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Usual, Customary and Reasonable Rate Data Services RFP

1. PURPOSE

L.A. Care is issuing this Request for Proposals (“RFP”) to solicit proposals for providing Usual, Customary, and Reasonable Rate Data. L.A. Care is seeking a vendor to provide us with rate data and advise us on rates for non-contracted (out-of-network) claims. The vendor must demonstrate that the rates are fiscally prudent, legally defensible, and comply with Knox Keene regulation, below, and all applicable laws. Data should represent all geographic areas in the United States.
 
The Knox-Keene Act requires health plans to reimburse out-of-network (non-contracted) providers at Usual, Customary, and Reasonable (“UCR”) rates when providers render emergency and non-emergency services to members belonging to a commercial health plan. The “Reimbursement of a Claim” for non-contracted providers is defined as: (a) The payment of the reasonable and customary value for the health care services rendered based upon statistically credible information that is updated at least annually and takes into consideration: (i) the provider's training, qualifications, and length of time in practice; (ii) the nature of the services provided; (iii) the fees usually charged by the provider; (iv) prevailing provider rates charged in the general geographic area in which the services were rendered; (v) other aspects of the economics of the medical provider's practice that are relevant; and (vi) any unusual circumstances in the case; [CCR 1300.71]. For this reason, L.A Care is seeking UCR rate data for reimbursement for out–of–network claims.
 
Interested Bidders Interested Bidders may submit a proposal (“Proposal”) containing the information requested in this RFP. L.A. Care will select one Bidder to be contracted at L.A. Care's discretion to perform the required services. The Bidder will provide services as set forth in Appendix A (Master Services Agreement) and Exhibit A-1 (Statement of Work) pursuant to a contract to be entered into with L.A. Care. L.A. Care is under no obligation to order any work pursuant to this RFP.
 

2. SOLICITATION, TERMS AND CONDITIONS

The following terms and conditions apply to the submission of proposals.

2.1 Letter of Intent and W-9

The Letter of Intent (“LOI”) and W-9 is required prior to submission of an RFP response. The LOI and W-9 must be submitted to L.A. Care Health Plan no later than 5:00 pm PST on Friday, March 7, 2019. Please submit the signed LOI and W-9 via e-mail to: 

Attention: Procurement Department
Email Address: RFP@lacare.org

 

Letters must contain the following:

  • Name of the vendor, address, and phone number
  • Name, address, phone and fax number, and e-mail address of the person responsible/contact for the RFP response
  • Brief description of the qualifications and experience of the vendor.
  • The LOI may be in the form of an email as well as an attached letter.
  • Attach a copy of your Company’s W-9. The W-9 must be signed within the last 12 months.
     

2.2 Proposal timetable. The timetable for this RFP is as follows:

Activity Date

Release of Request For Proposal

3/1/19

Letter of Intent (LOI), W-9, and Questions Due

3/7/19

Questions and Answers Released

3/22/19

RFP Proposals Due (No Exceptions)

4/5/19

Semi - Finalist Selections

4/16/19

Semi - Finalist Presentations 4/22/19 - 4/26/19

Vendor(s) Selected

5/10/19


Preparation and submission of a Proposal by interested Bidders will be at no cost or obligation to L.A. Care. L.A. Care reserves the right to terminate its efforts to contract for said services without obligation. Proposals and other materials submitted will become the property of L.A. Care and will not be returned. Your proposal must not be marked proprietary or confidential. Please note that L.A. Care is subject to the California Public Records Act.

2.3 Submission of proposals. Proposals shall be submitted to L.A. Care, as follows. 

An electronic copy shall be submitted to:


A complete version of the RFP is available as a PDF document under Resources.