| More |
Deliverable Number
|
Commodity/Service Type
|
Major Deliverable
|
Method of Payment
|
|
|
|
Medical office services
|
Deliverable #46: Extension (9/10/23 - 3/9/24) Peer Specialty Record Reviews - First Level Review $10...
|
Fixed Fee / Unit Rate
|
| Major Deliverable: Deliverable #46: Extension (9/10/23 - 3/9/24) Peer Specialty Record Reviews - First Level Review $105 per review |
| Deliverable Price: $5,040.00 |
| Non Price Justification: |
| Performance Metrics: Adherence to contract requirements
|
| Financial Consequences: Corrective Action Plan |
| Source Documentation Page Reference: Page 34 and 44 |
| Deliverable Number: |
|
|
|
|
Medical office services
|
Deliverable #45: Extension (9/10/23 - 3/9/24) Precertified Hospital Admissions and Concurrent Hospit...
|
Fixed Fee / Unit Rate
|
| Major Deliverable: Deliverable #45: Extension (9/10/23 - 3/9/24) Precertified Hospital Admissions and Concurrent Hospital Admissions Reviews - First Level Review $110.00 per certification Second Level Review - $225.00 per review |
| Deliverable Price: $107,100.00 |
| Non Price Justification: |
| Performance Metrics: Evaluate hospital admissions and make pre-cert determination within 3 Business Days of the request for admission or treatment Timely report submission
|
| Financial Consequences: $100 for each Business Day beyond the due date Report submission: $50 for each Business Day beyond the due date
|
| Source Documentation Page Reference: Page 23, 24 and 43 |
| Deliverable Number: |
|
|
|
|
Medical office services
|
Deliverable #44: Extension (9/10/23 - 3/9/24) Additional Bill Review Line item fee (included in Bill...
|
Fixed Fee / Unit Rate
|
| Major Deliverable: Deliverable #44: Extension (9/10/23 - 3/9/24) Additional Bill Review Line item fee (included in Bill Review Re-pricing and Utilization fee above) |
| Deliverable Price: $0.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: Timely report submission
|
| Financial Consequences: $50.00 for each Business Day beyond the due date
|
| Source Documentation Page Reference: Page 20 and 42 |
| Deliverable Number: |
|
|
|
|
Medical office services
|
Deliverable #43: Extension (9/10/23 - 3/9/24) Bill Review Re-pricing and Utilization Fee - $9.00 eac...
|
Fixed Fee / Unit Rate
|
| Major Deliverable: Deliverable #43: Extension (9/10/23 - 3/9/24) Bill Review Re-pricing and Utilization Fee - $9.00 each
|
| Deliverable Price: $10,950,000.00 |
| Non Price Justification: |
| Performance Metrics: Monthly average turn-around time of eight (8) Business Days or less to review/re-price medical bills assigned by the Department.
|
| Financial Consequences: $100 for each Business Day exceeding the maximum eight (8) Business Days
|
| Source Documentation Page Reference: Page 19 and 42 |
| Deliverable Number: |
|
|
|
|
Medical office services
|
Deliverable #42: Contract Year Ten (9/10/22 - 9/9/23) Peer Specialty Record Reviews - First Level R...
|
Fixed Fee / Unit Rate
|
| Major Deliverable: Deliverable #42: Contract Year Ten (9/10/22 - 9/9/23) Peer Specialty Record Reviews - First Level Review $105 per review
|
| Deliverable Price: $5,040.00 |
| Non Price Justification: |
| Performance Metrics: Adherence to contract requirements
|
| Financial Consequences: Corrective Action Plan
|
| Source Documentation Page Reference: Page 34 and 44 |
| Deliverable Number: |
|
|
|
|
Medical office services
|
Deliverable #41: Contract Year Ten (9/10/22 - 9/9/23) Pre-certified Hospital Admissions and ...
|
Fixed Fee / Unit Rate
|
| Major Deliverable: Deliverable #41: Contract Year Ten (9/10/22 - 9/9/23) Pre-certified Hospital Admissions and conncurrent Hospital Admissions Reviews - First Level Review $110.00 per certification Second Level Review - $225.00 per review
|
| Deliverable Price: $107,100.00 |
| Non Price Justification: |
| Performance Metrics: Evaluate hospital admissions and make pre-cert determination within 3 Business Days of the request for admission or treatment Timely report submission
|
| Financial Consequences: $100 for each Business Day beyond the due date Report submission: $50 for each Business Day beyond the due date
|
| Source Documentation Page Reference: Page 23, 24 and 43 |
| Deliverable Number: |
|
|
|
|
Medical office services
|
Deliverable #40: Contract Year Ten (9/10/22 - 9/9/23) Additional Bill Review Line item fee (include...
|
Fixed Fee / Unit Rate
|
| Major Deliverable: Deliverable #40: Contract Year Ten (9/10/22 - 9/9/23) Additional Bill Review Line item fee (included in Bill Review Re-pricing and Utilization fee above)
|
| Deliverable Price: $0.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: Timely report submission
|
| Financial Consequences: $50.00 for each Business Day beyond the due date
|
| Source Documentation Page Reference: Page 20 and 42 |
| Deliverable Number: |
|
|
|
|
Medical office services
|
Deliverable #39: Contract Year Ten (9/10/22 - 9/9/23) Bill Review Re-pricing and Utilization Fee - ...
|
Fixed Fee / Unit Rate
|
| Major Deliverable: Deliverable #39: Contract Year Ten (9/10/22 - 9/9/23) Bill Review Re-pricing and Utilization Fee - $9.00 each
|
| Deliverable Price: $1,095,000.00 |
| Non Price Justification: |
| Performance Metrics: Monthly average turn-around time of eight (8) Business Days or less to review/re-price medical bills assigned by the Department.
|
| Financial Consequences: $100 for each Business Day exceeding the maximum eight (8) Business Days
|
| Source Documentation Page Reference: Page 19 and 42 |
| Deliverable Number: |
|
|
|
|
Medical office services
|
Deliverable #38: Contract Year Nine (9/10/21 - 9/9/22) Peer Specialty Record Reviews - First Level ...
|
Fixed Fee / Unit Rate
|
| Major Deliverable: Deliverable #38: Contract Year Nine (9/10/21 - 9/9/22) Peer Specialty Record Reviews - First Level Review $105 per review
|
| Deliverable Price: $5,040.00 |
| Non Price Justification: |
| Performance Metrics: Adherence to contract requirements
|
| Financial Consequences: Corrective Action Plan
|
| Source Documentation Page Reference: Page 34 and 44 |
| Deliverable Number: |
|
|
|
|
Medical office services
|
Deliverable #37: Contract Year Nine (9/10/21 - 9/9/22) Pre-certified Hospital Admissions and Concur...
|
Fixed Fee / Unit Rate
|
| Major Deliverable: Deliverable #37: Contract Year Nine (9/10/21 - 9/9/22) Pre-certified Hospital Admissions and Concurrent Hospital Admissions Reviews - First Level Review $110.00 per certification Second Level Review - $225.00 per review
|
| Deliverable Price: $107,100.00 |
| Non Price Justification: |
| Performance Metrics: Evaluate hospital admissions and make pre-cert determination within 3 Business Days of the request for admission or treatment Timely report submission
|
| Financial Consequences: $100 for each Business Day beyond the due date Report submission: $50 for each Business Day beyond the due date
|
| Source Documentation Page Reference: Page 23, 24 and 43 |
| Deliverable Number: |
|
|
|
|
Medical office services
|
Deliverable #36: Contract Year Nine (9/10/21 - 9/9/22) Additional Bill Review Line item fee (includ...
|
Fixed Fee / Unit Rate
|
| Major Deliverable: Deliverable #36: Contract Year Nine (9/10/21 - 9/9/22) Additional Bill Review Line item fee (included in Bill Review Re-pricing and Utilization fee above)
|
| Deliverable Price: $0.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: Timely report submission
|
| Financial Consequences: $50.00 for each Business Day beyond the due date
|
| Source Documentation Page Reference: Page 20 and 42 |
| Deliverable Number: |
|
|
|
|
Medical office services
|
Deliverable #35: Contract Year Nine (9/10/21 - 9/9/22) Bill Review Re-pricing and Utilization Fee -...
|
Fixed Fee / Unit Rate
|
| Major Deliverable: Deliverable #35: Contract Year Nine (9/10/21 - 9/9/22) Bill Review Re-pricing and Utilization Fee - $8.83 each
|
| Deliverable Price: $1,095,000.00 |
| Non Price Justification: |
| Performance Metrics: Monthly average turn-around time of eight (8) Business Days or less to review/re-price medical bills assigned by the Department.
|
| Financial Consequences: $100 for each Business Day exceeding the maximum eight (8) Business Days
|
| Source Documentation Page Reference: Page 19 and 42 |
| Deliverable Number: |
|
|
|
|
Medical office services
|
Deliverable #34: Contract Year Eight (9/10/20 - 9/9/21) Peer Specialty Record Reviews - First Leve...
|
Fixed Fee / Unit Rate
|
| Major Deliverable: Deliverable #34: Contract Year Eight (9/10/20 - 9/9/21) Peer Specialty Record Reviews - First Level Review $105 per review
|
| Deliverable Price: $5,040.00 |
| Non Price Justification: |
| Performance Metrics: Adherence to contract requirements
|
| Financial Consequences: Corrective Action Plan
|
| Source Documentation Page Reference: Page 34 and 44 |
| Deliverable Number: |
|
|
|
|
Medical office services
|
Deliverable #33: Contract Year Eight (9/10/20 - 9/9/21) Precertified Hospital Admissions and Concu...
|
Fixed Fee / Unit Rate
|
| Major Deliverable: Deliverable #33: Contract Year Eight (9/10/20 - 9/9/21) Precertified Hospital Admissions and Concurrent Hospital Admissions Reviews - First Level Review $110.00m Second Level Review - $225.00
|
| Deliverable Price: $107,100.00 |
| Non Price Justification: |
| Performance Metrics: Evaluate hospital admissions and make pre-cert determination within 3 Business Days of the request for admission or treatment Timely report submission
|
| Financial Consequences: $100 for each Business Day beyond the due date Report submission: $50 for each Business Day beyond the due date
|
| Source Documentation Page Reference: Page 23, 24 and 43 |
| Deliverable Number: |
|
|
|
|
Medical office services
|
Deliverable #32: Contract Year Eight (9/10/20 - 9/9/21) Additional Bill Review Line item fee (incl...
|
Fixed Fee / Unit Rate
|
| Major Deliverable: Deliverable #32: Contract Year Eight (9/10/20 - 9/9/21) Additional Bill Review Line item fee (included in Bill Review Re-pricing and Utilization fee above)
|
| Deliverable Price: $0.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: Timely report submission
|
| Financial Consequences: $50.00 for each Business Day beyond the due date
|
| Source Documentation Page Reference: Page 20 and 42 |
| Deliverable Number: |
|
|
|
|
Medical office services
|
Deliverable #31: Contract Year Eight (9/10/20 - 9/9/21) Bill Review Re-pricing and Utilization Fee...
|
Fixed Fee / Unit Rate
|
| Major Deliverable: Deliverable #31: Contract Year Eight (9/10/20 - 9/9/21) Bill Review Re-pricing and Utilization Fee - $8.83 each
|
| Deliverable Price: $1,095,000.00 |
| Non Price Justification: |
| Performance Metrics: Monthly average turn-around time of eight (8) Business Days or less to review/re-price medical bills assigned by the Department.
|
| Financial Consequences: $100 for each Business Day exceeding the maximum eight (8) Business Days
|
| Source Documentation Page Reference: Page 19 and 42 |
| Deliverable Number: |
|
|
|
|
Medical office services
|
Deliverable #30: Contract Year Seven (9/10/19 - 9/9/20) Peer Specialty Record Reviews - First Leve...
|
Fixed Fee / Unit Rate
|
| Major Deliverable: Deliverable #30: Contract Year Seven (9/10/19 - 9/9/20) Peer Specialty Record Reviews - First Level Review $105 per review
|
| Deliverable Price: $5,040.00 |
| Non Price Justification: |
| Performance Metrics: Adherence to contract requirements
|
| Financial Consequences: Corrective Action Plan
|
| Source Documentation Page Reference: Page 34 and 44 |
| Deliverable Number: |
|
|
|
|
Medical office services
|
Deliverable #29: Contract Year Seven (9/10/19 - 9/9/20) Pre-certified Hospital Admissions and Conc...
|
Fixed Fee / Unit Rate
|
| Major Deliverable: Deliverable #29: Contract Year Seven (9/10/19 - 9/9/20) Pre-certified Hospital Admissions and Concurrent Hospital Admissions Reviews - First Level Review $110.00m Second Level Review - $225.00
|
| Deliverable Price: $107,100.00 |
| Non Price Justification: |
| Performance Metrics: Evaluate hospital admissions and make pre-cert determination within 3 Business Days of the request for admission or treatment Timely report submission
|
| Financial Consequences: $100 for each Business Day beyond the due date Report submission: $50 for each Business Day beyond the due date
|
| Source Documentation Page Reference: Page 23, 24 and 43 |
| Deliverable Number: |
|
|
|
|
Medical office services
|
Deliverable #28: Contract Year Seven (9/10/19 - 9/9/20) Additional Bill Review Line item fee (incl...
|
Fixed Fee / Unit Rate
|
| Major Deliverable: Deliverable #28: Contract Year Seven (9/10/19 - 9/9/20) Additional Bill Review Line item fee (included in Bill Review Re-pricing and Utilization fee above)
|
| Deliverable Price: $0.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: Timely report submission
|
| Financial Consequences: $50.00 for each Business Day beyond the due date
|
| Source Documentation Page Reference: Page 20 and 42 |
| Deliverable Number: |
|
|
|
|
Medical office services
|
Deliverable #27: Contract Year Seven (9/10/19 - 9/9/20) Bill Review Re-pricing and Utilization Fee...
|
Fixed Fee / Unit Rate
|
| Major Deliverable: Deliverable #27: Contract Year Seven (9/10/19 - 9/9/20) Bill Review Re-pricing and Utilization Fee - $8.83 each
|
| Deliverable Price: $1,080,000.00 |
| Non Price Justification: |
| Performance Metrics: Monthly average turn-around time of eight (8) Business Days or less to review/re-price medical bills assigned by the Department.
|
| Financial Consequences: $100 for each Business Day exceeding the maximum eight (8) Business Days
|
| Source Documentation Page Reference: Page 19 and 42 |
| Deliverable Number: |
|
|
|
|
Medical office services
|
Deliverable #26: Contract Year Six (9/10/18 - 9/9/19) PPO Services and Pricing
|
Fixed Fee / Unit Rate
|
| Major Deliverable: Deliverable #26: Contract Year Six (9/10/18 - 9/9/19) PPO Services and Pricing
|
| Deliverable Price: $625,000.00 |
| Non Price Justification: |
| Performance Metrics: Apply provider network discounts.
|
| Financial Consequences: Corrective Action Plan.
|
| Source Documentation Page Reference: Page 20 |
| Deliverable Number: |
|
|
|
|
Medical office services
|
Deliverable #25: Contract Year Six (9/10/18 - 9/9/19) Peer Specialty Record Reviews - First Level ...
|
Fixed Fee / Unit Rate
|
| Major Deliverable: Deliverable #25: Contract Year Six (9/10/18 - 9/9/19) Peer Specialty Record Reviews - First Level Review $105 per review
|
| Deliverable Price: $5,040.00 |
| Non Price Justification: |
| Performance Metrics: Adherence to contract requirements
|
| Financial Consequences: Corrective Action Plan
|
| Source Documentation Page Reference: Page 34 and 44 |
| Deliverable Number: |
|
|
|
|
Medical office services
|
Deliverable #24: Contract Year Six (9/10/18 - 9/9/19) Precertified Hospital Admissions and Concurr...
|
Fixed Fee / Unit Rate
|
| Major Deliverable: Deliverable #24: Contract Year Six (9/10/18 - 9/9/19) Precertified Hospital Admissions and Concurrent Hospital Admissions Reviews - First Level Review $110.00m Second Level Review - $225.00
|
| Deliverable Price: $107,100.00 |
| Non Price Justification: |
| Performance Metrics: Evaluate hospital admissions and make pre-cert determination within 3 Business Days of the request for admission or treatment Timely report submission
|
| Financial Consequences: $100 for each Business Day beyond the due date Report submission: $50 for each Business Day beyond the due date
|
| Source Documentation Page Reference: Page 23, 24 and 43 |
| Deliverable Number: |
|
|
|
|
Medical office services
|
Deliverable #23: Contract Year Six (9/10/18 - 9/9/19) Additional Bill Review Line item fee (includ...
|
Fixed Fee / Unit Rate
|
| Major Deliverable: Deliverable #23: Contract Year Six (9/10/18 - 9/9/19) Additional Bill Review Line item fee (included in Bill Review Re-pricing and Utilization fee above)
|
| Deliverable Price: $0.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: Timely report submission
|
| Financial Consequences: $50.00 for each Business Day beyond the due date
|
| Source Documentation Page Reference: Page 20 and 42 |
| Deliverable Number: |
|
|
|
|
Medical office services
|
Deliverable #22: Contract Year Six (9/10/18 - 9/9/19) Bill Review Re-pricing and Utilization Fee -...
|
Fixed Fee / Unit Rate
|
| Major Deliverable: Deliverable #22: Contract Year Six (9/10/18 - 9/9/19) Bill Review Re-pricing and Utilization Fee - $8.83 each
|
| Deliverable Price: $1,060,000.00 |
| Non Price Justification: |
| Performance Metrics: Monthly average turn-around time of eight (8) Business Days or less to review/re-price medical bills assigned by the Department.
|
| Financial Consequences: $100 for each Business Day exceeding the maximum eight (8) Business Days
|
| Source Documentation Page Reference: Page 19 and 42 |
| Deliverable Number: |
|