Q and a - Online Real Time Claims Processing

Questions and AnswersOn Line Real Time Tender – RAF/2012/000071. Question “The Database preferred in RAF Environment is ORACLE but MSSQL”Answer“The Database(s) preferred in RAF Environment are ORACLE and MSSQL”2. Question Please confirm that the solution you are looking for is a complete solution including the initial claim from the individual AND the subsequent claims from providers against the Undertaking Certificate. Answer The RAF is not seeking proposals for a complete processing solution rather a solution to enhance its current capability3. Question On the RAF website, there is a brief outline of the Claims Procedure (http://www.raf.co.za/Claims/Pages/ClaimsProcedure.aspx). May we assume that this is the process that the system has to automate? Answer The RAF is not seeking proposals for a complete processing solution rather a solution to enhance its current capability. Please refer to the process outlined in the presentation. 4. Question 3.2 e Verification – With respect to banking details verifications. It was mentioned that the RAF does these checks manually. Would the RAF like to automate this with the banks.Answer No5. Question 3.2 e Verification – With respect to an individual’s id validity and status. It was mentioned that the RAF does these checks manually. Would the RAF like to automate this with the Department of Home Affairs. Answer No1 | P a g e 6. Question Branch – Does the tender included providing entry points to the claims system from all the Regional Office, all Satellite Offices and all Hospital Offices and if so are these numbers correct (5 Regional Offices, 9 Satellite Offices and 62 Hospital Offices) Answer The system must integrate with out claims system, being Fineos or Old Claims. We are running a cloud computing setup that does not need physical connection to any location. If you are on the internet, then you can connect...7. Question Do all these Offices have fixed line internet access? Answer Our internet breakout is in Vodacom data centre. Everyone is running on a Virtual Private Network, being Leased line, Satellite or Access Point Network (3G) that enable connection to the data centre. 8. Question Is there a requirement for some of these Offices to be mobile? (Peter)Answer Based on our Architecture, we can establish offices with no or minimal infrastructure setup.9. Question Does the RAF have fully documents process flows of their current claims processes that will be shared with the eventual solution provider or would it be expected that the chosen provider produce a full Business Process Requirement Specification.Answer Yes same will be provided to the successful bidder10. Question 3.2 b - How many current documents are there in the claims process. Answer Documents vary based on the complexities of the claim and that basics are set out in Annexure A.2 | P a g e 11.Question Are the claims forms available on the RAF website at http://www.raf.co.za/Claims/Pages/DownloadableClaimForms.aspx to be used in the proposed solution?Answer No12.Question Does Fineos provide XML services that can be access via an API. If not, what is the interface that is exposed via the Fineos?Answer Yes, still they need to be developed or configured to your requirements. The database is also open; therefore some integration can be entertained through Open Database connections.13.Question Would the RAF allow automated submissions of claims based on various prior validations and business rule checking to replace the data capture in 3.2 d Intake or would they still require a human authorisation to accept the claim being loaded. Answer Yes, but there are statutory requirements that still need to be ironed out. if the capability is available, we will definitely welcome it even though might not be enabled on Go Live day.14.Question Should the allocation of merits be done inside the claims submission system or is it done from inside Fineos. How much of the business processes functionality, that needs to be automated already located within the Fineos system? Or does the Solution have to implement all of these? i.e. Is Fineos only a “Repository” for claims, or does it already have functionality that can be leveraged? Answer It is done in Fineos3 | P a g e 15.Question 3.2 j Payment control. What format is expected by SAP for the notification to be sent confirming a payment instruction that has been authorised in the claims process? What Enterprise Service Bus is available and what format should the instruction be sent in. Answer Integration between SAP and Fineos is active. The System would be required to feed Fineos which will in turn feed SAP. This control will be preferred as it will point to a claim as a reference object.16.Question How many individuals at the RAF are involved in the claims process. In addition, what are the various Roles and responsibilities of these people? Can they be categorised into specific groups? Answer Not relevant17.Question How many Supervisors, that approve payments, are there?Answer Not Relevant18.Question Confirmation from the tender briefing that all links to the data providers such as BHF, HPCSA, Department of Home Affairs (if required), Banks will be provided by the RAF and do not have to be costed into the proposal. Answer It was confirmed at Briefing.19.Question Confirmation from the tender briefing that all Hardware and Operating Software and Data Base Software licensing and costs will be for the RAF.Answer Yes4 | P a g e 20.Question 3.3 point “Should be capable of collecting medical data from medical service providers to the RAF”…in the case where a service provider charges for data to be sent from the medical doctor to a claims processing environment such as a medical aid company or the RAF….can it be assumed that the RAF will carry this cost or should the cost be built into the solution proposed. Answer The system must have the capability for the function. Commercial interactions will be subject of agreement with the successful bidder.21.Question 4.0 Payment response messaging – What is meant by this. Is it a response that the payment has been authorised such as an email or an SMS or does this have some other meaning. Answer This has to do with co-payment issue and how much will be due to Service Provider. Co- payment from RAF side will be mainly caused by merits percentage whereby if the claimant was found to be 50% at fault thus the copayment will be 50% of the total cost and what should be recovered from RAF is the balance.22.Question If it is email and/or SMS can it be assumed that the cost of sending will be picked up by the RAF or should this be added as an ongoing operating cost.Answer Refer to above i.e. 2123.Question What versions of Oracle and Microsoft SQL does the RAF support. Answer Oracle 10g and we are in the process of upgrading to 11. MS SQL ranges from 2003 to 2008.24.Question What versions of UNIX, AIX and Windows does the RAF support?Answer HP Unix 11.5, IBM AIX 5 and windows 2003 and windows 2008 (Enterprise Agreement) 5 | P a g e 25.Question What email system does the RAF use?AnswerExchange Server26.Question Does the RAF have an Enterprise Service Bus?AnswerNo27.Question Is it possible to obtain a high level overview of the RAF internal architecture?AnswerYes, this will be possible during contracting. 28.Question What is the desktop configuration of the RAF desktop PCs? Answer No desktop, we use thin-client machine to access Citrix Zen Apps though Citrix Client software installed on terminals.29.Question Does the RAF have mobile staff that would need to interact with the system and if so what platforms and what communication methods do they use?Answer Yes, as depicted above.30.Question What data storage devices SANs/etc does the RAF use?Answer HP EVA 80006 | P a g e 31.Question Does the RAF have a standard SLA agreement that they use or will the RAF and the chosen provider decide on a SLA at time of contract negotiation.Answer Negotiate SLAs32.Question Can the RAF set a standard Exchange Rate that all providers use for comparative analysis, should there be a need for any international software to run the suggested solution? Answer Check page 55. Annexure F: pricing schedule no. 6 for the exchange rates33.Question What Adobe software is the RAF licensed for currentlyAnswer Adobe Acrobat 8.34.Question What is the duration of the contract? Answer Once-off installation, 3 years on maintenance and support35.Question Site visits?Answer Visit will be done where the system was installed.36.Question What is the timeline for running the tender?Answer 90 days, but wish to conclude before the expiry of that period. Should the 90 days expire extension of the validity period will be requested from all responded bidders.7 | P a g e 37.Question Will the system be hosted in house or remote?Answer The system should be run in the RAF environment.38.Question Guarantees?Answer Legal clauses will be put in place (PAIA/confidentiality clauses) will also depend on the system configuration.39.Question Provision of two pricing options?Answer Hardware and software should be provided by Service provider, the RAF will provide the operating system.40.Question What about data storageAnswer The service provider should advice the RAF the data capacity storage of the proposed system41.Question How long after the tender is awarded, do RAF expect implementation.Answer Immediately after contract is signed with the awarded service provider.42.Question Does RAF have a data warehouse?Answer The tender is in process at an advanced stage of awarding.8 | P a g e 43.Question Are there expectations to link with Fineos?Answer Yes Definitely.9 | P a g e

Q and a - Online Real Time Claims Processing

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