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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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Renewal 1 - 2019-2020
Medicare Set Aside from DRM assigned Workers Compensation claim, or Liability ...
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Fixed Fee / Unit Rate
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| Major Deliverable: Renewal 1 - 2019-2020
Medicare Set Aside from DRM assigned Workers Compensation claim, or Liability claim for submission to and approval by CMS. ($1,500/claim)
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| Deliverable Price: $0.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: Timely and accurate handling of MSA, and acceptance by CMS
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| Financial Consequences: Non payment
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| Source Documentation Page Reference: Pgs. 3-4 |
| 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 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 each
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| Deliverable Price: $0.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: Timely and accurate completion of report and acceptance by DRM
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| Financial Consequences: Non payment
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| Source Documentation Page Reference: Pgs 3-4 |
| 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: $0.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: Timely and accurate completion of task and acceptance by DRM
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| Financial Consequences: Non payment
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| Source Documentation Page Reference: Pgs 3-4 |
| 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
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| Deliverable Price: $0.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: Timely and accurate completion of task and acceptance by DRM
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| Financial Consequences: Non payment
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| Source Documentation Page Reference: Pgs 3-4 |
| Deliverable Number: |
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Medical Claims Review and Management
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Custodial Medical Accounts $750 - $1,750/year
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Fixed Fee / Unit Rate
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| Major Deliverable: Custodial Medical Accounts $750 - $1,750/year
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| Deliverable Price: $0.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: Timely and accurate completion of task and acceptance by DRM
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| Financial Consequences: Non payment
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| Source Documentation Page Reference: Pgs 3-4 |
| 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/day
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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/day
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| Deliverable Price: $0.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: Timely and accurate completion of task and acceptance by DRM
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| Financial Consequences: Non payment
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| Source Documentation Page Reference: Pgs 3-4 |
| Deliverable Number: |
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Medical Claims Review and Management
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Self-Administered Support Services $2,500.00
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Fixed Fee / Unit Rate
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| Major Deliverable: Self-Administered Support Services $2,500.00
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| Deliverable Price: $0.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: Criteria to be developed by DRM as determined by specific need
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| Financial Consequences: Non payment
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| Source Documentation Page Reference: Pgs 3-4 |
| Deliverable Number: |
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Medical Claims Review and Management
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Future Medical Cost Projection $2,450 each
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Fixed Fee / Unit Rate
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| Major Deliverable: Future Medical Cost Projection $2,450 each
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| Deliverable Price: $0.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: Timely and accurate completion of report and acceptance by DRM
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| Financial Consequences: Non payment
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| Source Documentation Page Reference: Pgs 3-4 |
| Deliverable Number: |
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Medical Claims Review and Management
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Future Medical Cost Projection $2,450 each
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Fixed Fee / Unit Rate
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| Major Deliverable: Future Medical Cost Projection $2,450 each
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| Deliverable Price: $0.00 |
| Non Price Justification: Price cannot be determined until the work has been completed |
| Performance Metrics: Timely and accurate completion of report and acceptance by DRM
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| Financial Consequences: Non payment
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| Source Documentation Page Reference: Pages 3-4 of Contract |
| Deliverable Number: |
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Medical Claims Review and Management
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Self-Administered Support Services 1-Year: $700, 3-Year: $1,800, 5-Year: $2,500
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Fixed Fee / Unit Rate
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| Major Deliverable: Self-Administered Support Services 1-Year: $700, 3-Year: $1,800, 5-Year: $2,500
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| Deliverable Price: $0.00 |
| Non Price Justification: Price cannot be determined until the work has been completed |
| Performance Metrics: Criteria to be developed by DRM as determined by specific need
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| Financial Consequences: Non payment
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| Source Documentation Page Reference: Pages 3-4 of Contract |
| 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/day
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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/day
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| Deliverable Price: $0.00 |
| Non Price Justification: Price cannot be determined until the work has been completed |
| Performance Metrics: Timely and accurate completion of task and acceptance by DRM
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| Financial Consequences: Non payment
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| Source Documentation Page Reference: Pages 3-4 of Contract |
| Deliverable Number: |
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Medical Claims Review and Management
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Custodial Medical Accounts $750 - $1,750/year
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Fixed Fee / Unit Rate
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| Major Deliverable: Custodial Medical Accounts $750 - $1,750/year
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| Deliverable Price: $0.00 |
| Non Price Justification: Price cannot be determined until the work has been completed |
| Performance Metrics: Timely and accurate completion of task and acceptance by DRM
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| Financial Consequences: Non payment
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| Source Documentation Page Reference: Pages 3-4 of Contract |
| 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
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| Deliverable Price: $0.00 |
| Non Price Justification: Price cannot be determined until the work has been completed |
| Performance Metrics: Timely and accurate completion of task and acceptance by DRM
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| Financial Consequences: Non payment
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| Source Documentation Page Reference: Pages 3-4 of Contract |
| 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: $0.00 |
| Non Price Justification: Price cannot be determined until the work has been completed |
| Performance Metrics: Timely and accurate completion of task and acceptance by DRM
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| Financial Consequences: Non payment
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| Source Documentation Page Reference: Pages 3-4 of Contract |
| 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 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 each
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| Deliverable Price: $0.00 |
| Non Price Justification: Price cannot be determined until the work has been completed |
| Performance Metrics: Timely and accurate completion of report and acceptance by DRM
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| Financial Consequences: Non payment
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| Source Documentation Page Reference: Pages 3-4 of Contract |
| Deliverable Number: |
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Medical Claims Review and Management
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Medicare Set Aside from DRM assigned Workers Compensation claim, or Liability claim for submission t...
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Fixed Fee / Unit Rate
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| Major Deliverable: Medicare Set Aside from DRM assigned Workers Compensation claim, or Liability claim for submission to and approval by CMS. (Year 1: $1,800/claim Year 2: $1,750/claim Year 3: $1,700/claim Years 4-8: $1,500/claim)
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| Deliverable Price: $0.00 |
| Non Price Justification: Price cannot be determined until the work has been completed |
| Performance Metrics: Timely and accurate handling of MSA, and acceptance by CMS
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| Financial Consequences: Non payment
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| Source Documentation Page Reference: Pages 3-4 of Contract |
| Deliverable Number: |
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