120174 O3 COST PROPOSAL.pdf
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- Solicitation number
- 120174 O3
- Issued by
- Douglas County, Nebraska
About this file
This is a Cost Proposal form for RFP 120174 O3 issued for a third-party administrator to process payments for claims/invoices for incarcerated individual(s) healthcare services. The form requires bidders to provide pricing for both medical and dental payment processing fees based on an average daily population (ADP) of 5,872 incarcerated individuals. The contract structure includes an initial term plus two optional renewal periods.
The pricing must be submitted in two formats: a monthly flat rate and a rate per incarcerated individual for both medical and dental payment processing fees. All expenses must be bid as all-inclusive with no additional billable costs. The form includes a formula for calculating the per-individual rate (fee multiplied by ADP), with an example showing "$19.50 x 5872 = $114,504". The form also includes a section for optional services that may be awarded at the time of contract award or after, if deemed in the state's best interest. The state will determine whether to award based on the monthly flat rate or per-individual rate depending on what is most advantageous to the state.
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Text version
Cost Proposal
RFP 120174 O3
Third-party administrator to process payments for claims/ invoices for an incarcerated individual(s) healthcare services.
Bidder Name: _________________________________________
All expenses associated with these services must be bid as all-inclusive. No other costs shall be billed. This is an estimated usage contract based on historical data and will fluctuate based on the average daily population (ADP). The bidder may use the ADP of 5872 and may refer to the historical information provided in the RFP to help aid in developing cost. This contract shall have no minimum/maximum ADP requirements.
The bidder shall provide two (2) cost solutions for the Medical and Dental payment processing fees. One (1) cost solution will be for a flat monthly rate and one (1) cost solution at a rate per incarcerated individual. The State will determine if the award will be based on the monthly flat rate or award at the rate per incarcerated individual, whichever is deemed in the best interest of the State.
1. Bidder shall:
a. Provide a monthly flat rate for both the Medical Payment Processing Fee and the Dental Payment Processing Fee.
2. Bidder shall:
a. Provide a rate per incarcerated individual for the Medical Payment Processing Fee and the Dental Payment Processing Fee.
i. For billing purposes, the formula used to calculate the processing fee shall be “fee per incarcerated individual multiplied by the average daily population”, the formula used shall be on every monthly invoice.
1. Example: “$19.50 (fee) x 5872 (ADP) = $114,504”.
Monthly flat rate Unit of Measure ADP Initial contract term cost per month Renewal 1 (Optional)
Renewal 2 (Optional)
Medical payment processing fee Per month 5872
Dental payment processing fee Per month 5872
Rate per incarcerated individual Unit of Measure ADP Initial contract term cost per individual Renewal 1 (Optional)
Renewal 2 (Optional)
Medical payment processing fee Per person 5872
Dental payment processing fee Per person 5872
Cost Proposal
RFP 120174 O3
Third-party administrator to process payments for claims/ invoices for an incarcerated individual(s) healthcare services.
Bidder Name: _________________________________________
3. OPTIONAL SERVICES, NOT REQUIRED.
a. NDCS may consider awarding optional services as outlined in section V.K. at the time of award or after contract award, if deemed in the best interest of the State.
b. If optional services are provided with the RFP response, the bidder must provide cost for optional services with the response.
c. Bidder may add additional rows if needed.
Description of Optional Service Unit of Measure
Initial contract term cost
Renewal 1 (Optional)
Renewal 2 (Optional)
File details come from the government source that posted it. Updated .