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Deliverable Number
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Commodity/Service Type
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Major Deliverable
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Method of Payment
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1
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MEDICAL SERVICES, ADMINISTRATION
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Telephonic Case Managers (TCMs)-The annual fee for case management services for claims assigned to t...
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Fixed Fee / Unit Rate
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| Major Deliverable: Telephonic Case Managers (TCMs)-The annual fee for case management services for claims assigned to this Contract shall be based upon the number of full-time (TCMs) provided.
Six (6) TCMs will be provided for the period Jan. 1, 2013 through Dec. 31, 2013 at an annual cost of $682,800. Invoiced monthly at the rate of $9,483.33 per TCM.
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| Deliverable Price: $9,483.33 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: Contractor will provide monthly reports by the 15th of each month for the previous month and whenever staffing levels change, showing the following data:
a) Name of TCM & verification of licensure as a registered nurse
b) E-mail address & telephone number of TCM
c) Hours worked by the TCM during the month
d) Date work began for the Department as a TCM
e) Number of active claims assigned for each TCM
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| Financial Consequences: The contractor is not allowed to hire replacement TCMs unless the Department had peformed a review of the reports received from the contractor by the 15th of each month. Each report identifies the number of TCMs on duty, the number of cases worked for the reported month and the number of hours worked by each TCM. Failure to continuously maintain the staffing levels in this section throughout the term of this Renewal shall result in a fee offset of $9,333 per full-time understaffed TCM for any month or portion thereof in which understaffing occurs. However, Contractor will be allowed ten (10) business days to replace TCMs when their departure is not previously known to the Contractor. |
| Source Documentation Page Reference: Ex. B para.1 |
| Deliverable Number: 1 |
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2
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MEDICAL SERVICES, ADMINISTRATION
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Additional Full Time Telephonic Case Managers (TCMs)-The Department will pay the Contractor an annua...
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Fixed Fee / Unit Rate
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| Major Deliverable: Additional Full Time Telephonic Case Managers (TCMs)-The Department will pay the Contractor an annual rate of $113,800. per full-time TCM assigned, with said payment being prorated on a monthly basis for the actual time worked by the TCM during the calendar year. Invoiced monthly at the rate of $9,483.33 per TCM. |
| Deliverable Price: $113,800.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: At the end of each calendar quarter, the Department will review internal reporting to determine the number of active claims assigned to the Contractor. At the end of the third calendar quarter, or whenever the Department assigns 275 or more claims to the Contractor within a calendar quarter, the Department will determine the average number of claims assigned to the Contractor for the previous three (3) quarters and upon written notice from the Department, the Contractor will receive instructions to add or reduce the number of full-time TCMs on duty to handle claims on the basis of one (1) full-time TCM per 275 active assigned claims. |
| Financial Consequences: Failure to continuously maintain the staffing levels in this section throughout the term of this Renewal shall result in a fee offset of $9,333 per full-time understaffed TCM for any month or portion thereof in which understaffing occurs. However, Contractor will be allowed ten (10) business days to replace TCMs when their departure is not previously known to the Contractor. |
| Source Documentation Page Reference: Ex.B para 2 & 3 |
| Deliverable Number: 2 |
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3
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MEDICAL SERVICES, ADMINISTRATION
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The flat rate for medical bill review services shall be $6.44 per bill reviewed. For the purposes o...
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Fixed Fee / Unit Rate
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| Major Deliverable: The flat rate for medical bill review services shall be $6.44 per bill reviewed. For the purposes of this medical bill review fee, one medical bill includes all dates of service and line items in a single submission by a medical provider on an individual employee regardless of the number of line items or pages submitted by the medical provider and Invoiced weekly. |
| Deliverable Price: $0.00 |
| Non Price Justification: Price cannot be determined until the work has been completed |
| Performance Metrics: Upon written request from the Contractor, an annual inflationary price increase will be awarded to the medical bill review fee and check writing fee based on the annual change to the Consumer Price Index (CPI). At the conclusion of year four (4) of this Contract, and years one (1) and two (2) of this Renewal, Contractor may apply to the Department for an inflationary price increase for the subsequent year. This increase will be based on the CPI for Medical Care Services, All Urban Consumers, Southern Region, 1982-84=100, as published by the U.S. Department of Labor in its latest report preceding the end of the Contract or Renewal year. This increase shall be retroactive to the beginning of the new year. Price increase calculations shall be rounded to two (2) decimal places. |
| Financial Consequences: Contractor agrees to pay liquidated damages, which the parties agree are necessary to secure a subsequent provider. Contract shall continue to provide services under the contract for ninety (90) days from termination or until the subsequsnt provider is fully operational, whichever first occurs. |
| Source Documentation Page Reference: Ex. B para. 4 and page 8 para. H |
| Deliverable Number: 3 |
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4
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MEDICAL SERVICES, ADMINISTRATION
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The flat rate for check writing services is $4.89 per check issued. For the purposes of this check ...
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Fixed Fee / Unit Rate
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| Major Deliverable: The flat rate for check writing services is $4.89 per check issued. For the purposes of this check writing fee, all payments made to a single provider in the check writing cycle will be consolidated onto a single check or electronic payment (Automated Clearing House/ACH transaction). Payment will be made only for checks or electronic payments that are issued to the provider and invoices weekly. |
| Deliverable Price: $0.00 |
| Non Price Justification: Price cannot be determined until the work has been completed |
| Performance Metrics: Upon written request from the Contractor, an annual inflationary price increase will be awarded to the medical bill review fee and check writing fee based on the annual change to the Consumer Price Index (CPI). At the conclusion of year four (4) of this Contract, and years one (1) and two (2) of this Renewal, Contractor may apply to the Department for an inflationary price increase for the subsequent year. This increase will be based on the CPI for Medical Care Services, All Urban Consumers, Southern Region, 1982-84=100, as published by the U.S. Department of Labor in its latest report preceding the end of the Contract or Renewal year. This increase shall be retroactive to the beginning of the new year. Price increase calculations shall be rounded to two (2) decimal places. |
| Financial Consequences: Contractor agrees to pay liquidated damages, which the parties agree are necessary to secure a subsequent provider. Contract shall continue to provide services under the contract for ninety (90) days from termination or until the subsequsnt provider is fully operational, whichever first occurs. |
| Source Documentation Page Reference: Ex. B para. 5 and agr. Page 8 para. H |
| Deliverable Number: 4 |
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5
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MEDICAL SERVICES, ADMINISTRATION
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Reimbursement to CorVel for network of CorCare Preferred Provider Network, which consist of CorVel's...
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Fixed Fee / Unit Rate
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| Major Deliverable: Reimbursement to CorVel for network of CorCare Preferred Provider Network, which consist of CorVel's network of contracted hospitals, physician and other health care providers for delivery of Covered Medical Services. Reimbursement will be limited to the Florida Workers' Compensation Health Care Provider Reimbursement Manual or the network contracted rate. Invoices are submitted on a weekly basis. |
| Deliverable Price: $0.00 |
| Non Price Justification: Price cannot be determined until the work has been completed |
| Performance Metrics: On a weekly basis, the contractor shall submit electronic payment records to the Division so that payment records may be posted to the appropriate claim file within the Divisions claims adminstration system. Prior to submitting payment records the contractor reviews bill services invoices to ensure bills priced per fee schedule/unit rate and submits an annual SSAE-16 reports. To facilitate review of invoices submitted by the medical services providers within the contractors network of service providers, the contractor will be required to receive an electronic transmission of claims information from the Division on a daily basis. Details of the specific claim data elements to be transmitted to the contractor will be determined by consultation with the contractor to ascertain the necessary claim data elements required by the contractor to conduct mandated invoice review. The Division verifies the provider payment files to reimbursement invoices. Also quarterly payment audits are conducted. |
| Financial Consequences: Upon reimbursement invoice and electronic file review, In no event shall the contractor be reimbursed by the Division for any amount in excess of the amount paid to the network service providers for covered services. |
| Source Documentation Page Reference: Agreement pg 4. c2 & pg 12. |
| Deliverable Number: 5 |
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