APPENDIX 6 INCORPORATED ATTACHMENTS Attachment 1 - RFP Checklist Attachment 2 Draft Contract (to be provided by Amendment to the RFP) – Attachment 3 PEBB Members by County, by Plan – Attachment 4 UMP Classic 2017 Certificate of Coverage – Attachment 5 - UMP CDHP 2017 Certificate of Coverage Attachment 6 - UMP Plus Puget Sound High Value Network 2017 Certificate of Coverage Attachment 7 - UMP Plus UW Medicine 2017 Certificate of Coverage Attachment 8 UMP Operations Manual – Attachment 9 HCA Value-based Roadmap – Attachment 10 PEBB Performance Quality Measures – Attachment 11 Example Work Order – Attachment 12 Data Exchanges – Attachment 13 Health Benefits K-12 Reporting – Attachment 14 Document Employee Benefits Report –K-12 Attachment 15 ACN Operations Manual – Attachment 16 - ACN - Network Consent for Non-Network and Out of Network Services Attachment 17 ACN - Sample UMP Plus Business Rules – Attachment 18 - ACN Adding ACN Affiliate or ACN Partner Providers – Attachment 19 - ACN Adding TIN Provider to Partner or Affiliate – Attachment 20 - ACN Provider Data End to End Process – Attachment 21 - ACN HCA Review Monthly Provider – Attachment 22 - ACN Remove ACN Affiliate or ACN Partner Provider – Attachment 23 - ACN Monthly Provider Change Roster – Attachment 24 - Paying for Value Survey Attachment 25 Completion Dates for Quarterly Eligibility Reconciliation – Attachment 26 Common Measure Set – Attachment 27 Administrative Fees – Attachment 28 Proposal Scoring and Weights – Attachment 29 WA Provider Network Analysis – Attachment 30 Repricing of Claims Summary –
APPENDIX 6 INCORPORATED ATTACHMENTS Attachment 1 - RFP Checklist Attachment 2 – Draft Contract (to be provided by Amendment to the RFP) Attachment 3 – PEBB Members by County, by Plan Attachment 4 – UMP Classic 2017 Certificate of Coverage Attachment 5 - UMP CDHP 2017 Certificate of Coverage Attachment 6 - UMP Plus Puget Sound High Value Network 2017 Certificate of Coverage Attachment 7 - UMP Plus UW Medicine 2017 Certificate of Coverage Attachment 8 – UMP Operations Manual Attachment 9 – HCA Value-based Roadmap Attachment 10 – PEBB Performance Quality Measures Attachment 11 – Example Work Order Attachment 12 – Data Exchanges Attachment 13 – Health Benefits K-12 Reporting Attachment 14 –K-12 Document Employee Benefits Report Attachment 15 – ACN Operations Manual Attachment 16 - ACN - Network Consent for Non-Network and Out of Network Services Attachment 17 – ACN - Sample UMP Plus Business Rules Attachment 18 - ACN – Adding ACN Affiliate or ACN Partner Providers Attachment 19 - ACN – Adding TIN Provider to Partner or Affiliate Attachment 20 - ACN – Provider Data End to End Process Attachment 21 - ACN – HCA Review Monthly Provider Attachment 22 - ACN – Remove ACN Affiliate or ACN Partner Provider Attachment 23 - ACN – Monthly Provider Change Roster Attachment 24 - Paying for Value Survey Attachment 25 – Completion Dates for Quarterly Eligibility Reconciliation Attachment 26 – Common Measure Set Attachment 27 – Administrative Fees Attachment 28 – Proposal Scoring and Weights Attachment 29 – WA Provider Network Analysis Attachment 30 – Repricing of Claims Summary