HomeMy WebLinkAboutC2018-305 - 5/22/2018 - Approved 8
SERVICE AGREEMENT NO. 1551
min
Medical and Pharmacy Claims Audit
'Agri
THIS Medical and Pharmacy Claims Audit Agreement ("Agreement") is entered
into by and between the City of Corpus Christi, a Texas home-rule municipal
corporation ("City") and Claim Technologies Incorporated ("Contractor"), effective
upon execution by the City Manager or the City Manager's designee ("City
Manager").
WHEREAS, Contractor has bid to provide Medical and Pharmacy Claims Audit
Services in response to Request for Bid/Proposal No. 1551 ("RFB/RFP"), which RFB/RFP
includes the required scope of work and all specifications and which RFB/RFP and the
Contractor's bid or proposal response, as applicable, are incorporated by reference
in this Agreement as Exhibits 1 and 2, respectively, as if each were fully set out here in
its entirety.
NOW, THEREFORE, City and Contractor agree as follows:
1. Scope. Contractor will provide Medical And Pharmacy Claims Audit Services
("Services") in accordance with the attached Scope of Work, as shown in
Attachment A, the content of which is incorporated by reference into this
Agreement as if fully set out here in its entirety, and in accordance with Exhibit 2.
2. Term. This Agreement is for six months, with performance commencing upon the
date of issuance of a notice to proceed from the Contract Administrator or
Purchasing Division. The parties may mutually extend the term of this Agreement
for up to zero additional zero-month periods ("Option Period(s)"), provided, the
parties do so in writing and prior to the expiration of the original term or the then-
current Option Period. The City's extension authorization must be executed by
the City Manager or designee.
3. Compensation and Payment. The total value of this Agreement is not to exceed
$72,193.00, subject to approved extensions and changes. Payment will be made
for Services completed and accepted by the City within 30 days of acceptance,
subject to receipt of an acceptable invoice. All pricing must be in accordance
with the attached Bid/Pricing Schedule, as shown in Attachment B, the content
of which is incorporated by reference into this Agreement as if fully set out here in
its entirety.
4. Contract Administrator. The Contract Administrator designated by the City is
responsible for approval of all phases of performance and operations under this
Agreement, including deductions for non-performance and authorizations for
2018-305 contract Administrator for this Agreement is as follows:
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M2018-087 5/17
Claim Technologies Incorporated
INDEXED
Name: Rose Bond
Department: Human Resources
Phone: 361.826.3878
Email: Roseb2@cctexas.com
5. Insurance; Bonds.
(A) Before performance can begin under this Agreement, the Contractor must
deliver a certificate of insurance ("COI"), as proof of the required insurance
coverages, to the City's Risk Manager and the Contract Administrator.
Additionally, the 001 must state that the City will be given at least 30 days'
advance written notice of cancellation, material change in coverage, or intent
not to renew any of the policies. The City must be named as an additional insured.
The City Attorney must be given copies of all insurance policies within 10 days of
the City Manager's written request. Insurance requirements are as stated in
Attachment C, the content of which is incorporated by reference into this
Agreement as if fully set out here in its entirety.
(B) In the event a payment bond, a performance bond, or both, are required of
the Contractor to be provided to the City under this Agreement before
performance can commence, the terms, conditions, and amounts required in the
bonds and appropriate surety information are as included in the RFB/RFP or as
may be added to Attachment C, and such content is incorporated here in this
Agreement by reference as if each bond's terms, conditions, and amounts were
fully set out here in its entirety.
6. Purchase Release Order. For multiple-release purchases of Services to be
provided by the Contractor over a period of time, the City will exercise its right to
specify time, place and quantity of Services to be delivered in the following
manner: any City department or division may send to Contractor a purchase
release order signed by an authorized agent of the department or division. The
purchase release order must refer to this Agreement, and Services will not be
rendered until the Contractor receives the signed purchase release order.
7. Inspection and Acceptance. Any Services that are provided but not accepted by
the City must be corrected or re-worked immediately at no charge to the City. If
immediate correction or re-working at no charge cannot be made by the
Contractor, a replacement service may be procured by the City on the open
market and any costs incurred, including additional costs over the item's
bid/proposal price, must be paid by the Contractor within 30 days of receipt of
City's invoice.
8. Warranty.
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(A) The Contractor warrants that all products supplied under this Agreement
are new, quality items that are free from defects, fit for their intended purpose,
and of good material and workmanship. The Contractor warrants that it has clear
title to the products and that the products are free of liens or encumbrances.
(B) In addition, the products purchased under this Agreement shall be
warranted by the Contractor or, if indicated in Attachment D by the
manufacturer, for the period stated in Attachment D. Attachment D is attached
to this Agreement and is incorporated by reference into this Agreement as if fully
set out here in its entirety.
9. Quality/Quantity Adjustments. Any Service quantities indicated on the Bid/Pricing
Schedule are estimates only and do not obligate the City to order or accept more
than the City's actual requirements nor do the estimates restrict the City from
ordering less than its actual needs during the term of the Agreement and including
any Option Period. Substitutions and deviations from the City's product
requirements or specifications are prohibited without the prior written approval of
the Contract Administrator.
10. Non•ApproprIation. The continuation of this Agreement after the close of any
fiscal year of the City, which fiscal year ends on September 30Th annually, is subject
to appropriations and budget approval specifically covering this Agreement as
anexpenditure in said budget, and it is within the sole discretion of the City's City
Council to determine whether or not to fund this Agreement. The City does not
represent that this budget item will be adopted, as said determination is within the
City Council's sole discretion when adopting each budget.
11. Independent Contractor. Contractor will perform the work required by this
Agreement as an independent contractor and will furnish such Services in its own
manner and method, and under no circumstances or conditions will any agent,
servant or employee of the Contractor be considered an employee of the City.
12. Subcontractors. Contractor may use subcontractors in connection with the work
performed under this Agreement. When using subcontractors, however, the
Contractor must obtain prior written approval from the Contract Administrator if
the subcontractors were not named at the time of bid or proposal, as applicable.
In using subcontractors, the Contractor is responsible for all their acts and
omissions to the same extent as if the subcontractor and its employees were
employees of the Contractor. All requirements set forth as part of this Agreement,
including the necessity of providing a COI in advance to the City, are applicable
to all subcontractors and their employees to the same extent as if the Contractor
and its employees had performed the work.
13. Amendments. This Agreement may be amended or modified only by written
change order signed by both parties. Change orders may be used to modify
quantities as deemed necessary by the City.
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14. Waiver. No waiver by either party of any breach of any term or condition of this
Agreement waives any subsequent breach of the same.
15. Taxes. The Contractor covenants to pay payroll taxes, Medicare taxes, FICA
taxes, unemployment taxes and all other related taxes. Upon request, the City
Manager shall be provided proof of payment of these taxes within 15 days of such
request.
16. Notice. Any notice required under this Agreement must be given by fax, hand
delivery, or certified mail, postage prepaid, and is deemed received on the day
faxed or hand-delivered or on the third day after postmark if sent by certified mail.
Notice must be sent as follows:
IF TO CITY:
City of Corpus Christi
Attn: Rose Bond
Title: Health Benefits Manager
Address: 1201 Leopard St., Corpus Christi, Texas 78401
Phone: 361 .826.3878
Fax:
_.. _ IF TO CONTRACTOR:
Claim Technologies Incorporated
Attn: Michelle Suckow
Title: Vice President
Address: 100 Court Ave, Suite 306, Des Moines, IA 50309
Phone: 515.244.7322 ext. 315
Fax: 515.244.8650
17. CONTRACTOR SHALL FULLY INDEMNIFY, HOLD HARMLESS AND DEFEND
THE CITY OF CORPUS CHRISTI AND ITS OFFICERS, EMPLOYEES AND
AGENTS ("INDEMNITEES') FROM AND AGAINST ANY AND ALL LIABILITY,
LOSS, CLAIMS, DEMANDS, SUITS, AND CAUSES OF ACTION OF
WHATEVER NATURE, CHARACTER, OR DESCRIPTION ON ACCOUNT OF
PERSONAL INJURIES, PROPERTY LOSS, OR DAMAGE, OR ANY OTHER KIND
OF INJURY, LOSS, OR DAMAGE, INCLUDING ALL EXPENSES OF
LITIGATION, COURT COSTS, ATTORNEYS' FEES AND EXPERT WITNESS FEES,
WHICH ARISE OR ARE CLAIMED TO ARISE OUT OF OR IN CONNECTION
WITH A BREACH OF THIS AGREEMENT OR THE PERFORMANCE OF THIS
AGREEMENT BY THE CONTRACTOR OR RESULTS FROM THE NEGLIGENT
ACT, OMISSION, MISCONDUCT, OR FAULT OF THE CONTRACTOR OR ITS
EMPLOYEES OR AGENTS. CONTRACTOR MUST, AT ITS OWN EXPENSE,
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INVESTIGATE ALL CLAIMS AND DEMANDS, ATTEND TO THEIR SETTLEMENT
OR OTHER DISPOSITION, DEFEND ALL ACTIONS BASED THEREON WITH
COUNSEL SATISFACTORY TO THE CITY ATTORNEY, AND PAY ALL
CHARGES OF ATTORNEYS AND ALL OTHER COSTS AND EXPENSES OF
ANY KIND ARISING OR RESULTING FROM ANY SAID LIABILITY, DAMAGE,
LOSS, CLAIMS, DEMANDS, SUITS, OR ACTIONS. THE INDEMNIFICATION
OBLIGATIONS OF CONTRACTOR UNDER THIS SECTION SHALL SURVIVE
THE EXPIRATION OR EARLIER TERMINATION OF THIS AGREEMENT.
18. Termination.
(A) The City Manager may terminate this Agreement for Contractor's failure to
perform the work specified in this Agreement or to keep any required insurance
policies in force during the entire term of this Agreement. The Contract
Administrator must give the Contractor written notice of the breach and set out a
reasonable opportunity to cure. If the Contractor has not cured within the cure
period, the City Manager may terminate this Agreement immediately thereafter.
(B) Alternatively, the City Manager may terminate this Agreement for
convenience upon 30 days advance written notice to the Contractor. The City
Manager may also terminate this Agreement upon 24 hours written notice to the
Contractor for failure to pay or provide proof of payment of taxes as set out in this
Agreement.
19. Assignment. No assignment of this Agreement by the Contractor, or of any right
or interest contained herein, is effective unless the City Manager first gives written
consent to such assignment. The performance of this Agreement by the
Contractor is of the essence of this Agreement, and the City Manager's right to
withhold consent to such assignment is within the sole discretion of the City
Manager on any ground whatsoever.
20. Severability. Each provision of this Agreement is considered to be severable and,
if, for any reason, any provision or part of this Agreement is determined to be
invalid and contrary to applicable law, such invalidity shall not impair the
operation of nor affect those portions of this Agreement that are valid, but this
Agreement shall be construed and enforced in all respects as if the invalid or
unenforceable provision or part had been omitted.
21. Order of Precedence. In the event of any conflicts or inconsistencies between this
Agreement, its attachments, and exhibits, such conflicts and inconsistencies will
be resolved by reference to the documents in the following order of priority:
A. this Agreement (excluding attachments and exhibits);
B. its attachments;
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C. the bid solicitation document including any addenda (Exhibit 1); then,
D. the Contractor's bid response Exhibit 2).
22. Certificate of Interested Parties. Contractor agrees to comply with Texas
Government Code Section 2252.908, as it may be amended, and to complete
Form 1295 "Certificate of Interested Parties" as part of this Agreement.
23. Verification Regarding Israel. In accordance with Chapter 2270, Texas
Government Code, the City may not enter into a contract with a company for
goods or services unless the contract contains a written verification from the
company that it: (1) does not boycott Israel; and (2) will not boycott Israel during
the term of the contract. The signatory executing this Agreement on behalf of the
Contractor verifies that the company does not boycott Israel and will not boycott
Israel during the term of this Agreement.
24. Governing Law.This Agreement is subject to all federal, State, and local laws, rules,
and regulations. The applicable law for any legal disputes arising out of this
Agreement is the law of the State of Texas, and such form and venue for such
disputes is the appropriate district, county, or justice court in and for Nueces
County, Texas.
25. Entire Agreement. This Agreement constitutes the entire agreement between the
parties concerning the subject matter of this Agreement and supersedes all prior
negotiations, arrangements, agreements and understandings, either oral or
written, between the parties.
(SIGNATURE PAGE FOLLOWS)
Service Agreement Standard Form Page 6 of 7
Approved as to Legal Form 12/15/17
CONTRACT•R ,
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CITY OF CORPUS CHRISTI
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ATTEST: 11 •
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CITY SECRETARY
Attached and Incorporated by Reference:
Attachment A: Scope of Work
Attachment B: Bid/Pricing Schedule
Attachment C: Insurance and Bond Requirements c ) ISL" Dg7
Attachment D: Warranty Requirements '"1 .AUINUK tc►
Incorporated by Reference Only: iY COUNCIL.. 5 2:2'
Exhibit 1 : RFB/RFP No. 1551 _
Exhibit 2: Contractor's Bid/Proposal Response SECRETAR
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Attachment A - Scope of Work
Medical and Pharmacy Claims Audit
1.1 Background
The City of Corpus Christi (City) has been administering a self-funded plan for more
than ten years. The medical claims are administered by United Healthcare and the
Pharmacy Benefit Manager (PBM) is Express Scripts (Administrators). The City's plans
cover 2,719 active employees which includes Pre-65 retirees. There are three
divisions of employees including General Employee, Fire and Public Safety. Each
division has a distinct medical and prescription plan of benefits. Fire and Public
Safety plans are identical with Public Safety having an additional Consumer Driven
Health Plan (CDHP) medical benefit option.
1.2 General Requirements
A. Audit Coordination and Management
Contractor shall schedule and organize all planned or requested audit project
tasks, consistent with the timeline outlines in this scope. This schedule may be
amended as needed to complete the audit.
B. Understanding Existing Plan
Contractor shall develop an understanding of the existing self-insured plan
administered by plan Administrators to successfully support this project. The plan
coverage summary may be found at the following link:
httb://www.citynet.cc/citynet/hr/benefit-plans-and-proarams.
C. Operational Review
Contractor shall review the operations maintained by Administrator(s) on behalf
of the City from an efficiency, control and security perspective.
At a minimum, this operations review will include such areas as:
• Quality improvement activities
• Internal audit
• Workflow
• Claims administration and controls
• Coordination of Benefits
• Handling of third party liability and subrogation
• Eligibility administration
• Customer service administration
D. Claims Audit
1. A statistically valid random, stratified sample will be required. The sampled
claims should be audited in detail to determine their accuracy relative to the
benefit plan and to determine whether their handling is consistent with
standard industry practices. The Contractor should compare and identify if
the claim processing accuracy meets the Performance Guarantees as
outlined in the City's contracts with UHC and Express Scripts.
2. To the extent possible, within a reasonable timeframe for finalizing the project,
the Contractor should discuss the errors discovered with the Administrators,
identify a recovery plan with the Administrators and note any specific areas
of disagreement.
E. Pharmacy Rebate Audit
The Contractor shall identify the top five manufacturers and compare the rebates
credited to the City under each manufacturer's contract with Express Scripts for
the last two calendar quarters during the 2016-2017 plan year. The Contractor
will also confirm that the manufacturer's administrative fees were passed one
hundred percent to the City.
F. Schedule
The schedule for the audit is an approximate start date of April 2, 2018 to be
completed by August 31, 2018.
G. Reports/Deliverables:
The Contractor shall provide reports detailing the findings from the claims audit.
The reports may be used by the City for review against performance standards
and incentives. It is critical that the reports clearly identify the extent of potential
financial recovery and any areas of disagreement with the Administrator(s). The
Contractor will provide the following reports:
o Status Reports - Provide periodic electronic status updates to the designated
representative of the City.
o Final Draft Report-Submit a draft report to be reviewed before any final report
is delivered.
o Final Report - Submit a specific detailed, written final report with
recommendations. The written report must include, at a minimum:
• Executive summary
• Description of the audit process, including major audit components and
key events associated with those components
• Recommendations for corrective action to ensure optimal claims handling
• Administrator(s)'s action plan in response to the Contractor's
recommendations
• Statement indicating the Contractor has observed all conflict of interest
requirements mandated by the City with respect to the audit process and
has not received anything of value or any benefit of any description while
performing audit services.
Attachment B - Schedule of Pricing
PRICING SHEET
CITY OF CORPUS CHRISTI
jig \ Pricing/Submission Forms
ioPURCHASING DIVISION
i RFP No. 1551
- ;sea/ Medical and Pharmacy Claims Audit
PAGE 1 OF 1
DATE: March 16, 2010 (. c
Claim Technologies Incorporated YV ' 1 -'4"1-\,
PROPOSER AUTHORIZED SIGNATURE
1. Refer to "Instructions to Proposers" and Contract Terms and Conditions
before completing proposal.
2. Provide your best price for each item.
3. In submitting this proposal, Proposer certifies that:
a, the prices in this proposal have been arlved at independently, without
consultation, communication, or agreement with any other Proposer or
competitor, for the purpose of restricting competition with regard to prices;
b. Proposer is an Equal Opportunity Empinyer; and the Disclosure of Interest
information an fits with City's purchasing office, pursuant to the Code of
Ordinances,is current and true.
c. Proposer has incorporated any changes issue through Addenda to the RFP In
this pricing.
ITEM DESCRIPTION UNIT TOTAL PRICE
LO Administrative PerformanceAudit of Medical Cain t $29,e8S.00
2.0 Pharmacy Rebate Audit 1 $27,109.00
I 3.0 , Optional Pharmacy Performance Guaranee Audit 1 $15,399.00
36
Attachment C — Insurance Requirements
3.1. Insurance Requirements
CONTRACTOR'S LIABILITY INSURANCE
A. Contractor must not commence work under this agreement until all insurance
required has been obtained and such insurance has been approved by the City.
Contractor must not allow any subcontractor Agency to commence work until all
similar insurance required of any subcontractor Agency has been obtained.
B. Contractor must furnish to the City's Risk Manager and Director Human Resources,
2 copies of Certificates of Insurance (COI) with applicable policy endorsements
showing the following minimum coverage by an insurance company(s)
acceptable to the City's Risk Manager. The City must be listed as an additional
insured on the General liability and Auto Liability policies by endorsement, and a
waiver of subrogation is required on all applicable policies. Endorsements must be
provided with COI. Project name and or number must be listed in Description Box
of COI.
TYPE OF INSURANCE MINIMUM INSURANCE COVERAGE
30-written day notice of cancellation, Bodily Injury and Property Damage
required on all certificates or by Per occurrence - aggregate
applicable policy endorsements
COMMERCIAL GENERAL LIABILITY $1,000,000 Per Occurrence
Including:
1 . Commercial Broad Form
2. Premises - Operations
3. Products/Completed
Operations
4. Contractual Liability
5. Independent Contractors
6. Personal Injury- Advertising Injury
AUTO LIABILITY (including) $1,000,000 Combined Single Limit
1. Owned
2. Hired and Non-Owned
3. Rented/Leased
PROFESSIONAL LIABILITY $1,000,000 Per Claim
(Errors and Omissions) (Defense costs not included in face
value of the policy)
If claims made policy, retro date must
be prior to inception of agreement,
have extended reporting period
provisions and identify any limitations
regarding who is insured.
CRIME/EMPLOYEE DISHONESTY $1,000,000 Per Occurrence
Contractor shall name the City of
Corpus Christi, Texas as Loss Payee
WORKERS' COMPENSATION Statutory
EMPLOYER'S LIABILITY $500,000 4500,000 /$500,000
C. In the event of accidents of any kind related to this agreement, Contractor must
furnish the Risk Manager with copies of all reports of any accidents within 10 days
of the accident.
IL ADDITIONAL REQUIREMENTS
A. Applicable for paid employees, Contractor must obtain workers' compensation
coverage through a licensed insurance company. The coverage must be written
on a policy and endorsements approved by the Texas Department of Insurance.
The workers' compensation coverage provided must be in an amount sufficient to
assure that all workers' compensation obligations incurred by the Contractor will
be promptly met.
B. Contractor shall obtain and maintain in full force and effect for the duration of this
Contract, and any extension hereof, at Contractor's sole expense, insurance
coverage written on an occurrence basis, by companies authorized and admitted
to do business in the State of Texas and with an A.M. Best's rating of no less than A-
VII.
C. Contractor shall be required to submit a copy of the replacement certificate of
insurance to City at the address provided below within 10 days of the requested
change. Contractor shall pay any costs incurred resulting from said changes. All
notices under this Article shall be given to City at the following address:
City of Corpus Christi
Attn: Risk Manager
P.O. Box 9277
Corpus Christi, TX 78469-9277
D. Contractor agrees that with respect to the above required insurance, all insurance
policies are to contain or be endorsed to contain the following required provisions:
• List the City and its officers, officials, employees, volunteers, and elected
representatives as additional insured by endorsement, as respects operations,
completed operation and activities of, or on behalf of, the named insured
performed under contract with the City, with the exception of the workers'
compensation policy;
• Provide for an endorsement that the "other insurance clause shall not apply to the
City of Corpus Christi where the City is an additional insured shown on the policy;
• Workers' compensation and employers' liability policies will provide a waiver of
subrogation in favor of the City; and
• Provide thirty (30) calendar days advance written notice directly to City of any
suspension, cancellation, non-renewal or material change in coverage, and not
less than ten (10) calendar days advance written notice for nonpayment of
premium.
E. Within five (5) calendar days of a suspension, cancellation, or non-renewal of
coverage, Contractor shall provide a replacement Certificate of Insurance and
applicable endorsements to City. City shall have the option to suspend
Contractor's performance should there be a lapse in coverage at any time during
this contract. Failure to provide and to maintain the required insurance shall
constitute a material breach of this contract.
F. In addition to any other remedies the City may have upon Contractor's failure to
provide and maintain any insurance or policy endorsements to the extent and
within the time herein required, the City shall have the right to order Contractor to
remove the exhibit hereunder, and/or withhold any payment(s) if any, which
become due to Contractor hereunder until Contractor demonstrates compliance
with the requirements hereof.
G. Nothing herein contained shall be construed as limiting in any way the extent to
which Contractor may be held responsible for payments of damages to persons or
property resulting from Contractor's or ifs subcontractor's performance of the work
covered under this agreement.
H. It is agreed that Contractor's insurance shall be deemed primary and non-
contributory with respect to any insurance or self insurance carried by the City of
Corpus Christi for liability arising out of operations under this agreement.
It is understood and agreed that the insurance required is in addition to and
separate from any other obligation contained in this agreement.
2018 Insurance Requirements
Purchasing
Medical and Pharmacy Claims Audit
02/14/2018 sw Risk Management
Attachment D - Warranty
Not applicable to this agreement.