RFP Process and Procedures
Whether exploring options for new clients or nurturing our existing clients, requesting proposals from alternative carriers is a critical part of what makes Sullivan your trusted partner. Of course, we manage your general day-to-day services, but we also release a Request for Proposal (RFP) to the marketplace in order to review your entire vendor options now and at renewal. After thorough evaluation and tough negotiation, Sullivan recommends insurers and providers to our clients that are the very best fit for their needs. We take great pride in our ability to perform this important function.
Our position in the marketplace allows us to enjoy preferred financial arrangements with insurance vendors and third party administrators across the United States. We actively cultivate long-standing relationships with major carriers. Those relationships allow us to negotiate aggressively and obtain highly cost-effective proposals for our clients.
As we negotiate with vendors, we will also examine your loss history, establish the necessary types of coverage consistent with your risk tolerance, choose carriers who provide superior services, and adopt the optimal funding mechanisms for your specific needs.
We have established rigorous selection criteria for potential vendors and recommend a selection based on the following considerations.
|Claim turnaround time||90% in 10 calendar days|
|Claim processing standards||Financial accuracy*: 99%
Payment accuracy*: 98%
Coding accuracy*: 97%
|Internal audits||Quarterly reports|
|External audits||As needed|
|Updated eligibility information||Within 5 work days of receipt|
|Updated network provider file||Within 10 work days of receipt|
|Availability of general service representative||As needed|
|Delivery of standard management reports||Standard reports: within 1 week of request|
|Delivery of custom management reports||Custom reports: within 2 weeks of initial request or as agreed upon|
|Personnel changes||Notification before changes occur|
|Telephone responsiveness||Average speed to answer: 90% within 30 seconds|
|Employee satisfaction||Survey results (to be determined)|
Critical Vendor Selection Criteria
- Overall service and quality
- Experience in administering network-based programs
- Commitment to continuous quality improvement processes
- Experience in administering multiple option health programs
- Quality of communication materials (e.g. booklets, EOBs, etc.)
- Effective administration procedures (e.g. coordination of benefits, subrogation, etc.)
- Responsiveness of group representative
- Cost efficiency
- Responsiveness to client feedback
- Professionalism of response to RFP
- Willingness to adapt to changing needs and circumstances
- Adequate staffing ratios
- Superior network coverage in relation to location of client employees
Financial accuracy: total amount of claims dollars paid correctly, divided by the total claims dollars paid.
Payment accuracy: total amount of checks issued for the correct dollar amount divided by the total number of checks issued.
Coding accuracy: total number of claims processed without a coding error (i.e. any inaccurate entry of information that does not result in a payment error), divided by the total number of claims processed.