5-USBE-CC26314-RFP - Cost Proposal Form .xlsx
XLSX spreadsheet 18 KB Posted
- Solicitation number
- USBE-CC26314-RFP
- Issued by
- Utah
About this file
This is a Cost Proposal Form for Solicitation #USBE-CC26314-RFP, issued by the Utah State Board of Education (USBE) on behalf of the Utah Schools for the Deaf and the Blind (USDB). The RFP seeks a qualified vendor to provide Medicaid billing services, specifically a documentation program that tracks delivery of health-related services and submits claims to Medicaid. The solution must offer an intuitive, user-friendly experience for service providers and administrators while streamlining documentation and billing processes. The contract is anticipated to result in a single award and will have a five-year term. No specific response dates, site visits, or bidder's meetings are detailed in this cost proposal form document.
The maximum contract budget is $30,000 annually for a total of $150,000 over the five-year contract period, though this amount is not guaranteed. USBE estimates $30,000 in federal Medicaid participation annually, with actual invoiced amounts calculated by multiplying the vendor's bid rate by actual participation amounts. Offerors must propose an all-inclusive rate covering software, hosting, implementation, claims submission, training, support, and all related expenses. Cost proposals are scored based on the lowest total cost over five years, with the lowest bidder receiving 100 percent of price points and other bidders receiving proportional points based on their percentage above the lowest cost. Offerors whose proposed total cost exceeds 200 percent of the lowest total cost receive no points. The form includes an optional items section for additional services not required by the RFP and not factored into cost evaluation.
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Text version
Mandatory (Scored) Costs
SOLICITATION #USBE-CC26314-RFP
MEDICAID BILLING SERVICES
COST PROPOSAL FORM
INSTRUCTIONS: USBE/USDB estimates that $30,000 in federal participation is received annually. Actual participation may be more or less than this amount and the amount invoiced by the vendor will be calculated by multiplying the bid rate by the actual participation amounts. The maximum contract budget is $30,000.00 per year for a total of $150,000.00 for the duration of the contract. However, this is NOT a guaranteed total amount. You are not required to expend the entire amount of funds when calculating your cost proposal. Cost proposals exceeding these identified amounts will be considered non-responsive and ineligible for contract award.
Offerors shall propose a rate for services in the applicable ORANGE fields below. The proposed annual cost will be calculated by multiplying the proposed rate by a fixed annual base amount of $30,000. Annual totals will be calculated for each contract year, and the Grand Total will reflect the sum of all five years.
All costs will be SCORED, and evaluation shall be based on the GRAND TOTAL.
USBE/USDB will use the following cost formula for scoring: The points assigned to each offerors cost proposal will be based on the lowest total cost over 5 years. The offeror with the Lowest Total Cost will receive 100% of the price points. All other offerors will receive a portion of the total cost points based on what percentage higher their Proposed Total Cost is than the Lowest Total Cost. An offeror whose Proposed Total Cost is more than double (200%) the Lowest Total Cost will receive no points. The formula to compute the points is: Cost Points x (2- Proposed Total Cost/Lowest Total Cost).
NOTE: Any formulas entered into this form have been entered as a courtesy, and it is solely the responsibility of each Offeror to ensure that all information entered into this spreadsheet--including mathematical calculations--are complete and accurate. If you have any questions or concerns regarding this cost proposal form, please submit a question during this RFP’s question and answer period. Any deviation from this format may result in disqualification of your proposal.
| ITEM | YEAR 1 | YEAR 2 | YEAR 3 | YEAR 4 | YEAR 5 | |
| 1 | The proposed rate must be all‑inclusive and represent the total cost to USDB for all services required under this RFP, including software, hosting, implementation, claims submission, training, support, and all other related expenses. | 0% | 0% | 0% | 0% | 0% |
| ANNUAL TOTALS†: | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | |
| GRAND TOTAL†: | $ - 0 | |||||
| †Calculated by USBE. |
Optional Items - Not Scored
SOLICITATION #USBE-CC26314-RFP
MEDICAID BILLING SERVICES
COST PROPOSAL FORM
Use this tab to provide pricing on any additional items that are NOT required to use your proposed solution and are NOT listed as a requirement in this RFP. Items listed below are subject to inclusion in the contract resulting from this RFP and may be purchased at USBE's option, but they will NOT be included in the Offeror's Proposed Price and will not be used in the evaluation of cost points.
INSTRUCTIONS: Please complete all fields below. If any cost is “$0” or not applicable, clearly indicate so. If you have any questions or concerns regarding this cost proposal form, please submit a question during this RFP’s question and answer period. Any deviation from this format may result in disqualification of your proposal. Where applicable, provide a detailed breakdown of the per-year costs for each item.
Any formulas entered into this form have been entered as a courtesy, and it is solely the responsibility of each Offeror to ensure that all information entered into this spreadsheet--including mathematical calculations--are complete and accurate.
| OPTIONAL ITEMS | YEAR 1 | YEAR 2 | YEAR 3 | YEAR 4 | YEAR 5 | |
| 1 | [Other] | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
| 2 | [Other] | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
| 3 | [Other] | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
| 4 | [Other] | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
| 5 | [Other] | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
| 6 | [Other] | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
| 7 | [Other] | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
| 8 | [Other] | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
File details come from the government source that posted it. Updated .