74BAI-S2953 Cost Schedule.docx
DOCX document 20 KB Posted
- Solicitation number
- 74BAI-S2953
- Issued by
- Nevada
About this file
This document is a Cost Schedule related to RFP 74BAI-S2953 for Workers' Compensation Uninsured Employers Claims Administration. The RFP is issued by the Texas Department of Insurance (DIR) and is seeking proposals from vendors to provide claim administration services, including data conversion, takeover of existing open claims, full claim system access, index bureau checking, hearing representation, check stock, banking fees, 1099 processing, ad-hoc/custom reports, state/federal regulatory reporting, Medicare reporting, medical bill review, and pharmacy benefit management program. The contract term is for 4 years.
The cost proposal requires vendors to provide a summary of all claim administration fees, detailing the services related to such fees. Vendors must disclose all components of their charges, including any fees based on time, per claim, and/or expense. The proposal also requires vendors to provide pricing for the annual fee, as well as any additional costs, for each of the 4 contract years. Vendors must explain any other fees that may be charged to the State and include additional fee schedules.
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Other files
| File | Type | Posted |
|---|---|---|
| Quote Instructions.pdf | ||
| 74BAI-S2953 RFP - Revised Workers Compensation Uninsured Claims Administration.docx | DOCX document | |
| 74BAI-S2953 Insurance Schedule.docx | DOCX document | |
| 74BAI-S2953 RFP Workers Comp Uninsured Claims Administration.docx | DOCX document | |
| Terms and Conditions for Services~4.pdf | ||
| 74BAI-S2953 LOSS_RUN -redacted.xlsx | XLSX spreadsheet | |
| 74BAI-S2953 Letter of Intent.docx | DOCX document | |
| Attachments for Signature~3.pdf | ||
| Proposed Staff Resume~2.docx | DOCX document | |
| Multiple Files to Reference Q and A.pdf | ||
| 74BAI-S2953 Scope of Work.docx | DOCX document | |
| Reference Questionnaire.docx | DOCX document | |
| Standard Form Contract~9.docx | DOCX document | |
| Terms and Conditions for Goods 2023-04-14.pdf | ||
| 74BAI-S2953 Q and A - 10.8.24.xls | XLS spreadsheet |
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Text version
COST SCHEDULE
RFP 74BAI-S2953
WORKERS’ COMPENSATION UNINSURED EMPLOYERS
CLAIMS ADMINISTRATION
VENDOR NAME: ______________________________________________________________
Provide a cost proposal that includes a summary of all claim’s administration fees detailing services related to such fees. All fees must be disclosed for total transparency of cost and proposer must detail all components of its charges. Any fees based on time, per claim, and/or expense shall be clearly identified. If a fee for service is included, please state “Included”.
Any cost, fees or expenses that's not provided in the proposers cost proposal will be assumed at no additional charge to the DIR.
| Description |
| Contract Year 1 |
| Contract Year 2 |
| Contract Year 3 |
| Contract Year 4 |
| Annual Fee |
| $ |
| $ |
| $ |
| $ |
Data Conversion
(electrically converting historical claim data)
Takeover of Existing Open Claims
Full Claim System Access (6 users)
Index Bureau Checking
Hearing Representation
Check stock
Banking Fees
ACH/Bank Clearing House
1099 Processing
Ad-Hoc/Custom Reports
State/Federal Regulatory Reporting
Medicare Reporting
Medical Bill Review
Pharmacy Benefit Management Program
PPO Network
Please explain any other fees that may be charged to the State and include additional fees schedules
| Contract Year 1 |
| Contract Year 2 |
| Contract Year 3 |
| Contract Year 4 |
| Total |
| $ |
| $ |
| $ |
| $ |
(Include Annual Fee + Additional Cost)
| Grand Total for 4 years |
| $ |
File details come from the government source that posted it. Updated .