
  2
       Descriptions                                                                               P
  3    Annual assessment of case management processes at the facility level                       P
  4    Initiate & Head up a CM &UR Committee                                                      P
  5    Implement & Maintain an Effective Case Management Program at the Facility Level                           P
       HIM & Coding
  1    Represent RCM on Clinical Coding Steering Committee, REG/HIM Council, HIM IUC group        P
  2    Development of and Maintenance of Facility Coding Review Program                           P
  3    Periodic Assessment (at least annually) of Facilities Coding Performance                   P
  4    Documentation & Coding of All Patient Encounters                                                     P
  5    Development of Corporate Coding Polices                                                    P         S




SEHA-G-RFP-05-2011                                                                                               Page 46
        Attachment (9) - Suggested Revenue Cycle Key Performance Metrics

  Key Revenue Cycle
                                                    Relevant Metrics
   Performance Area
Patient Access Quality         Physician authorization compliance
                               Inpatient admissions error ratio
                               Outpatient registration error ratio
                               Point-of-service cash (self-pay and co-
                                insurance/deductibles) collection %
                               % of preregistered accounts (inpatient)
                               % of preregistered accounts (outpatient)
                               Staffing Ratio (admissions & registration)
                               Denial % (authorization – initial and follow-up)
                               % Complaints
Case Management                Payer acceptance of clinical treatment plan (based on
                                authorization)
                               Clinical denials overturn rate
                               % LOS within clinical& PAYER guidelines
                               Lower Re-admission rates
                               Unnecessary bed delays
Health Information             Lost cash opportunity due to unbilled beyond suspense
Management Quality
                               Discharged Not Final Billed (DNFB) and HIM bill-holds
                                     o Awaiting coding
                                     o Awaiting dictation
                               Charge capture quality
                               Code Accuracy measurement
                               Productivity per coder
                               % of certified coders
PFS/Patient Accounting         Gross days receivable outstanding
(Cash Management and
                               GDRO for HMO/PPO on HMO/PPO revenue
Liquidity Focus)
                               Net days receivable outstanding
                               Net Days Receivable Outstanding by Payer
                               % A/R over 90 days
                               % A/R over 120 days
PFS/Patient Accounting         % A/R over 1 year
(Cash Management and
                               Patient accounting cash receipts as % of net revenue
Liquidity Focus)
                               Patient accounting cash receipts as % of net collectible
                                value
                               Credit balance A/R
PFS/Patient Accounting         Billing turnaround (days from discharge to billing)
(Billing Timeliness and
                               % clean claims submission
Quality)
                               Secondary/tertiary payer billing
                               % of resubmissions by payer

SEHA-G-RFP-05-2011                                                                         Page 47
  Key Revenue Cycle
                                                                  Relevant Metrics
  Performance Area
                                       Payer turnaround (average time to pay clean claim)
                                            o Electronic
                                            o Paper
PFS/Patient Accounting                 Claim rejection turnaround
(Collections and Follow-up
                                       High-value unpaid accounts worked
Quality)
                                       Low-value unpaid accounts worked
Accounts Receivable                    Conversion rate
Processing
                                       Cash posting
                                       Contractual allowance posting
                                       Credit balance threshold
                                       Credit balance turnaround
All Revenue Cycle                      Denial overturn ratio
Departments Net Revenue
                                       Underpayments overturn ratio
Exposure
                                       Cash factor analysis (payment to gross charge ratio) by
                                        payer grouping
Other Performance                      Cost-to-collect ratio
Indicators
                                       Bad debt expense as % of operating expense
                                       Bad debt expense as % of net revenue
                                       Denials as a % of net revenue
                                       Denial as a % of operating expense
Source: Newitt, Z., & Robertson, B. (2007). Key Revenue Cycle Metrics. hfm (Healthcare Financial Management), 61(5), 105-
107.

 *****************************************************************
              *************** END OF RFP DOCUMENT ***************
 *****************************************************************




SEHA-G-RFP-05-2011                                                                                               Page 48

								
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