74BAI-S3432 Cost Schedule.docx
DOCX document 19 KB Posted
- Solicitation number
- 74BAI-S3432
- Issued by
- Churchill County, Nevada
About this file
This document is a Cost Schedule attachment for a Workers' Compensation Self-Insured Insolvency Funds Claims Administration Request for Proposal (RFP). The procurement seeks a vendor to provide comprehensive claims administration services for a four-year contract period. The cost schedule template requires proposers to detail their pricing across multiple service categories, including annual fees, data conversion, claim opening, hearing and appeal representation, file storage, reporting, medical bill review, and network services.
The cost proposal mandates complete fee transparency, with vendors required to disclose all components of their charges, including any fees based on time, per claim, or expenses. The document provides a structured template for vendors to outline their pricing across four contract years, with spaces to specify costs for annual fees and additional services. Any fees not explicitly listed in the proposal will be assumed to be included at no additional charge to the Insolvency Funds. The total cost will be calculated by summing the annual fee and additional service costs, with a grand total calculated for the entire four-year contract period.
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Other files
| File | Type | Posted |
|---|---|---|
| 74BAI-S3432 INSURANCE REQUIREMENTS.docx | DOCX document | |
| 74BAI-S3432 Vendor-Information-Response.pdf | ||
| 74BAI-S3432 reference-questionnaire.docx | DOCX document | |
| Quote Instructions.pdf | ||
| 74BAI-S3432 Certification-regarding-lobbying.pdf | ||
| 74BAI-S3432 RFP Workers Comp Claim TPA.docx | DOCX document | |
| 74BAI-S3432 Standard-form-contract.docx | DOCX document | |
| Open Loss Runs Summary.pdf | ||
| 74BAI-S3432 Terms-and-conditions-for-services.pdf | ||
| 74BAI-S3432 RFP~2.docx | DOCX document |
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Text version
ATTACHMENT X - COST SCHEDULE
RFP XXXXX
WORKERS’ COMPENSATION SELF-INSURED INSOLVENCY FUNDS
CLAIMS ADMINISTRATION
VENDOR NAME: ______________________________________________________________
Provide a cost proposal that includes a summary of all claim 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, fee or expense that is not provided in the proposer’s cost proposal will be assumed at no additional charge to the Insolvency Funds.
| 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
Subsequent Claim Opening Fee
Hearing Representation
Appeal Representation
Paper Files Storage
Check stock1099 Processing
Ad-Hoc/Custom Reports
State/Federal Regulatory Reporting
Medicare Reporting
Medical Bill Review
Pharmacy Benefit Management Program
Non-Pharmacy Benefit Management Program (pharmacy payment systems, items unrelated to PBM activities, etc.)
PPO Network
| Please explain any other fees that may be charged to the State and include additional fee schedules |
| Contract Year 1 |
| Contract Year 2 |
| Contract Year 3 |
| Contract Year 4 |
| 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 .