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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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Medical Claims Review and Management
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Future Medical Cost Projection $2450 each
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Fixed Fee / Unit Rate
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| Major Deliverable: Future Medical Cost Projection $2450 each
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| Deliverable Price: $2,450.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: Completed report and acceptance by DRM. |
| Financial Consequences: The Contractor shall be liable to the Department for any damages due to the Contractor's failure to perform the services required by the Contract. Specifically, the Contractor shall be liable to and shall reimburse the Department for any and all fines, fees, penalties, litigation expenses, including attorney fees, assessments, and any and all charges resulting from the Contractor's failure to timely perform required services under this Contract. Without otherwise limiting the global intent of this paragraph, the Contractor agrees to pay all fees, charges, and assessments levied against it or the Department by a banking entity, hired pursuant to the "Checkwriting" services requested required by the Scope of Work in the ITN, for overdrafts, erroneous check drafting, or any other reason supplied by the banking entity. |
| Source Documentation Page Reference: Page 5 |
| Deliverable Number: |
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Medical Claims Review and Management
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Self-Administered Support Services. Criteria to be developed by DRM as needed. 1-year $700, 3-yea...
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Fixed Fee / Unit Rate
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| Major Deliverable: Self-Administered Support Services. Criteria to be developed by DRM as needed. 1-year $700, 3-year $1800, 5-year $2,500 |
| Deliverable Price: $0.00 |
| Non Price Justification: Price cannot be determined until the work has been completed |
| Performance Metrics: Completed self administered support services. |
| Financial Consequences: The Contractor shall be liable to the Department for any damages due to the Contractor's failure to perform the services required by the Contract. Specifically, the Contractor shall be liable to and shall reimburse the Department for any and all fines, fees, penalties, litigation expenses, including attorney fees, assessments, and any and all charges resulting from the Contractor's failure to timely perform required services under this Contract. Without otherwise limiting the global intent of this paragraph, the Contractor agrees to pay all fees, charges, and assessments levied against it or the Department by a banking entity, hired pursuant to the "Checkwriting" services requested required by the Scope of Work in the ITN, for overdrafts, erroneous check drafting, or any other reason supplied by the banking entity.
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| Source Documentation Page Reference: Page 5 |
| Deliverable Number: |
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Medical Claims Review and Management
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Custodial Medical Accounts. Criteria to be developed by DRM as needed. $750-$1750 per year
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Fixed Fee / Unit Rate
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| Major Deliverable: Custodial Medical Accounts. Criteria to be developed by DRM as needed. $750-$1750 per year
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| Deliverable Price: $0.00 |
| Non Price Justification: Price cannot be determined until the work has been completed |
| Performance Metrics: Completed custodial medical accounts and acceptance by DRM. |
| Financial Consequences: DRM's approval and inspection of the Contractor's services shall require no longer than five working days from date of delivery of services, and fifteen working days for delivery of documentary deliverables such as reports and procedures. The Department reserves the right to reject deliverables as incomplete, inadequate, or unacceptable due in whole or in part to the Contractor's lack of satisfactory performance under the terms of this contract. The Department, at its option, may allow additional time within which The Contractor may remedy the objections noted by the Department. In the event that an audit or the Department oversight reveals a failure to meet the minimum standards of the Scope of Service with regard to a previously accepted deliverable, the Department will be entitled to, and the Contractor shall pay to the Department, a credit for the amount paid for that deliverable.
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| Source Documentation Page Reference: Page 5 |
| Deliverable Number: |
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Medical Claims Review and Management
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"Contractor prepares Medicare Set Aside from DRM assigned Worker's Compensation claim, or Liability ...
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Fixed Fee / Unit Rate
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| Major Deliverable: "Contractor prepares Medicare Set Aside from DRM assigned Worker's Compensation claim, or Liability claim for submission to and approval by CMS. Task must be satisfactorily completed within the stated response time after request is made, and must be itemized in invoice
Year 1, $1,800 per claim, Year 2, $1750, Year 3, $1700, Year 4 thru 8 $1500.
" |
| Deliverable Price: $0.00 |
| Non Price Justification: Price cannot be determined until the work has been completed |
| Performance Metrics: Completed submission and approval by DRM. |
| Financial Consequences: The Contractor shall be liable to the Department for any damages due to the Contractor's failure to perform the services required by the Contract. Specifically, the Contractor shall be liable to and shall reimburse the Department for any and all fines, fees, penalties, litigation expenses, including attorney fees, assessments, and any and all charges resulting from the Contractor's failure to timely perform required services under this Contract. Without otherwise limiting the global intent of this paragraph, the Contractor agrees to pay all fees, charges, and assessments levied against it or the Department by a banking entity, hired pursuant to the "Checkwriting" services requested required by the Scope of Work in the ITN, for overdrafts, erroneous check drafting, or any other reason supplied by the banking entity. |
| Source Documentation Page Reference: Page 4 |
| Deliverable Number: |
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Medical Claims Review and Management
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MSAA Updates/Revisions over 6 months since original MSAA $500 per each
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Fixed Fee / Unit Rate
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| Major Deliverable: MSAA Updates/Revisions over 6 months since original MSAA $500 per each
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| Deliverable Price: $500.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: Completed MSAA updates/revisions. |
| Financial Consequences: The Contractor shall be liable to the Department for any damages due to the Contractor's failure to perform the services required by the Contract. Specifically, the Contractor shall be liable to and shall reimburse the Department for any and all fines, fees, penalties, litigation expenses, including attorney fees, assessments, and any and all charges resulting from the Contractor's failure to timely perform required services under this Contract. Without otherwise limiting the global intent of this paragraph, the Contractor agrees to pay all fees, charges, and assessments levied against it or the Department by a banking entity, hired pursuant to the "Checkwriting" services requested required by the Scope of Work in the ITN, for overdrafts, erroneous check drafting, or any other reason supplied by the banking entity. |
| Source Documentation Page Reference: Page 5 |
| Deliverable Number: |
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Medical Claims Review and Management
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Medicare Conditional Payment Services- Initial Verification $225 each
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Fixed Fee / Unit Rate
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| Major Deliverable: Medicare Conditional Payment Services- Initial Verification $225 each
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| Deliverable Price: $225.00 |
| Non Price Justification: Price cannot be determined until the work has been completed |
| Performance Metrics: Completed initial verification. |
| Financial Consequences: The Contractor shall be liable to the Department for any damages due to the Contractor's failure to perform the services required by the Contract. Specifically, the Contractor shall be liable to and shall reimburse the Department for any and all fines, fees, penalties, litigation expenses, including attorney fees, assessments, and any and all charges resulting from the Contractor's failure to timely perform required services under this Contract. Without otherwise limiting the global intent of this paragraph, the Contractor agrees to pay all fees, charges, and assessments levied against it or the Department by a banking entity, hired pursuant to the "Checkwriting" services requested required by the Scope of Work in the ITN, for overdrafts, erroneous check drafting, or any other reason supplied by the banking entity. |
| Source Documentation Page Reference: Page 5 |
| Deliverable Number: |
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Medical Claims Review and Management
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Medicare Conditional Payment Services- Hourly Negotiation Rate $100/hour
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Fixed Fee / Unit Rate
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| Major Deliverable: Medicare Conditional Payment Services- Hourly Negotiation Rate $100/hour |
| Deliverable Price: $100.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: Completed hour of negotation |
| Financial Consequences: The Contractor shall be liable to the Department for any damages due to the Contractor's failure to perform the services required by the Contract. Specifically, the Contractor shall be liable to and shall reimburse the Department for any and all fines, fees, penalties, litigation expenses, including attorney fees, assessments, and any and all charges resulting from the Contractor's failure to timely perform required services under this Contract. Without otherwise limiting the global intent of this paragraph, the Contractor agrees to pay all fees, charges, and assessments levied against it or the Department by a banking entity, hired pursuant to the "Checkwriting" services requested required by the Scope of Work in the ITN, for overdrafts, erroneous check drafting, or any other reason supplied by the banking entity.
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| Source Documentation Page Reference: Page 5 |
| Deliverable Number: |
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Medical Claims Review and Management
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Legal/Expert Services $225/hour, with a maximum of $1,200 per day. To be determined by specific ne...
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Fixed Fee / Unit Rate
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| Major Deliverable: Legal/Expert Services $225/hour, with a maximum of $1,200 per day. To be determined by specific need |
| Deliverable Price: $225.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: Completed hour of legal/expert services. |
| Financial Consequences: The Contractor shall be liable to the Department for any damages due to the Contractor's failure to perform the services required by the Contract. Specifically, the Contractor shall be liable to and shall reimburse the Department for any and all fines, fees, penalties, litigation expenses, including attorney fees, assessments, and any and all charges resulting from the Contractor's failure to timely perform required services under this Contract. Without otherwise limiting the global intent of this paragraph, the Contractor agrees to pay all fees, charges, and assessments levied against it or the Department by a banking entity, hired pursuant to the "Checkwriting" services requested required by the Scope of Work in the ITN, for overdrafts, erroneous check drafting, or any other reason supplied by the banking entity.
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| Source Documentation Page Reference: Page 5 |
| Deliverable Number: |
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