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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: 5/22/18 rm Page 1 of 7 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. Service Agreement Standard Form Page 2 of 7 Approved as to Legal Form 12/15/17 (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. Service Agreement Standard Form Page 3 of 7 Approved as to Legal Form 12/15/17 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, Service Agreement Standard Form Page 4 of 7 Approved as to Legal Form 12/15/17 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; Service Agreement Standard Form Page 5 of 7 Approved as to Legal Form 12/15/17 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 , Arlo> Signature: AP.- Printed Name:Pc,,vA -Z . 0- Title: piiQffSfP(c7-' T GT Date: 573/a-c'/ CITY OF CORPUS CHRISTI Signature: Printed Name: mcs Title: 1)r c-u., s Ems ` Date: ''./) 3/ , Or ATTEST: 11 • R B_CCA HUERTA 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 Service Agreement Standard Form Page 7 of 7 Approved as to Legal Form 12/15/17 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.