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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 Claims Review and Management
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Phase I - Prepare a written recommendation as specified in Phase I, including a cost budget and time...
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Fixed Fee / Unit Rate
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| Major Deliverable: Phase I - Prepare a written recommendation as specified in Phase I, including a cost budget and timeline.
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| Deliverable Price: $8,000.00 |
| Non Price Justification: |
| Performance Metrics: Submit within 30 days of the receipt of company information/data
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| Financial Consequences: Cancellation
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| Source Documentation Page Reference: 7 |
| Deliverable Number: 1 |
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2
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Medical Claims Review and Management
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Phase II - Administrative set-up as specified in Phase II.
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Fixed Fee / Unit Rate
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| Major Deliverable: Phase II - Administrative set-up as specified in Phase II.
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| Deliverable Price: $25,000.00 |
| Non Price Justification: |
| Performance Metrics: Submit confirmation of completion within 45 days of approval of the Phase I deliverable unless a mutually agreeable timeline is established under Phase I.
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| Financial Consequences: Cancellation
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| Source Documentation Page Reference: 7 |
| Deliverable Number: 2 |
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3
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Medical Claims Review and Management
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Phase II - Administrative set-up as specified in Phase II.
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Fixed Fee / Unit Rate
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| Major Deliverable: Phase II - Administrative set-up as specified in Phase II.
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| Deliverable Price: $0.00 |
| Non Price Justification: Price cannot be determined until the work has been completed |
| Performance Metrics: If this Phase requires more than forty-five (45) days to complete, a written status report will be submitted every two (2) weeks form the date this phase is triggered. The status report should include what items have been completed, what is pending and the expected completion date for pending items.
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| Financial Consequences: Cancellation
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| Source Documentation Page Reference: Page 12 |
| Deliverable Number: 3 |
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4
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Medical Claims Review and Management
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Phase III - Claims Administration Services.Flat Rate Per Claim without payment: 9.00 Flat Rate Per ...
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Fixed Fee / Unit Rate
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| Major Deliverable: Phase III - Claims Administration Services.Flat Rate Per Claim without payment: 9.00 Flat Rate Per Claim with payment: 10.50
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| Deliverable Price: $0.00 |
| Non Price Justification: Price cannot be determined until the work has been completed |
| Performance Metrics: Claims Activity Report-Monthly
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| Financial Consequences: Cancellation
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| Source Documentation Page Reference: |
| Deliverable Number: 4 |
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5
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Medical Claims Review and Management
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Phase III - Claims Administration Services.
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Fixed Fee / Unit Rate
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| Major Deliverable: Phase III - Claims Administration Services.
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| Deliverable Price: $0.00 |
| Non Price Justification: Price cannot be determined until the work has been completed |
| Performance Metrics: Medical Provider Claim Detail Report -Monthly
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| Financial Consequences: Cancellation
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| Source Documentation Page Reference: |
| Deliverable Number: 5 |
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6
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Medical Claims Review and Management
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Phase III - Claims Administration Services. Other Services: 50.00/per hour
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Fixed Fee / Unit Rate
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| Major Deliverable: Phase III - Claims Administration Services. Other Services: 50.00/per hour
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| Deliverable Price: $0.00 |
| Non Price Justification: Price cannot be determined until the work has been completed |
| Performance Metrics: Member Claim Detail Report -Monthly
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| Financial Consequences: Cancellation
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| Source Documentation Page Reference: |
| Deliverable Number: 6 |
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7
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Medical Claims Review and Management
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Phase III - Claims Administration Services.Payment is due upon the adjudication of a claim and the s...
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Fixed Fee / Unit Rate
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| Major Deliverable: Phase III - Claims Administration Services.Payment is due upon the adjudication of a claim and the submission of related deliverables as specified in this Contract. An additional adjudication fee will only be charged if the medical provider makes an error in the original submission; and
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| Deliverable Price: $0.00 |
| Non Price Justification: Price cannot be determined until the work has been completed |
| Performance Metrics: Medical Provider Payee Claim Summary Report to include all adjudication activity form inception to conclusion of the process.-At the conclusion of the adjudication process.
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| Financial Consequences: Cancellation
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| Source Documentation Page Reference: |
| Deliverable Number: 7 |
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8
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Medical Claims Review and Management
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Services to provide expert testimony or other services must be approved in writing, in advance, by t...
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Fixed Fee / Unit Rate
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| Major Deliverable: Services to provide expert testimony or other services must be approved in writing, in advance, by the RECEIVER.
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| Deliverable Price: $0.00 |
| Non Price Justification: Price cannot be determined until the work has been completed |
| Performance Metrics: EOB for each member claim evaluated in image or seachable PDF format with an associated index file-at the conclusion of the adjudication process.
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| Financial Consequences: Cancellation
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| Source Documentation Page Reference: |
| Deliverable Number: 8 |
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9
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Medical Claims Review and Management
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Phase IV - Training and Educational Support. 25.00/per hour
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Fixed Fee / Unit Rate
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| Major Deliverable: Phase IV - Training and Educational Support. 25.00/per hour
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| Deliverable Price: $0.00 |
| Non Price Justification: Price cannot be determined until the work has been completed |
| Performance Metrics: Not to begin unless written instruction is provided by the RECEIVER
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| Financial Consequences: Cancellation
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| Source Documentation Page Reference: Page 12 |
| Deliverable Number: 9 |
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