J.23.B Government Provided Proposal Assumptions CSR-Handled Telephone Inquiries Tables.docx
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- Solicitation number
- 75FCMC19R0023
About this file
This document contains templates for offerors responding to a solicitation for Medicare Part A and B administrative services in Jurisdiction E. The solicitation seeks a Medicare Administrative Contractor to process claims and payments, establish provider relationships, and ensure program integrity for California, Hawaii, Nevada, American Samoa, Guam, and the Northern Mariana Islands. Offerors must complete tables projecting telephone inquiries volumes for the base period and six option years, using or adjusting call volume estimates provided. Those adjusting estimates must explain variances from historical call-to-claim ratios. The solicitation is expected to be released on September 4, 2019, with proposals due November 4, 2019 and award anticipated for August 4, 2020. The contract includes a base year and six one-year options performed in accordance with Medicare laws and manuals.
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Attachment J.23 B Government Provided Proposal Assumptions CSR-Handled Telephone Inquiries Tables
RFP # 75FCMC19R0023
Provider Customer Service Program (PCSP) CSR-Handled A/B Telephone Inquiries Tables
Complete and include the following table for CSR-Handled Telephone Inquiries A/B. Offerors that propose to apply the CMS- provided workload estimates for CSR-handled provider telephone inquiries (shown in Row C of each Table below as well as in Attachment J.22, Basis of Estimate, Row 115, Column F) need only complete Row E (CMS has pre-filled Rows A through D) and submit only Rows A through E as part of its proposal. In this case the Offeror must also clearly confirm (in the PCSP section of the proposal) that its technical approach and staffing plan are based on the CMS-provided workload estimates for CSR-handled inquiries. Offerors that propose to adjust (overwrite or derive) the CMS-provided workloads for CSR-handled provider calls must complete Rows E through K and submit the tables in full, Rows A through K, and also provide the required narrative explanation. Further, such Offerors must provide conforming data in the BOE, in keeping with the BOE instructions. Finally, Offerors must align their staffing plans under Tab E to their proposed workloads for CSR-handled provider telephone inquiries.
Table 1 – CSR-Handled A/B Telephone Inquiries Workload
| Row |
| Workload/Proposal Element |
| BP |
| OY1 |
| OY2 |
| OY3 |
| OY4 |
| OY5 |
| OY6 |
| a |
| CMS-Projected A/B Claims Volume |
(BOE, column E, sum of rows 8, 18)
| 57,932,347 |
| 114,412,362 |
| 116,545,803 |
| 118,724,068 |
| 120,948,253 |
| 123,219,483 |
| 125,538,917 |
| b |
| CMS-Projected A/B Telephone Inquiries Volume |
(BOE, row 115, column E)
| 872,223 |
| 1,688,174 |
| 1,688,174 |
| 1,688,174 |
| 1,688,174 |
| 1,688,174 |
| 1,688,174 |
| c |
| CMS-Projected A/B CSR- Handled Telephone Inquiries Volume |
(BOE, row 115, column F as solicited)
| 392,697 |
| 760,058 |
| 729,656 |
| 700,469 |
| 672,451 |
| 645,553 |
| 619,731 |
| d |
| CMS-Projected Ratio of A/B CSR- Handled Calls to Claims |
(row d = row c ÷ row a)
| 0.00678 |
| 0.00664 |
| 0.00626 |
| 0.00590 |
| 0.00556 |
| 0.00524 |
| 0.00494 |
| e |
| Offeror’s Proposed A/B CSR- Handled Telephone Inquiries Volume |
(BOE, row 115 Col. F). Add explanation below and in BOE, row 115, Col. N, if change from CMS RFP projection.
| (fill in whether Offeror uses CMS row c or proposes a new CSR volume) |
| (fill in whether Offeror uses CMS row c or proposes a new CSR volume) |
| (fill in whether Offeror uses CMS row c or proposes a new CSR volume) |
| (fill in whether Offeror uses CMS row c or proposes a new CSR volume) |
| (fill in whether Offeror uses CMS row c or proposes a new CSR volume) |
| (fill in whether Offeror uses CMS row c or proposes a new CSR volume) |
| (fill in whether Offeror uses CMS row c or proposes a new CSR volume) |
| f |
| Offeror’s Proposed Ratio of A/B CSR-Handled Calls to Claims |
(row f = row e ÷ row a)
| (fill in only if row c and row e differ) |
| (fill in only if row c and row e differ) |
| (fill in only if row c and row e differ) |
| (fill in only if row c and row e differ) |
| (fill in only if row c and row e differ) |
| (fill in only if row c and row e differ) |
| (fill in only if row c and row e differ) |
| Row |
| Offeror’s Baseline Contract: |
<contract name>
(Insert contract name and complete rows g through k below, if rows e and f above differ from rows c and d)
| CY 2016 |
| CY 2017 |
| CY 2018 |
| g |
| CY Total A/B Claims Volume (Processed) for Baseline Contract |
| h |
| CY Total A/B Telephone Inquiries Volume (All Calls Received at PCC (CSR-handled and IVR- handled) for Baseline Contract |
| i |
| CY Total A/B CSR-Handled Telephone Inquiries Volume for Baseline Contract |
| j |
| CY Historic Actual Ratio of A/B CSR-Handled Calls to Claims for Baseline Contract |
| k |
| Offeror’s Rationale/Explanation for Changing the CMS-Projected A/B CSR Call Volume: |
Provide a narrative response of why Offeror proposes adjustments to CMS-projected A/B CSR call volume, i.e., why do rows e and f differ from rows c and d. If applicable, also provide a narrative response of why Offeror proposes a different call-to-claim ratio than it achieves in its own historic contract performance (historic call-to-claim ratio), i.e., why do rows j and f differ.
January 10, 2019 Page 3 of 3
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