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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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Phase III - Claims Administration Services
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Fixed Price - Lump Sum
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| Major Deliverable: Phase III - Claims Administration Services
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| Deliverable Price: $4.56 |
| Non Price Justification: |
| Performance Metrics: Claims Activity Report-Monthly
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| Financial Consequences: Cancellation
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| Source Documentation Page Reference: |
| Deliverable Number: |
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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 Price - Lump Sum
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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: $225.00 |
| Non Price Justification: |
| Performance Metrics: EOB for each member claim evaluated in image or searchable 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: |
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Medical Claims Review and Management
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Phase IV - Training and Educational Support
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Fixed Price - Lump Sum
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| Major Deliverable: Phase IV - Training and Educational Support
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| Deliverable Price: $225.00 |
| Non Price Justification: |
| 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: |
| Deliverable Number: |
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Medical Claims Review and Management
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Payment is due upon the adjudication of a claim and the submission of related deliverables as specif...
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Fixed Price - Lump Sum
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| Major Deliverable: 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: |
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Medical Claims Review and Management
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There will be no additional charge associated with the handling of duplicate claims previously subm...
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Fixed Price - Lump Sum
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| Major Deliverable: There will be no additional charge associated with the handling of duplicate claims previously submitted to the Provider;
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| Deliverable Price: $0.00 |
| Non Price Justification: Price cannot be determined until the work has been completed |
| Performance Metrics: Remittance Advice (RA) for each medical provider claim evaluated for the month being invoiced (summary of all claims submitted by the medical provider) in searchable image or PDF format with an associated index file
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| Financial Consequences: Cancellation
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| Source Documentation Page Reference: |
| Deliverable Number: |
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Medical Claims Review and Management
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Phase II - Administrative Set-up
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Fixed Price - Lump Sum
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| Major Deliverable: Phase II - Administrative Set-up
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| Deliverable Price: $408,600.00 |
| Non Price Justification: |
| 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: |
| Deliverable Number: |
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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 Price - Lump Sum
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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: $34,800.00 |
| 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: |
| Deliverable Number: |
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