36C10G19R0018-A0002005.docx

SECTION E – SOLICITATION PROVISIONS

E.1 NOTICE OF HYBRID CONTRACT

This is a Firm-Fixed-Price, Labor-Hour type contract.

The following symbols will appear next to the applicable clauses and provisions throughout this document.

$ = applicable to Fixed-Price line items only.

& = applicable to Time-and-Material/Labor-Hour line items only.

E.2 52.209-5 CERTIFICATION REGARDING RESPONSIBILITY MATTERS (OCT 2015)

(a)

(1) The Offeror certifies, to the best of its knowledge and belief, that --

(i) The Offeror and/or any of its Principals --

(A) Are [_] are not [_] presently debarred, suspended, proposed for debarment, or declared ineligible for the award of contracts by any Federal agency;

(B) Have [_] have not [_], within a three-year period preceding this offer, been convicted of or had a civil judgment rendered against them for: commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) contract or subcontract; violation of Federal or State antitrust statutes relating to the submission of offers; or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, tax evasion, violating Federal criminal tax laws, or receiving stolen property (if offeror checks “have”, the offeror shall also see 52.209-7, if included in this solicitation); and

(C) Are [_] are not [_] presently indicted for, or otherwise criminally or civilly charged by a governmental entity with, commission of any of the offenses enumerated in paragraph (a)(1)(i)(B) of this provision; and

(D) Have [_], have not [_], within a three-year period preceding this offer, been notified of any delinquent Federal taxes in an amount that exceeds $3,500 for which the liability remains unsatisfied.

(1) Federal taxes are considered delinquent if both of the following criteria apply:

(i) The tax liability is finally determined. The liability is finally determined if it has been assessed. A liability is not finally determined if there is a pending administrative or judicial challenge. In the case of a judicial challenge to the liability, the liability is not finally determined until all judicial appeal rights have been exhausted.

(ii) The taxpayer is delinquent in making payment. A taxpayer is delinquent if the taxpayer has failed to pay the tax liability when full payment was due and required. A taxpayer is not delinquent in cases where enforced collection action is precluded.

(2) Examples.

(i) The taxpayer has received a statutory notice of deficiency, under I.R.C. §6212, which entitles the taxpayer to seek Tax Court review of a proposed tax deficiency. This is not a delinquent tax because it is not a final tax liability. Should the taxpayer seek Tax Court review, this will not be a final tax liability until the taxpayer has exercised all judicial appeal rights.

(ii) The IRS has filed a notice of Federal tax lien with respect to an assessed tax liability, and the taxpayer has been issued a notice under I.R.C. §6320 entitling the taxpayer to request a hearing with the IRS Office of Appeals contesting the lien filing, and to further appeal to the Tax Court if the IRS determines to sustain the lien filing. In the course of the hearing, the taxpayer is entitled to contest the underlying tax liability because the taxpayer has had no prior opportunity to contest the liability. This is not a delinquent tax because it is not a final tax liability. Should the taxpayer seek tax court review, this will not be a final tax liability until the taxpayer has exercised all judicial appeal rights.

(iii) The taxpayer has entered into an installment agreement pursuant to I.R.C. §6159. The taxpayer is making timely payments and is in full compliance with the agreement terms. The taxpayer is not delinquent because the taxpayer is not currently required to make full payment.

(iv) The taxpayer has filed for bankruptcy protection. The taxpayer is not delinquent because enforced collection action is stayed under 11 U.S.C. 362 (the Bankruptcy Code).

(ii) The Offeror has [[_] has not [_], within a three-year period preceding this offer, had one or more contracts terminated for default by any Federal agency.

(2) “Principal,” for the purposes of this certification, means an officer; director; owner; partner; or a person having primary management or supervisory responsibilities within a business entity (e.g., general manager; plant manager; head of a division or business segment; and similar positions).

This Certification Concerns a Matter Within the Jurisdiction of an Agency of the United States and the Making of a False, Fictitious, or Fraudulent Certification May Render the Maker Subject to Prosecution Under Section 1001, Title 18, United States Code.

(b) The Offeror shall provide immediate written notice to the Contracting Officer if, at any time prior to contract award, the Offeror learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.

(c) A certification that any of the items in paragraph (a) of this provision exists will not necessarily result in withholding of an award under this solicitation. However, the certification will be considered in connection with a determination of the Offeror’s responsibility. Failure of the Offeror to furnish a certification or provide such additional information as requested by the Contracting Officer may render the Offeror nonresponsible.

(d) Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render, in good faith, the certification required by paragraph (a) of this provision. The knowledge and information of an Offeror is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.

(e) The certification in paragraph (a) of this provision is a material representation of fact upon which reliance was placed when making award. If it is later determined that the Offeror knowingly rendered an erroneous certification, in addition to other remedies available to the Government, the Contracting Officer may terminate the contract resulting from this solicitation for default.

(End of Provision)

E.3 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018)

(a) Definitions. As used in this provision— "Administrative proceeding" means a non-judicial process that is adjudicatory in nature in order to make a determination of fault or liability (e.g., Securities and Exchange Commission Administrative Proceedings, Civilian Board of Contract Appeals Proceedings, and Armed Services Board of Contract Appeals Proceedings). This includes administrative proceedings at the Federal and State level but only in connection with performance of a Federal contract or grant. It does not include agency actions such as contract audits, site visits, corrective plans, or inspection of deliverables.

"Federal contracts and grants with total value greater than $10,000,000" means—

(1) The total value of all current, active contracts and grants, including all priced options; and

(2) The total value of all current, active orders including all priced options under indefinite-delivery, indefinite-quantity, 8(a), or requirements contracts (including task and delivery and multiple-award Schedules).

"Principal" means an officer, director, owner, partner, or a person having primary management or supervisory responsibilities within a business entity (e.g., general manager; plant manager; head of a division or business segment; and similar positions).

(b) The offeror [ ] has [ ] does not have current active Federal contracts and grants with total value greater than $10,000,000.

(c) If the offeror checked "has" in paragraph (b) of this provision, the offeror represents, by submission of this offer, that the information it has entered in the Federal Awardee Performance and Integrity Information System (FAPIIS) is current, accurate, and complete as of the date of submission of this offer with regard to the following information:

(1) Whether the offeror, and/or any of its principals, has or has not, within the last five years, in connection with the award to or performance by the offeror of a Federal contract or grant, been the subject of a proceeding, at the Federal or State level that resulted in any of the following dispositions:

(i) In a criminal proceeding, a conviction.

(ii) In a civil proceeding, a finding of fault and liability that results in the payment of a monetary fine, penalty, reimbursement, restitution, or damages of $5,000 or more.

(iii) In an administrative proceeding, a finding of fault and liability that results in—

(A) The payment of a monetary fine or penalty of $5,000 or more; or

(B) The payment of a reimbursement, restitution, or damages in excess of $100,000.

(iv) In a criminal, civil, or administrative proceeding, a disposition of the matter by consent or compromise with an acknowledgment of fault by the Contractor if the proceeding could have led to any of the outcomes specified in paragraphs (c)(1)(i), (c)(1)(ii), or (c)(1)(iii) of this provision.

(2) If the offeror has been involved in the last five years in any of the occurrences listed in (c)(1) of this provision, whether the offeror has provided the requested information with regard to each occurrence.

(d) The offeror shall post the information in paragraphs (c)(1)(i) through (c)(1)(iv) of this provision in FAPIIS as required through maintaining an active registration in the System for Award Management, which can be accessed via https://www.sam.gov (see 52.204-7).

(End of Provision)

E.4 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS (OCT 2018)

(a) North American Industry Classification System (NAICS) code and small business size standard. The NAICS code and small business size standard for this acquisition appear in Block 10 of the solicitation cover sheet (SF 1449). However, the small business size standard for a concern which submits an offer in its own name, but which proposes to furnish an item which it did not itself manufacture, is 500 employees.

(b) Submission of offers. Submit signed and dated offers to the office specified in this solicitation at or before the exact time specified in this solicitation. Offers may be submitted on the SF 1449, letterhead stationery, or as otherwise specified in the solicitation. As a minimum, offers must show—

(1) The solicitation number;

(2) The time specified in the solicitation for receipt of offers;

(3) The name, address, and telephone number of the offeror;

(4) A technical description of the items being offered in sufficient detail to evaluate compliance with the requirements in the solicitation. This may include product literature, or other documents, if necessary;

(5) Terms of any express warranty;

(6) Price and any discount terms;

(7) "Remit to" address, if different than mailing address;

(8) A completed copy of the representations and certifications at FAR 52.212-3 (see FAR 52.212-3(b) for those representations and certifications that the offeror shall complete electronically);

(9) Acknowledgment of Solicitation Amendments;

(10) Past performance information, when included as an evaluation factor, to include recent and relevant contracts for the same or similar items and other references (including contract numbers, points of contact with telephone numbers and other relevant information); and

(11) If the offer is not submitted on the SF 1449, include a statement specifying the extent of agreement with all terms, conditions, and provisions included in the solicitation. Offers that fail to furnish required representations or information, or reject the terms and conditions of the solicitation may be excluded from consideration.

(c) Period for acceptance of offers. The offeror agrees to hold the prices in its offer firm for 30 calendar days from the date specified for receipt of offers, unless another time period is specified in an addendum to the solicitation.

(d) Product samples. When required by the solicitation, product samples shall be submitted at or prior to the time specified for receipt of offers. Unless otherwise specified in this solicitation, these samples shall be submitted at no expense to the Government, and returned at the sender's request and expense, unless they are destroyed during preaward testing.

(e) Multiple offers. Offerors are encouraged to submit multiple offers presenting alternative terms and conditions, including alternative line items (provided that the alternative line items are consistent with subpart 4.10 of the Federal Acquisition Regulation), or alternative commercial items for satisfying the requirements of this solicitation. Each offer submitted will be evaluated separately.

(f) Late submissions, modifications, revisions, and withdrawals of offers.

(1) Offerors are responsible for submitting offers, and any modifications, revisions, or withdrawals, so as to reach the Government office designated in the solicitation by the time specified in the solicitation. If no time is specified in the solicitation, the time for receipt is 4:30 p.m., local time, for the designated Government office on the date that offers or revisions are due.

(2)(i) Any offer, modification, revision, or withdrawal of an offer received at the Government office designated in the solicitation after the exact time specified for receipt of offers is "late" and will not be considered unless it is received before award is made, the Contracting Officer determines that accepting the late offer would not unduly delay the acquisition; and—

(A) If it was transmitted through an electronic commerce method authorized by the solicitation, it was received at the initial point of entry to the Government infrastructure not later than 5:00 p.m. one working day prior to the date specified for receipt of offers; or

(B) There is acceptable evidence to establish that it was received at the Government installation designated for receipt of offers and was under the Government's control prior to the time set for receipt of offers; or

(C) If this solicitation is a request for proposals, it was the only proposal received.

(ii) However, a late modification of an otherwise successful offer, that makes its terms more favorable to the Government, will be considered at any time it is received and may be accepted.

(3) Acceptable evidence to establish the time of receipt at the Government installation includes the time/date stamp of that installation on the offer wrapper, other documentary evidence of receipt maintained by the installation, or oral testimony or statements of Government personnel.

(4) If an emergency or unanticipated event interrupts normal Government processes so that offers cannot be received at the Government office designated for receipt of offers by the exact time specified in the solicitation, and urgent Government requirements preclude amendment of the solicitation or other notice of an extension of the closing date, the time specified for receipt of offers will be deemed to be extended to the same time of day specified in the solicitation on the first work day on which normal Government processes resume.

(5) Offers may be withdrawn by written notice received at any time before the exact time set for receipt of offers. Oral offers in response to oral solicitations may be withdrawn orally. If the solicitation authorizes facsimile offers, offers may be withdrawn via facsimile received at any time before the exact time set for receipt of offers, subject to the conditions specified in the solicitation concerning facsimile offers. An offer may be withdrawn in person by an offeror or its authorized representative if, before the exact time set for receipt of offers, the identity of the person requesting withdrawal is established and the person signs a receipt for the offer.

(g) Contract award (not applicable to Invitation for Bids). The Government intends to evaluate offers and award a contract without discussions with offerors. Therefore, the offeror's initial offer should contain the offeror's best terms from a price and technical standpoint. However, the Government reserves the right to conduct discussions if later determined by the Contracting Officer to be necessary. The Government may reject any or all offers if such action is in the public interest; accept other than the lowest offer; and waive informalities and minor irregularities in offers received.

(h) Multiple awards. The Government may accept any item or group of items of an offer, unless the offeror qualifies the offer by specific limitations. Unless otherwise provided in the Schedule, offers may not be submitted for quantities less than those specified. The Government reserves the right to make an award on any item for a quantity less than the quantity offered, at the unit prices offered, unless the offeror specifies otherwise in the offer.

(i) Availability of requirements documents cited in the solicitation.

(1)(i) The GSA Index of Federal Specifications, Standards and Commercial Item Descriptions, FPMR Part 101-29, and copies of specifications, standards, and commercial item descriptions cited in this solicitation may be obtained for a fee by submitting a request to— GSA Federal Supply Service Specifications Section Suite 8100 470 East L'Enfant Plaza, SW Washington, DC 20407 Telephone (202) 619-8925 Facsimile (202) 619-8978.

(ii) If the General Services Administration, Department of Agriculture, or Department of Veterans Affairs issued this solicitation, a single copy of specifications, standards, and commercial item descriptions cited in this solicitation may be obtained free of charge by submitting a request to the addressee in paragraph (i)(1)(i) of this provision. Additional copies will be issued for a fee.

(2) Most unclassified Defense specifications and standards may be downloaded from the following ASSIST websites:

(i) ASSIST (https://assist.dla.mil/online/start/);

(ii) Quick Search (http://quicksearch.dla.mil/);

(iii) ASSISTdocs.com (http://assistdocs.com).

(3) Documents not available from ASSIST may be ordered from the Department of Defense Single Stock Point (DoDSSP) by?

(i) Using the ASSIST Shopping Wizard (https://assist.dla.mil/wizard/index.cfm);

(ii) Phoning the DoDSSP Customer Service Desk (215) 697-2179, Mon-Fri, 0730 to 1600 EST; or

(iii) Ordering from DoDSSP, Building 4, Section D, 700 Robbins Avenue, Philadelphia, PA 19111-5094, Telephone (215) 697-2667/2179, Facsimile (215) 697-1462.

(4) Nongovernment (voluntary) standards must be obtained from the organization responsible for their preparation, publication, or maintenance.

(j) Unique entity identifier. (Applies to all offers exceeding $10,000, and offers of $10,000 or less if the solicitation requires the Contractor to be registered in the System for Award Management (SAM).) The Offeror shall enter, in the block with its name and address on the cover page of its offer, the annotation ‘‘Unique Entity Identifier’’ followed by the unique entity identifier that identifies the Offeror’s name and address. The Offeror also shall enter its Electronic Funds Transfer (EFT) indicator, if applicable. The EFT indicator is a four-character suffix to the unique entity identifier. The suffix is assigned at the discretion of the Offeror to establish additional SAM records for identifying alternative EFT accounts (see subpart 32.11) for the same entity. If the Offeror does not have a unique entity identifier, it should contact the entity designated at www.sam.gov for unique entity identifier establishment directly to obtain one. The Offeror should indicate that it is an offeror for a Government contract when contacting the entity designated at www.sam.gov for establishing the unique entity identifier.

(k) [Reserved]

(l) Debriefing. If a post-award debriefing is given to requesting offerors, the Government shall disclose the following information, if applicable:

(1) The agency's evaluation of the significant weak or deficient factors in the debriefed offeror's offer.

(2) The overall evaluated cost or price and technical rating of the successful and the debriefed offeror and past performance information on the debriefed offeror.

(3) The overall ranking of all offerors, when any ranking was developed by the agency during source selection.

(4) A summary of the rationale for award;

(5) For acquisitions of commercial items, the make and model of the item to be delivered by the successful offeror.

(6) Reasonable responses to relevant questions posed by the debriefed offeror as to whether source-selection procedures set forth in the solicitation, applicable regulations, and other applicable authorities were followed by the agency.

(End of Provision) ADDENDUM to FAR 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS Provisions that are incorporated by reference (by Citation Number, Title, and Date), have the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available.

The following provisions are incorporated into 52.212-1 as an addendum to this solicitation:

All proposal intentions, questions, and final proposal submission shall be submitted to both the Contracting Officer and the Contract Specialist via email to Sharon.Redman@va.gov and Glenn.Burtonjr@va.gov, respectively, no later than the dates and times below and as specified on the SF 1449, Block 20 and Block 8.

· Questions regarding the solicitation shall be submitted no later than 2:00 PM (EDT) on August 30, 2019.

· Proposals shall be submitted electronically to the Contracting Officer and the Contract Specialist identified above no later than 11:59 PM (EDT) on September 13, 2019 unless this date is changed via a formal Amendment.

Contractors are advised to not wait until just before proposals are due to submit proposals. Proposals received after the due date/time will be late and may not be considered/accepted for evaluation. To avoid submission of late proposals, the Government recommends transmitting proposal file 24 hours prior to the required proposal due date and time. Be advised that timeliness is determined by the date and time a proposal is received by the Government, not when a contractor attempted transmission. Contractors are encouraged to review and ensure that sufficient bandwidth is available on their end of the transmission. Finally, due to VA email file size restrictions, contractors may need to logically separate their proposal into separate emails. If this is necessary, contractors should attempt to contain a complete volume within single email transmissions (and not split volumes).

The Contractor’s proposal shall consist of four volumes:

Volume I, Technical Approach, and Volume II, Past Performance must be submitted in one .PDF redacted and one .PDF un-redacted version. The redacted version shall not contain Offeror’s/Company’s or subcontractor’s/teaming partner’s information, including Offeror’s/Company’s/Subcontractor’s/Teaming Partner’s name and logo, embedded graphs or pictures with Offeror’s/Company’s or Subcontractor’s/Teaming Partner’s name or logo. The redacted version shall refer to proposed subcontractor(s) or teaming partner(s) as Subcontractor/Teaming Partner A, B, etc. Past Performance Questionnaires (PPQs) do not need to be redacted. The page limits for each Volume are noted below and apply to each version.

1. Proposal Files

Contractor’s responses shall be submitted in accordance with the following instructions:

a. Format. The submission shall be clearly indexed and logically assembled. Each volume shall be clearly identified and shall begin at the top of a page. All pages of each volume shall be appropriately numbered and identified by the complete company name, date and solicitation number in the header and/or footer. Proposal page limitations are applicable to this procurement. The Table below indicates the maximum page count (when applicable) for each volume of the contractor’s submission.

All files will be submitted as either a Microsoft Excel (.XLS) file or an Acrobat (PDF) file or compatible as indicated in the table. Page size shall be no greater than 8 1/2" x 11" with printing on one side, only. The top, bottom, left and right margins shall be a minimum of one inch (1”) each. Font size shall be no smaller than 12-point. Arial or Times New Roman fonts are required. Characters shall be set at no less than normal spacing and 100% scale. Tables and illustrations may use a reduced font size not less than 8-point and may be landscape. Line spacing shall be set at no less than single space. Each paragraph shall be separated by at least one blank line. Page numbers, company logos, and headers and footers may be within the page margins ONLY, and are not bound by the 12-point font requirement. All proprietary information shall be clearly and properly marked. Footnotes to text shall not be used. Additionally, contractors shall not use hyperlinks or embedded files of any kind in any proposal volume. If included, these will not be reviewed or evaluated. If the contractor submits annexes, documentation, attachments or the like, not specifically required by this solicitation, such will count against the contractor’s page limitations unless otherwise indicated in the specific volume instructions below. Pages in violation of these instructions, either by exceeding the margin, font or spacing restrictions or by exceeding the total page limit for a particular volume, may not be evaluated. Pages not evaluated due to violation of the margin, font or spacing restrictions will not count against the page limitations. The page count will be determined by counting the pages in the order they come up in the print layout view.

b. File Packaging. All of the proposal files may be compressed (zipped) into one file entitled “proposal.zip” using WinZip version 6.2 or later version or the proposal files may be submitted individually.

c. Content Requirements. All information shall be confined to the appropriate file. The contractor shall confine submissions to essential matters, sufficient to define the proposal and provide an adequate basis for evaluation. Contractors are responsible for including sufficient details, in a concise manner, to permit a complete and accurate evaluation of each proposal.

The titles and page limits requirements for each file are shown in the Table below:

Volume, Title, and Page Limitations

(Key Personnel Résumés will not be included in page limitation. Résumés are limited to two pages each.)

(References will complete and provide the questionnaire [RFP ATTACHMENT F] to the Government. PPQs will not be included in page limitation)

NAME]Pricing Spreadsheet.xls/.xlsx

(Includes a completed

ATTACHMENT A)

None

Volume IV

NAME]Other.pdf None

A Cover Page, Table of Contents and/or a glossary of abbreviations or acronyms will not be included in the page count of any Volume. However, be advised that any and all information contained within any Table of Contents and/or glossary of abbreviations or acronyms submitted with a contractor’s response will not be evaluated by the Government.

1. Volume I - Technical Approach Factor (1)

Proposals should not simply restate the Government's requirements, but should describe, in detail, how the Offeror intends to meet the requirements. The evaluation will determine whether the requirements specified in the solicitation have been completely considered, addressed, and satisfied. The evaluation will also determine whether or not the proposal was submitted in accordance with the instructions contained in the addendum to FAR 52.212-1, Instructions to Offerors, of this solicitation.

Offerors shall address their Technical Approach to fulfilling the requirements contained in the Government’s PWS in detail. More specifically, Offerors will be expected to provide a written narrative that describes the approach they will take in responding to the objectives and requirements presented in the PWS. Offerors shall address their overall technical approach in detail. The Technical Sub-factors are listed below. At a minimum the technical approach must include the following:

1. Technical Plan- The Offeror shall provide a description of how they plan to accomplish the work entailed in the PWS including performance metrics and a demonstrated knowledge of medical pricing and medical coding standards needed to process claims. (section 2.1 & section 2.2). Contractor’s statement(s) as required by paragraph b. of the VAAR Clause 852.209-70 ORGANIZATIONAL CONFLICTS OF INTEREST.

1. Transition Plan- Describe your firm’s plan to transition in and assume the workload from the incumbent contractor, as well as a transition out plan to turn the workload over to a follow-on contractor. Provide a listing of tasks as well of timeline of each contract milestone. Transition in plan should include recruiting, hiring, background checks, security clearances, CAC issuance and training (Refer to PWS Section 3.4 – 3.10).

1. Training Plan- Describe your firm’s plan accomplish initial staff training and ongoing requirements. (Refer to Section 3.5, 3.9)

1. Human Capital Management Plan- Describe your firm’s plan to for implementing proven strategies and techniques for attracting, hiring, developing and retaining talent.

1. Staffing Approach-

4. Surge Capability- Describe how resources will be allocated across task areas, particularly in periods of surge, including an estimated timeline to activate such support.

4. Key Personnel The Government will evaluate the quality of proposed key personnel, to include experience, against the labor category definitions and ability to support the PWS requirements. In addition, the government will evaluate the depth of relevant experience of individual personnel as demonstrated by working on similar projects. Projects must be similar in topic, dollar value, workload, duration, and complexity. All key personnel must be employed for at least the first twelve months of the contract. Resumes are not part of the overall page count. Key Personnel Resumes are limited to two pages per resume. Key Personnel include the following:

1. Program Manager (PM) or Equivalent (Equiv)

The Program Manager (PM) or Equivalent (Equiv) shall provide the supervision needed for all Contractor personnel to perform the scope of work accurately, efficiently and within established time frames to attain the required performance metrics in this PWS. The PM or Equiv shall be the primary interface with the Government. The PM shall ensure this contract is sufficiently staffed and there is no lapse in services.

Minimum Experience: The PM or Equiv shall possess at least 5 years of experience supervising personnel on processing medical claims and vouchers using numerous database applications in accordance with medical claims coding regulations and guidelines. The PM or Equiv shall have demonstrated success leading a large team focused on meeting organizational goals, continuous improvement and implementing human capital management strategies.

The PM or Equiv shall possess in-depth subject matter knowledge and judgement to direct the performance of the personnel. In addition, the PM or Equiv shall have proven capability and experience to supervise a team of the size needed to perform the scope and accuracy of work and to attain the required performance metrics in the PWS. The PM shall have an in depth understanding of billing and follow up regulations as it relates to Medicare. The PM or Equiv shall have an in depth understanding of electronic claims editing and submission capabilities including Medicare and NEIC on-line claims processing and query system.

The PM shall have a thorough understanding of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) and International Classification of Diseases, Tenth Revision Clinical Modification (ICD-10-CM) standards (or latest version).

The PM shall have knowledge and expertise in the use of Microsoft Office Products such as Word, Excel, and Project.

Minimum Education: Bachelor’s Degree.

1. Medical Claims Processor Lead (Lead) or Equiv

The MCP Lead functions as the team supervisor and subject-matter expert for a claims area. Responsible for creating reports, distributing workload and training new employees. Responds accurately and timely to inquiries from team members, including management, concerning claims processing and other technical issues. Investigates and initiates resolutions to complex claim problems. Identifies training gaps and assists employees to ensure consistent application of established guidelines. Identifies issues with procedures or processes and provides feedback to management on changes and development. Serves as liaison with other departments to address claim, system and quality issues. May perform some testing functions and attend/participate in meetings as needed.

Responsible for the accurate and timely processing of medical claims in addition to their supervision duties. Researches and processes claims according to business regulation, internal standards and processing guidelines. Verifies the coding of procedure and diagnosis codes. Resolves system edits, audits and claims errors through research and use of approved policies, procedures or reference training materials. Coordinates with internal/external departments to work edits and deferrals, updating the patient identification, other health insurance, provider identification and other files as necessary. Examines and processes complex or specialty claims according to business/contract regulations, internal standards and examining guidelines. Determines whether to return, deny or pay claims following organizational policies and procedures. Corrects processing errors by reprocessing, adjusting, and/or recouping claims. Ensures claims are processed according to established quality and production standards (see section 8.0, Performance Measures). Responds to routine correspondence and provides customer service support for on-line and phone call inquires and/or complaints.

Minimum Experience: 2 years of experience processing, researching and adjudicating medical claims.

The Lead or Equiv shall have demonstrated success working in a team environment focused on meeting organizational goals, objectives, and strong customer service skills. Additionally, the Lead or Equiv shall have an in depth understanding of billing and follow up regulations as it relates to Medicare. Shall have an in depth understanding of electronic claims editing and submission capabilities including Medicare and NEIC on-line claims processing and query system.

Minimum Education: High School Diploma or Equivalent (Equiv)

The Lead or Equiv shall have a high school diploma and at least 2 years of experience processing medical claims and vouchers. The Lead shall work to have a thorough understanding of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) and International Classification of Diseases, and Tenth Revision Clinical Modification (ICD-10-CM) standards (or latest version) within three months from their date of hire. Additionally, the Lead shall possess working knowledge of Microsoft Office Suite.

1. Volume II – Past Performance Factor (2) Contractors may submit a narrative detailing up to three contracts (prime contracts, task/delivery orders, and/or major subcontracts) in performance during the past three years from the date of issuance of the final solicitation, which are relevant to the efforts required by the RFP. Areas of relevance include all tasks and deliverables addressed in the PWS. Experiences that are most relevant are those with projects that are similar in size, scope, and complexity.

Data concerning the prime contractor shall be provided first, followed by each proposed major subcontractor, if applicable, in alphabetical order. Contractor shall clearly state whether the data is for the prime contractor (submitting the proposal) or subcontractor (a subcontractor proposed for the new effort). This volume shall be organized into the following sections:

a. Section 1 - Contract Descriptions

b. Section 2 – Contract Narrative Contractors shall provide a specific narrative explanation of each contract listed in Section 1, describing the objectives achieved and detailing how the effort is relevant to the requirements of this RFP (i.e., similar size, scope, and complexity). For any contracts/ contracts that did not/do not meet original cost, schedule, or technical performance requirements, provide a brief explanation of the reasons for the shortcomings and any corrective actions taken to avoid recurrence. The contractor shall list each time the delivery schedule was revised and provide an explanation of why the revision was necessary. The contractor shall indicate if any of the contracts listed were terminated and the reasons for the termination.

c. Section 3 – Subcontracts To allow the Government to make a determination of whether proposed subcontractors are “major subcontractors, contractors shall provide an outline of how the effort required by the RFP will be assigned for performance within the contractor’s corporate entity and among the proposed subcontractors, if applicable, including work assigned and estimated dollar value of the efforts assigned. The information provided for the prime contractor and each proposed major subcontractor shall include the entire company name, company address, CAGE code, DUNS number, socioeconomic status, and type of work to be performed by citing the applicable Government PWS section number.

d. Section 4 - New Corporate Entities New corporate entities may submit data on prior contracts involving its officers and employees. In addition to the other requirements in this section, the contractor shall discuss in detail the role performed by such persons in the prior contracts cited. Information should be included in the files described in the sections above.

Complete PPQs: The Government will accept no more than one PPQ per past performance narrative (included as RFP ATTACHMENT F – PAST PERFORMANCE QUESTIONNAIRE). The contractor shall distribute the PPQ found in the RFP to the POC for each of the past performance references found in the narrative. The Government will accept only one completed PPQ per narrative; i.e. only one completed PPQ per reference. Should the Government receive more than one completed PPQs for any narrative, the Government will consider only the first received that corresponds to the contractor’s references found in the Past Performance volume. The contractor shall instruct the POC at the referenced entity to return a copy of the completed PPQ directly to both the CO and the Contract Specialist via email to Glenn.Burtonjr@va.gov and Sharon.Redman@va.gov respectively, no later than the closing date specified on the SF 1449, Block 8 (inclusive of any closing date extensions granted via Amendment).

The Government may also consider past performance information obtained through other sources. Past performance information will be utilized to determine the quality of the contractor’s past performance as it relates to the probability of success of the required effort. The Government may use information provided by the contractor in their proposal submission, information in both Government and commercial databases, and other available information that the VA Contracting Officer determines is reasonable. The more closely the prior performance of services matches the RFP requirements in terms of required performance (i.e., similar size, scope, and complexity), the more relevant the performance will be considered.

If the contractor has no relevant past performance, it shall affirmatively state that it possesses no relevant past performance.

1. Volume III- Price (3)

This will be an FFP Contract with optional labor hour CLINS. Offerors shall provide a price for each line item listed Attachment A, Price/Cost Schedule.

Labor mix/level of effort worksheet shall be submitted with Volume III. It shall be created in line with the CLIN structure and made to support the pricing.

Volume III shall include pricing information in an Excel spreadsheet, which shall be comprised of the CLINs from Attachment A Price/Cost Schedule and a breakout worksheet, which details the labor mix per each CLIN.

1. Volume IV- SF1449, Amendments, and Other Documents (5)

1. Signed Standard Form (SF1449) and Acknowledgement of Amendment(s), if any. An official authorized to bind the firm shall sign the SF 1449, all amendment(s) (SF30s), and all certifications requiring original signature. An Acrobat PDF file shall be created to capture the signatures for submission.

1. Any proposed terms and conditions and/or assumptions upon which the proposal is predicated. Contractors are hereby advised that any contractor-imposed terms and conditions and/or assumptions which deviate from the Government’s material terms and conditions established by the Solicitation, may render the contractor’s proposal Unacceptable, and thus ineligible for award.

(End of Addendum to 52.212-1)

E.5 FAR 52.212-2 EVALUATION – COMMERCIAL ITEMS- ADDENDUM

Provisions that are incorporated by reference (by Citation Number, Title, and Date), have the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available.

The following provisions are incorporated into 52.212-2 as an addendum to this solicitation:

a. BASIS FOR AWARD The Government will make an award to the responsible Offeror whose proposal conforms to the solicitation and is most advantageous to the Government (i.e., that which represents the best value to the Government), price and other factors considered.

b. FACTORS TO BE EVALUATED

1. Non-Price Factors

(2) Price Factor – Factor 3 Price (In accordance with Price schedule) Excel file. The excel spreadsheet should be comprised of the CLINs from Section B.2 and a breakout worksheet, which details the labor mix per each CLIN.

Technical Approach is significantly more important than Past Performance, which is significantly more important than the Price. All non-price Factors, when combined, are significantly more important than Price.

1. ACQUISITION APPROACH

The contract will be awarded for one Base 12-month period with two, 12-month Options and will include FFP and LH CLINs.

1. EVALUATION APPROACH

All proposals will be subject to evaluation by a team of Government personnel. Contents of the written proposals will be evaluated to determine the degree and extent to which the requirements set forth in the RFP and PWS are satisfied. The written content of proposals will be evaluated in strict accordance with the Evaluation Approach described herein. Proposals which merely restate the requirement or state that the requirement will be met, without providing supporting rationale, are not sufficient. To receive consideration for award, a minimum rating of “Satisfactory” must be achieved for all Non-Price factors contained in this solicitation. Offerors will be cautioned that the award may not necessarily be made to the lowest price offeror or the offeror with the most highly rated technical proposal. In accordance with (IAW) FAR 15.306(a) (3), the Government reserves the right to award without discussions based upon the initial evaluation of proposals. Offerors will thus be encouraged to submit their best offers in response to this solicitation.

Evaluation of the offeror’s proposal shall address each Non-Price factor as it applies to the PWS. Offerors must provide certification that they are verified within Vendor Information Pages (VIP). Any offeror who fails to provide proof they are verified within VIP as a SDVOSB with their proposal shall be deemed “Unsatisfactory” and thus, ineligible for award.

1. NON-PRICE FACTORS

The Technical Approach will be evaluated to determine the extent to which it demonstrates a clear understanding of all features involved in meeting the requirements delineated in the PWS The Technical Approach will be evaluated by Evaluation Team members to determine if the Offeror has addressed the sub-factors listed in the Addendum to FAR 52.212-1 Instructions to Offerors-Commercial Items.

1. The following sub-factors are equally important:

1. Technical Plan

1. Transition Plan

1. Training Plan

1. Humann Capital Management Plan

1. Staffing Approach

ii. Factor 2 – Past Performance Past Performance will be evaluated as follows:

1. The Past Performance will be evaluated based on PPQs (See Attachment F), and other Government sources including Past Performance Retrieval System (PPIRS) and given an adjectival rating as indicated in Section E.5.d, Evaluation Approach.

All past performance questionnaires, and their related projects, will be reviewed for quality, timeliness, and relevance. Timeliness is considered past performance from the last three years, relevance is considered experience in providing services similar in size, scope, and complexity as described in the PWS. Quality is how well the work was performed. In the case of an Offeror without a record of past performance or for whom information on past performance is not available, the Offeror may not be evaluated favorably or unfavorably on past performance.

1. Relevant Experience Past performance will also include evaluation of experience in completing projects in the same size/scope as the one being solicited for.

1. PRICE FACTOR

Factor 3 – Price

Price will not be evaluated adjectivally or assigned a score. For price evaluation purposes, the total amount of RFP, to include Ad-Hoc pricing will be evaluate as the total price and compared to any proposed prices received in response to the solicitation.

(End of Addendum to 52.212-2)

E.7 52.216-1 TYPE OF CONTRACT (APR 1984)

The Government contemplates award of a Firm-Fixed-Price, Labor-Hour contract resulting from this solicitation.

(End of Provision) E.8 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—COMMERCIAL ITEMS (OCT 2018) The Offeror shall complete only paragraph (b) of this provision if the Offeror has completed the annual representations and certification electronically in the System for Award Management (SAM) accessed through https://www.sam.gov. If the Offeror has not completed the annual representations and certifications electronically, the Offeror shall complete only paragraphs (c) through (u) of this provision.

(a) Definitions. As used in this provision— Economically disadvantaged women-owned small business (EDWOSB) concern means a small business concern that is at least 51 percent directly and unconditionally owned by, and the management and daily business operations of which are controlled by, one or more women who are citizens of the United States and who are economically disadvantaged in accordance with 13 CFR part 127. It automatically qualifies as a women-owned small business eligible under the WOSB Program.

Forced or indentured child labor means all work or service—

(1) Exacted from any person under the age of 18 under the menace of any penalty for its nonperformance and for which the worker does not offer himself voluntarily; or

(2) Performed by any person under the age of 18 pursuant to a contract the enforcement of which can be accomplished by process or penalties.

Highest-level owner means the entity that owns or controls an immediate owner of the offeror, or that owns or controls one or more entities that control an immediate owner of the offeror. No entity owns or exercises control of the highest level owner.

Immediate owner means an entity, other than the offeror, that has direct control of the offeror. Indicators of control include, but are not limited to, one or more of the following: Ownership or interlocking management,…