PROCUREMENT- AUDIT- JUNE 3

Audit Services for State Employee and Retiree Benefits Program



Solicitation No. F10B0400010



RFP Issue Date: April 26, 2010



RFP Issuing Office: Department of Budget and Management

Employee Benefits Division (EBD)



Procurement Officer: Joy Epstein

Procurement Officer

Office Phone: (410) 260-7570

Fax: (410) 974-3274

E-mail: jepstein@dbm.state.md.us



Proposals are to be sent to: Department of Budget and Management

45 Calvert Street, Room 143

Annapolis, MD 21401

Attention: Joy Epstein



Pre-Proposal Conference: May 13, 2010, 1:00PM (Local Time)

Department of Budget and Management

300 W. Preston Street, Ground Floor Auditorium

Baltimore, MD 21202

For directions, see Attachment E

Closing Date and Time: June 3, 2010 at 2:00 PM (Local Time)



The Department of Budget and Management is issuing this Request for Proposals (RFPs) to obtain one or more qualified auditing firms to complete annual audits of the claims adjudication and payment functions, clinical functions, and administrative performance of the following plans in the State Employee and Retiree Health and Welfare Benefits Program. The Department intends to award contracts for audit in the following categories:



Category 1 – Self Funded Medical Benefits Plans;

· Preferred Provider Organization Plans (PPO);

· Point of Service Plans (POS);and

· Exclusive Provider Organization Plans (EPO).



Category 2 – Fully Insured Dental Benefits Plans;

· Dental Preferred Provider (DPPO);and

· Health Maintenance Organization Plan (DHMO).



Category 3 - Mental Health/Substance Abuse Benefits Coverage;



Category 4 - Prescription Drug Benefits Plan, including pharmacy rebate audit; and



Category 5 - Flexible Spending Accounts.



The initial audit under the Contract(s) will be of the plan year 07-01-2010 through 06-30-2011. This is the initial audit cycle.



The State desires a statistical review of all claims processing elements through an audit of actual paid claims, in addition to a review of onsite operational procedures in place at the claims office. The State will also require a rebate audit of its’ Prescription Drug Benefits Plan.



Offerors may submit proposals to provide auditing services for any combination of or all Plan Categories. The State will award up to five contracts (one for each category) for the desired auditing services.



Hereafter, in this solicitation any time the word “Contract” appears in the singular, it shall mean each of the five contracts to be awarded. The term of any contracts awarded will cover five (5) audit cycles and will terminate upon successful completion of the last audit cycle (an audit of the coverage period beginning July 1, 2014 and ending June 30, 2015). Each audit is expected to begin shortly after the conclusion of the plan year.