Attachment J.16 Cost Template.xls

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Pricing, Data Analysis and Coding (PDAC) Contractor Federal contract opportunity
Solicitation number
75FCMC18R0010
Issued by
Department of Health and Human Services Centers for Medicare and Medicaid Services

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Attachment J.16 Cost Template

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Updated_Attachment_J.13_Product_Accessibility_Template.docx DOCX document
Revised_Question_and_Answers_2.20.18.xlsx XLSX spreadsheet
75FCMC18R0010_PDAC_RFP_Amendment_1.pdf PDF
Attachment_J.06_Proposal_Assumptions.docx DOCX document
Attachment_J.16_Cost_Template.xlsx XLSX spreadsheet
Final_Question_and_Answers_2.16.18.xlsx XLSX spreadsheet
Attachment_J.01_Statement_of_Work.docx DOCX document
Attachment_J.09_Security_Attestation.docx DOCX document
Attachment_J.05_GovtFurnishedMaterials.xls XLS spreadsheet
Attachment J.05 GovtFurnishedMaterials.xls XLS spreadsheet
Attachment J.01 Statement of Work.docx DOCX document
Attachment J.14 Reserved for PAT.doc DOC document
Attachment J.10 HHS Subcontract Plan Template.doc DOC document
Attachment J.13 Product Accessibility Template.docx DOCX document
Attachment J.19 Consent to Subcontract.docx DOCX document
Attachment J.02 Deliverable Schedule.xlsx XLSX spreadsheet
Attachment J.04 Non-Disclosure Statement.docx DOCX document
Attachment J.08 Key Personnel Attestation.docx DOCX document
Attachment J.12 Reserved for Wage Determinations.doc DOC document
Attachment J.18 Contractor Business Ethics COI and Compliance Program Requirements.docx DOCX document
Attachment J.09 Security Attestation.docx DOCX document
Attachment J.15 Service Center Matrix.xlsx XLSX spreadsheet
Attachment J.03 Past Performance Questionnaire.docx DOCX document
Attachment J.11 Reserved for Subcontracting Plan.doc DOC document
Attachment J.07 Questions and Answers Template.xlsx XLSX spreadsheet
75FCMC18R0010_PDAC_RFP.pdf PDF
Attachment J.17 Contractor Personal Conflicts of Interest Finaancial Disclosure Template.docx DOCX document
Attachment J.06 Proposal Assumptions.docx DOCX document
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SUMMARY

COST TEMPLATE
MM/DD/Y - MM/DD/YY
CLIN SUMMARY (Roll-up of SLIN Tabs)CLIN 0001CLIN 0002CLIN 0003CLIN 0004CLIN 0005CLIN 0006CLIN 0007
PDAC ServicesTotal FTEsBase Period: ImplementationBase Period: Operations, Task DirectivesOption Period 1: Operations, Task DirectivesOption Period 2: Operations, Task DirectivesOption Period 3: Operations, Task DirectivesOption Period 4: Operations, Task DirectivesOption Period 4: Outgoing Contractor Workload Transition ActivitiesGRAND TOTAL
HoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursTotal
COST ELEMENTS
Direct Labor
Labor Category ABC
(Add Appropriate Labor Categories)
Subtotal Direct Labor
Fringe Benefits (at __%)
Purchased Labor
Total Direct Labor
Travel$0$0$0$0$0$0$0$0
SUBCONTRACTORS
Subcontractor Name ABC
(Add Subcontractor Names Here)
Total Subcontractor
Other Direct Costs
Other Direct Costs - ABC
(Add Appropriate ODC categories)
Total Other Direct Costs
SUBTOTAL ALL DIRECT COSTS
Overhead @ __%
General and Administrative @ __%
SUBTOTAL COSTS BEFORE FEE
Fixed Fee (at __%)
TOTAL FIRM FIXED PRICE

&LHHSM-500-2013-RFP-0019&C&"Arial,Bold"&12CONTRACTOR NAME GOES HERE

Pricing, Data Analysis, and Coding (PDAC) &LJ10 Cost Template - Summary&C &R&P

CLIN 0001 Implementation

COST TEMPLATE
MM/DD/YY - MM//DD/YY
CLIN 0001 (See SOW C.1.1.1)
PDAC Services - ImplementationTotal FTEsGRAND TOTAL
HoursTotal
COST ELEMENTS
Direct Labor
Labor Category ABC
(Add Appropriate Labor Categories)
Subtotal Direct Labor
Fringe Benefits (at __%)
Purchased Labor
Total Direct Labor
Travel
SUBCONTRACTORS
Subcontractor Name ABC
(Add Subcontractor Names Here)
Total Subcontractor
Other Direct Costs
Other Direct Costs - ABC
(Add Appropriate ODC categories)
Total Other Direct Costs
SUBTOTAL ALL DIRECT COSTS
Overhead @ __%
General and Administrative @ __%
SUBTOTAL COSTS BEFORE FEE
Fixed Fee (at __%)
TOTAL FIRM FIXED PRICE

&LHHSM-500-2013-RFP-0019&C&"Arial,Bold"&12CONTRACTOR NAME GOES HERE

Pricing, Data Analysis, and Coding (PDAC) &LJ10 Cost Template Implementation - CLIN 0001&C &R&P

CLIN-SLIN 0002AA Base OPS

COST TEMPLATE
MM/DD/YY - MM/DD/YY
SLIN 0002AA (See SOW Sec E.)SLIN 0002AASLIN 0002AASLIN 0002AASLIN 0002AASLIN 0002AASLIN 0002AA
PDAC Services - Base Period OperationsTotal FTEsSOW Section E.1 - Administer HCPCS Coding DMEPOSSOW Section E.2 - Coding Advice and GuidanceSOW Section E.3 - Establish and Distribute Pricing FilesSOW Section E.4 - Statistical Analysis and ReportingSOW Section E.5 - Support Integrity DMEPOS BenefitSOW Section E.6 - Other Contractor ActivitiesGRAND TOTAL
HoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursTotal
COST ELEMENTS
Direct Labor
Labor Category ABC
(Add Appropriate Labor Categories)
Subtotal Direct Labor
Fringe Benefits (at __%)
Purchased Labor
Total Direct Labor
Travel
SUBCONTRACTORS
Subcontractor Name ABC
(Add Subcontractor Names Here)
Total Subcontractor
Other Direct Costs
Other Direct Costs - ABC
(Add Appropriate ODC categories)
Total Other Direct Costs
SUBTOTAL ALL DIRECT COSTS
Overhead @ __%
General and Administrative @ __%
SUBTOTAL COSTS BEFORE FEE
Fixed Fee (at __%)
TOTAL FIRM FIXED PRICE

&L75FCMC18R0010&C&"Arial,Bold"CONTRACTOR NAME GOES HERE

Pricing, Data Analysis and Coding &LJ10 - Cost Template SLIN 0002AA

CLIN-SLIN 0003AA OY1 OPS

COST TEMPLATE
MM/DD/YY - MM/DD/YY
SLIN 0003AA (See SOW Sec E.)SLIN 0003AASLIN 0003AASLIN 0003AASLIN 0003AASLIN 0003AASLIN 0003AA
PDAC Services - Option Period 1 OperationsTotal FTEsSOW Section E.1 - Administer HCPCS Coding DMEPOSSOW Section E.2 - Coding Advice and GuidanceSOW Section E.3 - Establish and Distribute Pricing FilesSOW Section E.4 - Statistical Analysis and ReportingSOW Section E.5 - Support Integrity DMEPOS BenefitSOW Section E.6 - Other Contractor ActivitiesGRAND TOTAL
HoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursTotal
COST ELEMENTS
Direct Labor
Labor Category ABC
(Add Appropriate Labor Categories)
Subtotal Direct Labor
Fringe Benefits (at __%)
Purchased Labor
Total Direct Labor
Travel
SUBCONTRACTORS
Subcontractor Name ABC
(Add Subcontractor Names Here)
Total Subcontractor
Other Direct Costs
Other Direct Costs - ABC
(Add Appropriate ODC categories)
Total Other Direct Costs
SUBTOTAL ALL DIRECT COSTS
Overhead @ __%
General and Administrative @ __%
SUBTOTAL COSTS BEFORE FEE
Fixed Fee (at __%)
TOTAL FIRM FIXED PRICE

&L75FCMC18R0010&C&"Arial,Bold"&12CONTRACTOR NAME GOES HERE

Pricing, Data Analysis, and Coding (PDAC) &LJ10 - Cost Template SLIN 0003AA&C &R&P

CLIN-SLIN 0004AA OY2 OPS

COST TEMPLATE
MM/DD/YY - MM/DD/YY
SLIN 0004AA (See SOW Sec E.)SLIN 0004AASLIN 0004AASLIN 0004AASLIN 0004AASLIN 0004AASLIN 0004AA
PDAC Services - Option Period 2 OperationsTotal FTEsSOW Section E.1 - Administer HCPCS Coding DMEPOSSOW Section E.2 - Coding Advice and GuidanceSOW Section E.3 - Establish and Distribute Pricing FilesSOW Section E.4 - Statistical Analysis and ReportingSOW Section E.5 - Support Integrity DMEPOS BenefitSOW Section E.6 - Other PDAC ActivitiesGRAND TOTAL
HoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursTotal
COST ELEMENTS
Direct Labor
Labor Category ABC
(Add Appropriate Labor Categories)
CL
Subtotal Direct Labor
Fringe Benefits (at __%)
Purchased Labor
Total Direct Labor
Travel
SUBCONTRACTORS
Subcontractor Name ABC
(Add Subcontractor Names Here)
Total Subcontractor
Other Direct Costs
Other Direct Costs - ABC
(Add Appropriate ODC categories)
Total Other Direct Costs
SUBTOTAL ALL DIRECT COSTS
Overhead @ __%
General and Administrative @ __%
SUBTOTAL COSTS BEFORE FEE
Fixed Fee (at __%)
TOTAL FIRM FIXED PRICE

&L75FCMC18R0010&C&"Arial,Bold"&12CONTRACTOR NAME GOES HERE

Pricing, Data Analysis, and Coding (PDAC) &LJ10 -Cost Template SLIN 0004AA&C &R&P

CLIN-SLIN 0005AA OY3 OPS

COST TEMPLATE
MM/DD/YY - MM/DD/YY
SLIN 0005AA (See SOW Sec E.)SLIN 0005AASLIN 0005AASLIN 0005AASLIN 0005AASLIN 0005AASLIN 0005AA
PDAC Services - Option Period 3 OperationsTotal FTEsSOW Section E.1 - Administer HCPCS Coding DMEPOSSOW Section E.2 - Coding Advice and GuidanceSOW Section E.3 - Establish and Distribute Pricing FilesSOW Section E.4 - Statistical Analysis and ReportingSOW Section E.5 - Support Integrity DMEPOS BenefitSOW Section E.6 - Other Contractor ActivitiesGRAND TOTAL
HoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursTotal
COST ELEMENTS
Direct Labor
Labor Category ABC
(Add Appropriate Labor Categories)
Subtotal Direct Labor
Fringe Benefits (at __%)
Purchased Labor
Total Direct Labor
Travel
SUBCONTRACTORS
Subcontractor Name ABC
(Add Subcontractor Names Here)
Total Subcontractor
Other Direct Costs
Other Direct Costs - ABC
(Add Appropriate ODC categories)
Total Other Direct Costs
SUBTOTAL ALL DIRECT COSTS
Overhead @ __%
General and Administrative @ __%
SUBTOTAL COSTS BEFORE FEE
Fixed Fee (at __%)
TOTAL FIRM FIXED PRICE

&L75FCMC18R0010&C&"Arial,Bold"&12CONTRACTOR NAME GOES HERE

Pricing, Data Analysis, and Coding (PDAC) &LJ10 - Cost Template SLIN 0005AA&C &R&P

CLIN-SLIN 0006AA OY4 OPS

COST TEMPLATE
MM/DD/YY - MM/DD/YY
SLIN 0006AA (See SOW Sec E.)SLIN 0006AASLIN 0006AASLIN 0006AASLIN 0006AASLIN 0006AASLIN 0006AA
PDAC Services - Option Period 4 OperationsTotal FTEsSOW Section E.1 - Administer HCPCS Coding DMEPOSSOW Section E.2 - Coding Advice and GuidanceSOW Section E.3 - Establish and Distribute Pricing FilesSOW Section E.4 - Statistical Analysis and ReportingSOW Section E.5 - Support Integrity DMEPOS BenefitSOW Section E.6 - Other PDAC ActivitiesGRAND TOTAL
HoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursTotal
COST ELEMENTS
Direct Labor
Labor Category ABC
(Add Appropriate Labor Categories)
Subtotal Direct Labor
Fringe Benefits (at __%)
Purchased Labor
Total Direct Labor
Travel
SUBCONTRACTORS
Subcontractor Name ABC
(Add Subcontractor Names Here)
Total Subcontractor
Other Direct Costs
Other Direct Costs - ABC
(Add Appropriate ODC categories)
Total Other Direct Costs
SUBTOTAL ALL DIRECT COSTS
Overhead @ __%
General and Administrative @ __%
SUBTOTAL COSTS BEFORE FEE
Fixed Fee (at __%)
TOTAL FIRM FIXED PRICE

&L75FCMC18R0010&C&"Arial,Bold"&12CONTRACTOR NAME GOES HERE

Pricing, Data Analysis, and Coding (PDAC) &LJ10 -Cost Template SLIN 0006AA&C &R&P

CLIN-SLIN 0007AA OY4 TRANSITION

COST TEMPLATE
MM/DD/YY - MM/DD/YY
SLIN 0007AA (See SOW Sec C.2)SLIN 0007AASLIN 0007AASLIN 0007AASLIN 0007AASLIN 0007AA
PDAC Services - Option Period 4 Transition OutTotal FTEsSOW Section C.2.1 - Transfer of PDAC Functions/Data/OpsSOW Section C.2.2 - Transition Out Project PlanSOW Section C.2.3 - MeetingsSOW Section C.2.4 -Transition Out Risk Management PlanOther (Explain in Proposal)GRAND TOTAL
HoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursTotal
COST ELEMENTS
Direct Labor
Labor Category ABC
(Add Appropriate Labor Categories)
Subtotal Direct Labor
Fringe Benefits (at __%)
Purchased Labor
Total Direct Labor
Travel
SUBCONTRACTORS
Subcontractor Name ABC
(Add Subcontractor Names Here)
Total Subcontractor
Other Direct Costs
Other Direct Costs - ABC
(Add Appropriate ODC categories)
Total Other Direct Costs
SUBTOTAL ALL DIRECT COSTS
Overhead @ __%
General and Administrative @ __%
SUBTOTAL COSTS BEFORE FEE
Fixed Fee (at __%)
TOTAL FIRM FIXED PRICE

&L&12 75FCMC18R0010&C&"Arial,Bold"&12CONTRACTOR NAME GOES HERE

Pricing, Data Analysis, and Coding (PDAC) &L&12J10 - Cost Template SLIN 0007AA&C &R&P

C.3

COST TEMPLATE
SLIN 0002AA - C.3C.3.1C.3.2C.3.3C.3.4
DME ServicesTotal FTEsSecurityCompliance ProgramInternal ControlsBusiness Continuity PlanningGRAND TOTAL
HoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursTotal
COST ELEMENTS
Direct Labor
Administrative Assistant0$0.00$00$0.00$00$00$0.00$00$0
Administrative Support0$0.00$00$0.00$00$00$0.00$00$0
Adv Systems Engineer0$0.00$00$0.00$00$00$0.00$00$0
Adv Sys Programming0$0.00$00$0.00$00$00$0.00$00$0
Appeals Representative0$0.00$00$0.00$00$00$0.00$00$0
Application Developer II0$0.00$00$0.00$00$00$0.00$00$0
Biostatistician0$0.00$00$0.00$00$00$0.00$00$0
Business Analyst0$0.00$00$0.00$00$00$0.00$00$0
Business Analyst I0$0.00$00$0.00$00$00$0.00$00$0
Business Analyst II0$0.00$00$0.00$00$00$0.00$00$0
Business Analyst III0$0.00$00$0.00$00$00$0.00$00$0
Claims Processor I0$0.00$00$0.00$00$00$0.00$00$0
Claims Processor II0$0.00$00$0.00$00$00$0.00$00$0
Claims Processor III0$0.00$00$0.00$00$00$0.00$00$0
Claims Team Lead0$0.00$00$0.00$00$00$0.00$00$0
Clerk I0$0.00$00$0.00$00$00$0.00$00$0
Clerk II0$0.00$00$0.00$00$00$0.00$00$0
Computer Operator I0$0.00$00$0.00$00$00$0.00$00$0
Computer Operator II0$0.00$00$0.00$00$00$0.00$00$0
Computer Operator III0$0.00$00$0.00$00$00$0.00$00$0
Customer Service Auditor0$0.00$00$0.00$00$00$0.00$00$0
Customer Service Rep I0$0.00$00$0.00$00$00$0.00$00$0
Customer Service Rep II0$0.00$00$0.00$00$00$0.00$00$0
Customer Service Rep III0$0.00$00$0.00$00$00$0.00$00$0
Customer Service Team Lead0$0.00$00$0.00$00$00$0.00$00$0
Data Analyst II0$0.00$00$0.00$00$00$0.00$00$0
Data Analyst Sr0$0.00$00$0.00$00$00$0.00$00$0
Data Technician0$0.00$00$0.00$00$00$0.00$00$0
Director, Customer Service0$0.00$00$0.00$00$00$0.00$00$0
Director, External Affairs0$0.00$00$0.00$00$00$0.00$00$0
Director, Info Systems0$0.00$00$0.00$00$00$0.00$00$0
Director, MSP0$0.00$00$0.00$00$00$0.00$00$0
Director, Operations0$0.00$00$0.00$00$00$0.00$00$0
DM Clerk I0$0.00$00$0.00$00$00$0.00$00$0
DM Clerk II0$0.00$00$0.00$00$00$0.00$00$0
DM Specialist0$0.00$00$0.00$00$00$0.00$00$0
E-Commerce Consultant0$0.00$00$0.00$00$00$0.00$00$0
EDI Enrollment Spec0$0.00$00$0.00$00$00$0.00$00$0
EDI Helpdesk Analyst0$0.00$00$0.00$00$00$0.00$00$0
EDI Helpdesk Tech0$0.00$00$0.00$00$00$0.00$00$0
EDI Sr Sys Engineer0$0.00$00$0.00$00$00$0.00$00$0
EDI Team Lead0$0.00$00$0.00$00$00$0.00$00$0
Grievance/Appeals Rep Lead0$0.00$00$0.00$00$00$0.00$00$0
Implementation Project Director0$0.00$00$0.00$00$00$0.00$00$0
IT Business System Analyst II0$0.00$00$0.00$00$00$0.00$00$0
Job Control Tech0$0.00$00$0.00$00$00$0.00$00$0
Manager, Appeals0$0.00$00$0.00$00$00$0.00$00$0
Manager, Business Information0$0.00$00$0.00$00$00$0.00$00$0
Manager, Claims0$0.00$00$0.00$00$00$0.00$00$0
Manager, Customer Service0$0.00$00$0.00$00$00$0.00$00$0
Manager, Data Center0$0.00$00$0.00$00$00$0.00$00$0
Manager, External Affairs0$0.00$00$0.00$00$00$0.00$00$0
Manager, Information Security0.000$0.00$00$0.00$00$00$0.00$00$0
Manager, Information Systems0$0.00$00$0.00$00$00$0.00$00$0
Manager, MSP0$0.00$00$0.00$00$00$0.00$00$0
Manager, Operations0$0.00$00$0.00$00$00$0.00$00$0
Manager, Operations Service0$0.00$00$0.00$00$00$0.00$00$0
Manager, Network Data0$0.00$00$0.00$00$00$0.00$00$0
Manager, Performance Enhancement0$0.00$00$0.00$00$00$0.00$00$0
Manager, Sys Programming0$0.00$00$0.00$00$00$0.00$00$0
Mcare Change Request Coor0$0.00$00$0.00$00$00$0.00$00$0
Mcare POE Consultant0$0.00$00$0.00$00$00$0.00$00$0
Medical Director0$0.00$00$0.00$00$00$0.00$00$0
Medical Policy Analyst Sr0$0.00$00$0.00$00$00$0.00$00$0
Mgr I Customer Care0$0.00$00$0.00$00$00$0.00$00$0
Mgr I Grievance/Appeals0$0.00$00$0.00$00$00$0.00$00$0
Mgr I Mcare Operations0$0.00$00$0.00$00$00$0.00$00$0
Mgr II Medical Mgt0$0.00$00$0.00$00$00$0.00$00$0
MR PSC Support Liaison0$0.00$00$0.00$00$00$0.00$00$0
MSP Coordinator0$0.00$00$0.00$00$00$0.00$00$0
Nurse Medical Mgt I0$0.00$00$0.00$00$00$0.00$00$0
Nurse Medical Mgt II0$0.00$00$0.00$00$00$0.00$00$0
Nurse Medical Mgt Lead0$0.00$00$0.00$00$00$0.00$00$0
Operations Forecaster0$0.00$00$0.00$00$00$0.00$00$0
Outreach Congressional Liaison0$0.00$00$0.00$00$00$0.00$00$0
Outreach Media Specialist0$0.00$00$0.00$00$00$0.00$00$0
Outreach Representative0$0.00$00$0.00$00$00$0.00$00$0
Outreach Team Lead0$0.00$00$0.00$00$00$0.00$00$0
Performance Specialist0$0.00$00$0.00$00$00$0.00$00$0
Process Improvement Coordinator0$0.00$00$0.00$00$00$0.00$00$0
Program Safeguard Contractor Liaison0$0.00$00$0.00$00$00$0.00$00$0
Programmer Analyst II0$0.00$00$0.00$00$00$0.00$00$0
Project Manager0$0.00$00$0.00$00$00$0.00$00$0
Provider Relations Research Specialist0$0.00$00$0.00$00$00$0.00$00$0
QA Analyst0$0.00$00$0.00$00$00$0.00$00$0
QI/Compliance Analyst0$0.00$00$0.00$00$00$0.00$00$0
Quality Specialist0$0.00$00$0.00$00$00$0.00$00$0
Recovery Specialist II0$0.00$00$0.00$00$00$0.00$00$0
Refund Investigator0$0.00$00$0.00$00$00$0.00$00$0
Refund Processor I0$0.00$00$0.00$00$00$0.00$00$0
Review Nurse0$0.00$00$0.00$00$00$0.00$00$0
Scheduling Analyst II0$0.00$00$0.00$00$00$0.00$00$0
Security Analyst0$0.00$00$0.00$00$00$0.00$00$0
Senior Business Analyst0$0.00$00$0.00$00$00$0.00$00$0
Senior Data Analyst0$0.00$00$0.00$00$00$0.00$00$0
Senior Programmer Analyst0$0.00$00$0.00$00$00$0.00$00$0
Senior Security Analyst0$0.00$00$0.00$00$00$0.00$00$0
Senior Sys Engineer0$0.00$00$0.00$00$00$0.00$00$0
Senior System Programmer0$0.00$00$0.00$00$00$0.00$00$0
Special Inquiry Representative0$0.00$00$0.00$00$00$0.00$00$0
Sr. Action Plan Coordinator0$0.00$00$0.00$00$00$0.00$00$0
System Programmer0$0.00$00$0.00$00$00$0.00$00$0
Tape Librarian0$0.00$00$0.00$00$00$0.00$00$0
The Project Manager0$0.00$00$0.00$00$00$0.00$00$0
Trainer I0$0.00$00$0.00$00$00$0.00$00$0
Trainer II0$0.00$00$0.00$00$00$0.00$00$0
Claims Processing Manager0$0.00$00$0.00$00$00$0.00$00$0
Subtotal Direct Labor0.000$00$00$00$00$0
Fringe Benefits (at 73.92%)73.92%$073.92%$0$073.92%$0$0
Purchased Labor0$0.00$00$0.00$00$00$0.00$00$0
Total Direct Labor$0$0$0$0$0
Travel$0$0$0$0$0
SUBCONTRACTORS
Subcontractor Name0$00$00$00$00$0
Subcontractor Name0$00$00$00$00$0
Total Subcontractor0$00$00$00$00$0
Other Direct Costs
Bonus$0$0$0$0$0
Consulting$0$0$0$0$0
Data Processing Services$0$0$0$0$0
Depreciation/Amortization Expense$0$0$0$0$0
Desktop Equipment$0$0$0$0$0
Hardware/Software Maintenance$0$0$0$0$0
Mailroom/Scanning$0$0$0$0$0
Medicare Operations Directors$ 3.0278$0$ 3.0278$0$0$ 3.0278$0$0
Occupancy Expense$ 4.5278$0$ 4.5278$0$0$ 4.5278$0$0
Postage$0$0$0$0$0
Print$0$0$0$0$0
Record Storage/General Supplies$0$0$0$0$0
Supplies$0$0$0$0$0
Telephone$0$0$0$0$0
Training & Subscriptions$0$0$0$0$0
Voice/Data Communications$0$0$0$0$0
Total Other Direct Costs$0$0$0$0$0
SUBTOTAL ALL DIRECT COSTS$0$0$0$0$0
Overhead @ 28.64%28.64%$028.64%$0$028.64%$0$0
General and Administrative @ 19.27%19.27%$019.27%$0$019.27%$0$0
SUBTOTAL COSTS BEFORE FEE$0$0$0$0$0
Base Fee (at 1%)1.00%$01.00%$0$01.00%$0$0
Award Fee (at 4%)4.00%$04.00%$0$04.00%$0$0
TOTAL COSTS$0$0$0$0$0$0
Complementary Credits$0$0
TOTAL COSTS$0$0$0$0$0

&C&"Arial,Bold"&12NATIONAL GOVERNMENT SERVICES, INC.

HHSM-500-2006-M0002Z

DME MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)&"Arial,Regular"&10 &L&D SLIN = Sub Line Item Number &F

&C &R

C.3.3

COST TEMPLATE
SLIN 0002AA - C.3.3C.3.3.1C.3.3.2C.3.3.3
DME SERVICESTotal FTEsWritten Policies and ProceduresAttestationCorrecting Internal Control DeficienciesGRAND TOTAL
HoursRatesTotalHoursRatesTotalHoursRatesTotalHoursTotal
COST ELEMENTS
Direct Labor
Administrative Assistant0$0.00$00$0.00$00$0.00$00$0
Administrative Support0$0.00$00$0.00$00$0.00$00$0
Adv Systems Engineer0$0.00$00$0.00$00$0.00$00$0
Adv Sys Programming0$0.00$00$0.00$00$0.00$00$0
Appeals Representative0$0.00$00$0.00$00$0.00$00$0
Application Developer II0$0.00$00$0.00$00$0.00$00$0
Biostatistician0$0.00$00$0.00$00$0.00$00$0
Business Analyst0$0.00$00$0.00$00$0.00$00$0
Business Analyst I0$0.00$00$0.00$00$0.00$00$0
Business Analyst II0$0.00$00$0.00$00$0.00$00$0
Business Analyst III0$0.00$00$0.00$00$0.00$00$0
Claims Processor I0$0.00$00$0.00$00$0.00$00$0
Claims Processor II0$0.00$00$0.00$00$0.00$00$0
Claims Processor III0$0.00$00$0.00$00$0.00$00$0
Claims Team Lead0$0.00$00$0.00$00$0.00$00$0
Clerk I0$0.00$00$0.00$00$0.00$00$0
Clerk II0$0.00$00$0.00$00$0.00$00$0
Computer Operator I0$0.00$00$0.00$00$0.00$00$0
Computer Operator II0$0.00$00$0.00$00$0.00$00$0
Computer Operator III0$0.00$00$0.00$00$0.00$00$0
Customer Service Auditor0$0.00$00$0.00$00$0.00$00$0
Customer Service Rep I0$0.00$00$0.00$00$0.00$00$0
Customer Service Rep II0$0.00$00$0.00$00$0.00$00$0
Customer Service Rep III0$0.00$00$0.00$00$0.00$00$0
Customer Service Team Lead0$0.00$00$0.00$00$0.00$00$0
Data Analyst II0$0.00$00$0.00$00$0.00$00$0
Data Analyst Sr0$0.00$00$0.00$00$0.00$00$0
Data Technician0$0.00$00$0.00$00$0.00$00$0
Director, Customer Service0$0.00$00$0.00$00$0.00$00$0
Director, External Affairs0$0.00$00$0.00$00$0.00$00$0
Director, Info Systems0$0.00$00$0.00$00$0.00$00$0
Director, MSP0$0.00$00$0.00$00$0.00$00$0
Director, Operations0$0.00$00$0.00$00$0.00$00$0
DM Clerk I0$0.00$00$0.00$00$0.00$00$0
DM Clerk II0$0.00$00$0.00$00$0.00$00$0
DM Specialist0$0.00$00$0.00$00$0.00$00$0
E-Commerce Consultant0$0.00$00$0.00$00$0.00$00$0
EDI Enrollment Spec0$0.00$00$0.00$00$0.00$00$0
EDI Helpdesk Analyst0$0.00$00$0.00$00$0.00$00$0
EDI Helpdesk Tech0$0.00$00$0.00$00$0.00$00$0
EDI Sr Sys Engineer0$0.00$00$0.00$00$0.00$00$0
EDI Team Lead0$0.00$00$0.00$00$0.00$00$0
Grievance/Appeals Rep Lead0$0.00$00$0.00$00$0.00$00$0
Implementation Project Director0$0.00$00$0.00$00$0.00$00$0
IT Business System Analyst II0$0.00$00$0.00$00$0.00$00$0
Job Control Tech0$0.00$00$0.00$00$0.00$00$0
Manager, Appeals0$0.00$00$0.00$00$0.00$00$0
Manager, Business Information0$0.00$00$0.00$00$0.00$00$0
Manager, Claims0$0.00$00$0.00$00$0.00$00$0
Manager, Customer Service0$0.00$00$0.00$00$0.00$00$0
Manager, Data Center0$0.00$00$0.00$00$0.00$00$0
Manager, External Affairs0$0.00$00$0.00$00$0.00$00$0
Manager, Information Security0$0.00$00$0.00$00$0.00$00$0
Manager, Information Systems0$0.00$00$0.00$00$0.00$00$0
Manager, MSP0$0.00$00$0.00$00$0.00$00$0
Manager, Operations0$0.00$00$0.00$00$0.00$00$0
Manager, Operations Service0$0.00$00$0.00$00$0.00$00$0
Manager, Network Data0$0.00$00$0.00$00$0.00$00$0
Manager, Performance Enhancement0$0.00$00$0.00$00$0.00$00$0
Manager, Sys Programming0$0.00$00$0.00$00$0.00$00$0
Mcare Change Request Coor0$0.00$00$0.00$00$0.00$00$0
Mcare POE Consultant0$0.00$00$0.00$00$0.00$00$0
Medical Director0$0.00$00$0.00$00$0.00$00$0
Medical Policy Analyst Sr0$0.00$00$0.00$00$0.00$00$0
Mgr I Customer Care0$0.00$00$0.00$00$0.00$00$0
Mgr I Grievance/Appeals0$0.00$00$0.00$00$0.00$00$0
Mgr I Mcare Operations0$0.00$00$0.00$00$0.00$00$0
Mgr II Medical Mgt0$0.00$00$0.00$00$0.00$00$0
MR PSC Support Liaison0$0.00$00$0.00$00$0.00$00$0
MSP Coordinator0$0.00$00$0.00$00$0.00$00$0
Nurse Medical Mgt I0$0.00$00$0.00$00$0.00$00$0
Nurse Medical Mgt II0$0.00$00$0.00$00$0.00$00$0
Nurse Medical Mgt Lead0$0.00$00$0.00$00$0.00$00$0
Operations Forecaster0$0.00$00$0.00$00$0.00$00$0
Outreach Congressional Liaison0$0.00$00$0.00$00$0.00$00$0
Outreach Media Specialist0$0.00$00$0.00$00$0.00$00$0
Outreach Representative0$0.00$00$0.00$00$0.00$00$0
Outreach Team Lead0$0.00$00$0.00$00$0.00$00$0
Performance Specialist0$0.00$00$0.00$00$0.00$00$0
Process Improvement Coordinator0$0.00$00$0.00$00$0.00$00$0
Program Safeguard Contractor Liaison0$0.00$00$0.00$00$0.00$00$0
Programmer Analyst II0$0.00$00$0.00$00$0.00$00$0
Project Manager0$0.00$00$0.00$00$0.00$00$0
Provider Relations Research Specialist0$0.00$00$0.00$00$0.00$00$0
QA Analyst0$0.00$00$0.00$00$0.00$00$0
QI/Compliance Analyst0$0.00$00$0.00$00$0.00$00$0
Quality Specialist0$0.00$00$0.00$00$0.00$00$0
Recovery Specialist II0$0.00$00$0.00$00$0.00$00$0
Refund Investigator0$0.00$00$0.00$00$0.00$00$0
Refund Processor I0$0.00$00$0.00$00$0.00$00$0
Review Nurse0$0.00$00$0.00$00$0.00$00$0
Scheduling Analyst II0$0.00$00$0.00$00$0.00$00$0
Security Analyst0$0.00$00$0.00$00$0.00$00$0
Senior Business Analyst0$0.00$00$0.00$00$0.00$00$0
Senior Data Analyst0$0.00$00$0.00$00$0.00$00$0
Senior Programmer Analyst0$0.00$00$0.00$00$0.00$00$0
Senior Security Analyst0$0.00$00$0.00$00$0.00$00$0
Senior Sys Engineer0$0.00$00$0.00$00$0.00$00$0
Senior System Programmer0$0.00$00$0.00$00$0.00$00$0
Special Inquiry Representative0$0.00$00$0.00$00$0.00$00$0
Sr. Action Plan Coordinator0$0.00$00$0.00$00$0.00$00$0
System Programmer0$0.00$00$0.00$00$0.00$00$0
Tape Librarian0$0.00$00$0.00$00$0.00$00$0
The Project Manager0$0.00$00$0.00$00$0.00$00$0
Trainer I0$0.00$00$0.00$00$0.00$00$0
Trainer II0$0.00$00$0.00$00$0.00$00$0
Claims Processing Manager0$0.00$00$0.00$00$0.00$00$0
Subtotal Direct Labor0.000$00$00$00$0
Fringe Benefits (at 73.92%)73.92%$073.92%$073.92%$0$0
Purchased Labor0$0.00$00$0.00$00$0.00$00$0
Total Direct Labor$0$0$0$0
Travel$0$0$0$0
SUBCONTRACTORS
Subcontractor Name0$00$00$00$0
Subcontractor Name0$00$00$00$0
Total Subcontractor0$00$00$00$0
Other Direct Costs
Bonus$0$0$0$0
Consulting$0$0$0$0
Data Processing Services$0$0$0$0
Depreciation/Amortization Expense$0$0$0$0
Desktop Equipment$0$0$0$0
Hardware/Software Maintenance$0$0$0$0
Mailroom/Scanning$0$0$0$0
Medicare Operations Directors$ 3.0278$0$ 3.0278$0$ 3.0278$0$0
Occupancy Expense$ 4.5278$0$ 4.5278$0$ 4.5278$0$0
Postage$0$0$0$0
Print$0$0$0$0
Record Storage/General Supplies$0$0$0$0
Supplies$0$0$0$0
Telephone$0$0$0$0
Training & Subscriptions$0$0$0$0
Voice/Data Communications$0$0$0$0
Total Other Direct Costs$0$0$0$0
SUBTOTAL ALL DIRECT COSTS$0$0$0$0
Overhead @ 28.64%28.64%$028.64%$028.64%$0$0
General and Administrative @ 19.27%19.27%$019.27%$019.27%$0$0
SUBTOTAL COSTS BEFORE FEE$0$0$0$0
Base Fee (at 1%)1.00%$01.00%$01.00%$0$0
Award Fee (at 4%)4.00%$04.00%$04.00%$0$0
TOTAL COSTS$0$0$0$0
Complementary Credits$0
TOTAL COSTS$0$0$0$0

&C&"Arial,Bold"&12NATIONAL GOVERNMENT SERVICES, INC.

HHSM-500-2006-M0002Z

DME MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)&"Arial,Regular"&10 &L&D

C.4

COST TEMPLATE
SLIN 0002AA - C.4C.4.1
DME ServicesTotal FTEsParticipate in Change Management Process
HoursRatesTotal
COST ELEMENTS
Direct Labor
Administrative Assistant0$0
Administrative Support0$0
Adv Systems Engineer0$0
Adv Sys Programming0$0
Appeals Representative0$0
Application Developer II0$0
Biostatistician0$0
Business Analyst0.000$0
Business Analyst I0$0
Business Analyst II0$0
Business Analyst III0$0
Claims Processor I0$0
Claims Processor II0$0
Claims Processor III0$0
Claims Team Lead0$0
Clerk I0$0
Clerk II0$0
Computer Operator I0$0
Computer Operator II0$0
Computer Operator III0$0
Customer Service Auditor0$0
Customer Service Rep I0$0
Customer Service Rep II0$0
Customer Service Rep III0$0
Customer Service Team Lead0.000$0
Data Analyst II0$0
Data Analyst Sr0$0
Data Technician0$0
Director, Customer Service0$0
Director, External Affairs0$0
Director, Info Systems0$0
Director, MSP0$0
Director, Operations0.000$0
DM Clerk I0$0
DM Clerk II0$0
DM Specialist0$0
E-Commerce Consultant0$0
EDI Enrollment Spec0$0
EDI Helpdesk Analyst0$0
EDI Helpdesk Tech0$0
EDI Sr Sys Engineer0$0
EDI Team Lead0$0
Grievance/Appeals Rep Lead0$0
Implementation Project Director0$0
IT Business System Analyst II0$0
Job Control Tech0$0
Manager, Appeals0$0
Manager, Business Information0.000$0
Manager, Claims0$0
Manager, Customer Service0$0
Manager, Data Center0$0
Manager, External Affairs0$0
Manager, Information Security0$0
Manager, Information Systems0$0
Manager, MSP0$0
Manager, Operations0$0
Manager, Operations Service0$0
Manager, Network Data0$0
Manager, Performance Enhancement0$0
Manager, Sys Programming0$0
Mcare Change Request Coor0$0
Mcare POE Consultant0$0
Medical Director0$0
Medical Policy Analyst Sr0$0
Mgr I Customer Care0$0
Mgr I Grievance/Appeals0$0
Mgr I Mcare Operations0$0
Mgr II Medical Mgt0$0
MR PSC Support Liaison0$0
MSP Coordinator0$0
Nurse Medical Mgt I0$0
Nurse Medical Mgt II0$0
Nurse Medical Mgt Lead0$0
Operations Forecaster0$0
Outreach Congressional Liaison0$0
Outreach Media Specialist0$0
Outreach Representative0$0
Outreach Team Lead0$0
Performance Specialist0$0
Process Improvement Coordinator0.000$0
Program Safeguard Contractor Liaison0$0
Programmer Analyst II0$0
Project Manager0$0
Provider Relations Research Specialist0$0
QA Analyst0$0
QI/Compliance Analyst0.000$0
Quality Specialist0$0
Recovery Specialist II0$0
Refund Investigator0$0
Refund Processor I0$0
Review Nurse0$0
Scheduling Analyst II0$0
Security Analyst0$0
Senior Business Analyst0.000$0
Senior Data Analyst0$0
Senior Programmer Analyst0$0
Senior Security Analyst0$0
Senior Sys Engineer0$0
Senior System Programmer0$0
Special Inquiry Representative0$0
Sr. Action Plan Coordinator0$0
System Programmer0$0
Tape Librarian0$0
The Project Manager0$0
Trainer I0$0
Trainer II0$0
Claims Processing Manager0$0
Subtotal Direct Labor0.000$0
Fringe Benefits (at 73.92%)$0
Purchased Labor0$0
Total Direct Labor$0
Travel$0
SUBCONTRACTORS
Subcontractor Name0$0
Subcontractor Name0$0
Total Subcontractor0$0
Other Direct Costs
Bonus$0
Consulting$0
Data Processing Services$0
Depreciation/Amortization Expense$0
Desktop Equipment$0
Hardware/Software Maintenance$0
Mailroom/Scanning$0
Medicare Operations Directors$0
Occupancy Expense$0
Postage$0
Print$0
Record Storage/General Supplies$0
Supplies$0
Telephone$0
Training & Subscriptions$0
Voice/Data Communications$0
Total Other Direct Costs$0
SUBTOTAL ALL DIRECT COSTS$0
Overhead @ 28.64%$0
General and Administrative @ 19.27%$0
SUBTOTAL COSTS BEFORE FEE$0
Base Fee (at 1%)$0
Award Fee (at 4%)$0
TOTAL COSTS$0
Complementary Credits$0
TOTAL COSTS$0

&C&"Arial,Bold"&12NATIONAL GOVERNMENT SERVICES, INC.

HHSM-500-2006-M0002Z

DME MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)&"Arial,Regular"&10 &L&D

C.4.1

COST TEMPLATE
SLIN 0002AA - C.4.1C.4.1.1C.4.1.2C.4.1.3C.4.1.4
DME ServicesTotal FTEsCompliance with Regulations and General InstructionsReview and Comment on Change RequestsSuccessful Implementation of Change RequestsSuccessful Post Implementation OperationGRAND TOTAL
HoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursTotal
COST ELEMENTS
Direct Labor
Administrative Assistant0$0.00$00$0.00$00$0.00$00$0.00$00$0
Administrative Support0$0.00$00$0.00$00$0.00$00$0.00$00$0
Adv Systems Engineer0$0.00$00$0.00$00$0.00$00$0.00$00$0
Adv Sys Programming0$0.00$00$0.00$00$0.00$00$0.00$00$0
Appeals Representative0$0.00$00$0.00$00$0.00$00$0.00$00$0
Application Developer II0$0.00$00$0.00$00$0.00$00$0.00$00$0
Biostatistician0$0.00$00$0.00$00$0.00$00$0.00$00$0
Business Analyst0.000$0.00$00$0.00$00$0.00$00$0.00$00$0
Business Analyst I0$0.00$00$0.00$00$0.00$00$0.00$00$0
Business Analyst II0$0.00$00$0.00$00$0.00$00$0.00$00$0
Business Analyst III0$0.00$00$0.00$00$0.00$00$0.00$00$0
Claims Processor I0$0.00$00$0.00$00$0.00$00$0.00$00$0
Claims Processor II0$0.00$00$0.00$00$0.00$00$0.00$00$0
Claims Processor III0$0.00$00$0.00$00$0.00$00$0.00$00$0
Claims Team Lead0$0.00$00$0.00$00$0.00$00$0.00$00$0
Clerk I0$0.00$00$0.00$00$0.00$00$0.00$00$0
Clerk II0$0.00$00$0.00$00$0.00$00$0.00$00$0
Computer Operator I0$0.00$00$0.00$00$0.00$00$0.00$00$0
Computer Operator II0$0.00$00$0.00$00$0.00$00$0.00$00$0
Computer Operator III0$0.00$00$0.00$00$0.00$00$0.00$00$0
Customer Service Auditor0$0.00$00$0.00$00$0.00$00$0.00$00$0
Customer Service Rep I0$0.00$00$0.00$00$0.00$00$0.00$00$0
Customer Service Rep II0$0.00$00$0.00$00$0.00$00$0.00$00$0
Customer Service Rep III0$0.00$00$0.00$00$0.00$00$0.00$00$0
Customer Service Team Lead0.000$0.00$00$0.00$00$0.00$00$0.00$00$0
Data Analyst II0$0.00$00$0.00$00$0.00$00$0.00$00$0
Data Analyst Sr0$0.00$00$0.00$00$0.00$00$0.00$00$0
Data Technician0$0.00$00$0.00$00$0.00$00$0.00$00$0
Director, Customer Service0$0.00$00$0.00$00$0.00$00$0.00$00$0
Director, External Affairs0$0.00$00$0.00$00$0.00$00$0.00$00$0
Director, Info Systems0$0.00$00$0.00$00$0.00$00$0.00$00$0
Director, MSP0$0.00$00$0.00$00$0.00$00$0.00$00$0
Director, Operations0.000$0.00$00$0.00$00$0.00$00$0.00$00$0
DM Clerk I0$0.00$00$0.00$00$0.00$00$0.00$00$0
DM Clerk II0$0.00$00$0.00$00$0.00$00$0.00$00$0
DM Specialist0$0.00$00$0.00$00$0.00$00$0.00$00$0
E-Commerce Consultant0$0.00$00$0.00$00$0.00$00$0.00$00$0
EDI Enrollment Spec0$0.00$00$0.00$00$0.00$00$0.00$00$0
EDI Helpdesk Analyst0$0.00$00$0.00$00$0.00$00$0.00$00$0
EDI Helpdesk Tech0$0.00$00$0.00$00$0.00$00$0.00$00$0
EDI Sr Sys Engineer0$0.00$00$0.00$00$0.00$00$0.00$00$0
EDI Team Lead0$0.00$00$0.00$00$0.00$00$0.00$00$0
Grievance/Appeals Rep Lead0$0.00$00$0.00$00$0.00$00$0.00$00$0
Implementation Project Director0$0.00$00$0.00$00$0.00$00$0.00$00$0
IT Business System Analyst II0$0.00$00$0.00$00$0.00$00$0.00$00$0
Job Control Tech0$0.00$00$0.00$00$0.00$00$0.00$00$0
Manager, Appeals0$0.00$00$0.00$00$0.00$00$0.00$00$0
Manager, Business Information0.000$0.00$00$0.00$00$0.00$00$0.00$00$0
Manager, Claims0$0.00$00$0.00$00$0.00$00$0.00$00$0
Manager, Customer Service0$0.00$00$0.00$00$0.00$00$0.00$00$0
Manager, Data Center0$0.00$00$0.00$00$0.00$00$0.00$00$0
Manager, External Affairs0$0.00$00$0.00$00$0.00$00$0.00$00$0
Manager, Information Security0$0.00$00$0.00$00$0.00$00$0.00$00$0
Manager, Information Systems0$0.00$00$0.00$00$0.00$00$0.00$00$0
Manager, MSP0$0.00$00$0.00$00$0.00$00$0.00$00$0
Manager, Operations0$0.00$00$0.00$00$0.00$00$0.00$00$0
Manager, Operations Service0$0.00$00$0.00$00$0.00$00$0.00$00$0
Manager, Network Data0$0.00$00$0.00$00$0.00$00$0.00$00$0
Manager, Performance Enhancement0$0.00$00$0.00$00$0.00$00$0.00$00$0
Manager, Sys Programming0$0.00$00$0.00$00$0.00$00$0.00$00$0
Mcare Change Request Coor0$0.00$00$0.00$00$0.00$00$0.00$00$0
Mcare POE Consultant0$0.00$00$0.00$00$0.00$00$0.00$00$0
Medical Director0$0.00$00$0.00$00$0.00$00$0.00$00$0
Medical Policy Analyst Sr0$0.00$00$0.00$00$0.00$00$0.00$00$0
Mgr I Customer Care0$0.00$00$0.00$00$0.00$00$0.00$00$0
Mgr I Grievance/Appeals0$0.00$00$0.00$00$0.00$00$0.00$00$0
Mgr I Mcare Operations0$0.00$00$0.00$00$0.00$00$0.00$00$0
Mgr II Medical Mgt0$0.00$00$0.00$00$0.00$00$0.00$00$0
MR PSC Support Liaison0$0.00$00$0.00$00$0.00$00$0.00$00$0
MSP Coordinator0$0.00$00$0.00$00$0.00$00$0.00$00$0
Nurse Medical Mgt I0$0.00$00$0.00$00$0.00$00$0.00$00$0
Nurse Medical Mgt II0$0.00$00$0.00$00$0.00$00$0.00$00$0
Nurse Medical Mgt Lead0$0.00$00$0.00$00$0.00$00$0.00$00$0
Operations Forecaster0$0.00$00$0.00$00$0.00$00$0.00$00$0
Outreach Congressional Liaison0$0.00$00$0.00$00$0.00$00$0.00$00$0
Outreach Media Specialist0$0.00$00$0.00$00$0.00$00$0.00$00$0
Outreach Representative0$0.00$00$0.00$00$0.00$00$0.00$00$0
Outreach Team Lead0$0.00$00$0.00$00$0.00$00$0.00$00$0
Performance Specialist0$0.00$00$0.00$00$0.00$00$0.00$00$0
Process Improvement Coordinator0.000$0.00$00$0.00$00$0.00$00$0.00$00$0
Program Safeguard Contractor Liaison0$0.00$00$0.00$00$0.00$00$0.00$00$0
Programmer Analyst II0$0.00$00$0.00$00$0.00$00$0.00$00$0
Project Manager0$0.00$00$0.00$00$0.00$00$0.00$00$0
Provider Relations Research Specialist0$0.00$00$0.00$00$0.00$00$0.00$00$0
QA Analyst0$0.00$00$0.00$00$0.00$00$0.00$00$0
QI/Compliance Analyst0.000$0.00$00$0.00$00$0.00$00$0.00$00$0
Quality Specialist0$0.00$00$0.00$00$0.00$00$0.00$00$0
Recovery Specialist II0$0.00$00$0.00$00$0.00$00$0.00$00$0
Refund Investigator0$0.00$00$0.00$00$0.00$00$0.00$00$0
Refund Processor I0$0.00$00$0.00$00$0.00$00$0.00$00$0
Review Nurse0$0.00$00$0.00$00$0.00$00$0.00$00$0
Scheduling Analyst II0$0.00$00$0.00$00$0.00$00$0.00$00$0
Security Analyst0$0.00$00$0.00$00$0.00$00$0.00$00$0
Senior Business Analyst0.000$0.00$00$0.00$00$0.00$00$0.00$00$0
Senior Data Analyst0$0.00$00$0.00$00$0.00$00$0.00$00$0
Senior Programmer Analyst0$0.00$00$0.00$00$0.00$00$0.00$00$0
Senior Security Analyst0$0.00$00$0.00$00$0.00$00$0.00$00$0
Senior Sys Engineer0$0.00$00$0.00$00$0.00$00$0.00$00$0
Senior System Programmer0$0.00$00$0.00$00$0.00$00$0.00$00$0
Special Inquiry Representative0$0.00$00$0.00$00$0.00$00$0.00$00$0
Sr. Action Plan Coordinator0$0.00$00$0.00$00$0.00$00$0.00$00$0
System Programmer0$0.00$00$0.00$00$0.00$00$0.00$00$0
Tape Librarian0$0.00$00$0.00$00$0.00$00$0.00$00$0
The Project Manager0$0.00$00$0.00$00$0.00$00$0.00$00$0
Trainer I0$0.00$00$0.00$00$0.00$00$0.00$00$0
Trainer II0$0.00$00$0.00$00$0.00$00$0.00$00$0
Claims Processing Manager0$0.00$00$0.00$00$0.00$00$0.00$00$0
Subtotal Direct Labor0.000$00$00$00$00$0
Fringe Benefits (at 73.92%)73.92%$073.92%$073.92%$073.92%$0$0
Purchased Labor0$0.00$00$0.00$00$0.00$00$0.00$00$0
Total Direct Labor$0$0$0$0$0
Travel$0$0$0$0$0
SUBCONTRACTORS
Subcontractor Name0$00$00$00$00$0
Subcontractor Name0$00$00$00$00$0
Total Subcontractor0$00$00$00$00$0
Other Direct Costs
Bonus$0$0$0$0$0
Consulting$0$0$0$0$0
Data Processing Services$0$0$0$0$0
Depreciation/Amortization Expense$0$0$0$0$0
Desktop Equipment$0$0$0$0$0
Hardware/Software Maintenance$0$0$0$0$0
Mailroom/Scanning$0$0$0$0$0
Medicare Operations Directors$ 3.0278$0$ 3.0278$0$ 3.0278$0$ 3.0278$0$0
Occupancy Expense$ 4.5278$0$ 4.5278$0$ 4.5278$0$ 4.5278$0$0
Postage$0$0$0$0$0
Print$0$0$0$0$0
Record Storage/General Supplies$0$0$0$0$0
Supplies$0$0$0$0$0
Telephone$0$0$0$0$0
Training & Subscriptions$0$0$0$0$0
Voice/Data Communications$0$0$0$0$0
Total Other Direct Costs$0$0$0$0$0
SUBTOTAL ALL DIRECT COSTS$0$0$0$0$0
Overhead @ 28.64%28.64%$028.64%$028.64%$028.64%$0$0
General and Administrative @ 19.27%19.27%$019.27%$019.27%$019.27%$0$0
SUBTOTAL COSTS BEFORE FEE$0$0$0$0$0
Base Fee (at 1%)1.00%$01.00%$01.00%$01.00%$0$0
Award Fee (at 4%)4.00%$04.00%$04.00%$04.00%$0$0
TOTAL COSTS$0$0$0$0$0$0
Complementary Credits$0
TOTAL COSTS$0$0$0$0$0

&C&"Arial,Bold"&12NATIONAL GOVERNMENT SERVICES, INC.

HHSM-500-2006-M0002Z

DME MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)&"Arial,Regular"&10 &L&D

C.5

COST TEMPLATE
SLIN 0002AA - C.5C.5.1C.5.2C.5.3C.5.4C.5.5C.5.6C.5.7C.5.8
DME ServicesTotal FTEsTrust FundBanking RelationsOverpaymentDebt CollectionDebt ReferralRefunds RequestOverpay BankruptcyFinancial Reporting & AccountingGRAND TOTAL
HoursRatesTotalHoursRatesTotalHoursRatesTotalHoursTotal
COST ELEMENTS
Direct Labor
Administrative Assistant0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Administrative Support0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Adv Systems Engineer0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Adv Sys Programming0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Appeals Representative0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Application Developer II0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Biostatistician0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Business Analyst0.000$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Business Analyst I0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Business Analyst II0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Business Analyst III0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Claims Processor I0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Claims Processor II0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Claims Processor III0.000$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Claims Team Lead0.000$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Clerk I0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Clerk II0.000$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Computer Operator I0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Computer Operator II0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Computer Operator III0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Customer Service Auditor0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Customer Service Rep I0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Customer Service Rep II0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Customer Service Rep III0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Customer Service Team Lead0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Data Analyst II0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Data Analyst Sr0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Data Technician0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Director, Customer Service0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Director, External Affairs0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Director, Info Systems0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Director, MSP0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Director, Operations0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
DM Clerk I0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
DM Clerk II0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
DM Specialist0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
E-Commerce Consultant0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
EDI Enrollment Spec0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
EDI Helpdesk Analyst0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
EDI Helpdesk Tech0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
EDI Sr Sys Engineer0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
EDI Team Lead0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Grievance/Appeals Rep Lead0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Implementation Project Director0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
IT Business System Analyst II0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Job Control Tech0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0
Manager, Appeals0$0.00$00$0.00$00$00$00$00$0.00$00$0.00$00$00$0

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