Attachment 6 – True-Up: Beneficiary Quantities, Claims Volume, and Unit Pricing for Medicare Claims Processing Software

1. Purpose This Attachment establishes the estimated beneficiary quantities, estimated claims volume, and fixed unit prices used to calculate the firm-fixed prices for the CLINs subject to the annual prospective price adjustment (“True-Up”) as described in Special Contract Requirements Section, True-Up Clause, of this Task OrderContract.

Offerors may propose pricing using one of the following methodologies:

· Beneficiary-Based (PMPM) Pricing

· Claims Volume-Based (Per Claim) Pricing

2. Applicable CLINs The beneficiary quantities, claims volume, and unit prices identified in this Attachment apply solely to the following CLINs, which are subject to prospective adjustment:

- CLIN 0004

- CLIN 0006

- CLIN 0008

- CLIN 0010

- CLIN 0012

- CLIN 0014

The following CLINs are expressly excluded from adjustment under the True-Up Clause and are not reflected in the calculations herein:

- CLIN 0002

3. Unit Pricing Assumptions

- Unit prices are firm-fixed monthly prices per unique beneficiary (i.e., Per Member / Per Month (PMPM)) or price per claim processed.

- Prices apply to software services as defined in the Performance Work Statement (PWS).

- Beneficiary counts are based on unique beneficiaries per month processed through the Contractor’s software system.

- Claims counts are based on unique claims received per month processed through the contractor software systems.

- The estimated annual quantity reflects the projected average monthly beneficiary count multiplied by twelve (12) months.

4. Estimated Beneficiary Quantities and Unit Prices The tables below identifies identify the estimated beneficiary quantities and unit prices applicable to the CLINs subject to adjustment.

A. Beneficiary-Based Pricing (PMPM) Unit prices shall be firm-fixed monthly prices per unique beneficiary.

Calculated Annual CLIN Price Formula:

Estimated Average Monthly Beneficiaries × Unit Price × 12 Months

B. Claims Volume-Based Pricing (Per Claim) Unit prices shall be firm-fixed prices per processed claim.

Annual CLIN Price Formula:

Estimated Average Monthly Claims Volume × Unit Price per Claim × 12 Months

5. Annual True-Up Submission Requirements In accordance with the True-Up Clause, the Contractor shall submit an updated version of this Attachment in MS Excel format no later than 90 days prior to the end of the current period of performance, reflecting:

- Actual average monthly unique beneficiary counts for the current period

- Revised projected beneficiary quantities or claims volume for all forthcoming option periods (for informational purposes only).

- Recalculated prospective CLIN prices using the fixed unit rates identified herein

The revised Attachment shall be accompanied by:

- Supporting basis of estimate for projected beneficiary or claim volumes

- Historical beneficiary or claim volume trends from the current period of performance

- Identification of any anticipated changes in beneficiary population or claim volume that may impact pricing (e.g., MAC cut-overs)

6. Price Adjustment Process Following CMS review of the submitted report and revised Attachment 6, the Contracting Officer may adjust the prices of the applicable CLINs for the subsequent option period via unilateral modification. All adjustments will be prospective only. No retrospective price adjustments will be made for differences between estimated and actual beneficiary quantities or claims volume.

Table 1: Estimated Beneficiary Quantities and Unit Prices Table

*For the solicitation/proposal purposes, CMS is using a 2025 monthly National Average.

Table 2: Estimated Claim Volume and Unit Prices Table

(Per Claim) Calculated Annual Price