Identify Markets

Be Aware of Your Company's Growing Needs

We also evaluate vendors for other performance objectives and incorporate these objectives into the service agreement.

Activity Suggested Objective
Delivery of renewal information Employee satisfaction
Claim Turnaround time 90% in 10 calendar days
Claim processing standards Financial accuracy*: 99%
Payment accuracy*: 99%
Coding accuracy*: 97%
Internal audits Quarterly reports
External audits As needed
Updated eligibility information Within 5 work days of receipt
Updated network provider file Within 10 work days of receipt
Availability of general services representitive As needed
Delivery of management reports Standard reports: within 1 week of request
Custom reports: within 2 weeks of initial request or as agreed upon
Personnel changes Notification before changes
Telephone responsiveness Call abandonment rate: <5%
Employee satisfaction Survey results (to be determined)


Financial accuracy: Total amount of claims dollars paid correctly, divided by the total claims dollars paid.

Payment accuracy: Total amount of checks issued for the correct dollar amount divided by the total number of checks issued.

Coding accuracy: Total number of claims processed without a coding error (i.e. any inaccurate entry of information that does not result in a payment error), divided by the total number of claims processed.

Additional meetings will be required to understand all of your employee benefits objectives. Implementation of the complete marketing action plan described in the Marketing Action Plan will then commence.

Step 1
• Request claims by location from current vendors 
• Analyze claims data to identify utilization trends 
• Prepare and present utilization data report with plan design recommendations 
• Model plan design changes to provide cost differentials (if applicable) 
• Prepare summary of current employee provider usage 
• Prepare network evaluation based on utilization data and available networks 

Step 2
While completing the activities described in Step 1, above, The Capitol Group will perform a complete market study to determine the best possible insurance and/or administrator vendors. The market study will entail the following activities.

Planning Phase/Meeting
• Identify/introduce team members 
• Establish communication channels 
• Determine client's satisfaction with current service 
• Determine client's expectations for future service 
• Determine client's specific objectives for an insurer or administrator 
• Determine project scope 
• Discuss timeframe 
• Review fixed costs 
• Review current carrier financial information (experience and rate guarantee) 
• Determine stop-loss insurance to include 
• Identify information needed 

Information Gathering

    • Determine missing information 
    • Request missing information 
    • Acquire historical claims data 
    • Acquire and review summary plan descriptions 
    • Acquire and review plan document(s) and amendments 
    • Acquire and review rate, benefit, and financial histories

Develop Specificatioons
    • Inventory current services provided 
    • Review contractual obligations of current vendors 
    • Finalize list of desired vendor services 
    • Determine other bidding requirements 
    • Review and prioritize bid specifications 
    • Meet to confirm specifications 
    • Decide upon scoring/evaluation system 
    • Vendor solicitation 
    • Identify suitable vendors 
    • Copy and mail specifications 
    • Answer vendor questions and provide additional information 
    • Receive proposals 

Vendor Selection
    • Conduct preliminary review of proposals 
    • Request clarification of missing information 
    • Conduct reference checks 
    • Evaluate and score proposals 
    • Develop a report and recommendations for finalists 
    • Conduct on-site review of finalists 
    • Review contracts with finalists 
    • Negotiate contractual provisions 
    • Select successful bidders 

Communicate with Client
    • Review prior communication media and current goals 
    • Develop theme and construct plan 
    • Decide on method and media 
    • Draft text 
    • Modify and approve communications with management 
    • Involve successful vendors 
    • Finalize text and design of communication materials 
    • Print communication materials 
    • Distribute communication materials 

Step 3
    • Implementation of selected vendors, PPO networks, and HMOs 
    • Create implementation blueprint identifying each specific task, responsible party, and target completion date 
    • Monitor each step of blueprint throughout implementation process 

Step 4
After the initial plan is complete, we propose developing a three-to five-year strategic plan. This plan will identify and prioritize additional long-term objectives. It will also establish specific deadlines for meeting those objectives, and will allow for ongoing modification as the need arises.