A19-J.11-PWS TECHNICAL EXHIBIT 3E- DME AND DIAGNOSTICS BILLS FOR ALL PROGRAMS.xlsx

XLSX spreadsheet 16 MB Posted

Attached to
PHARMACY BENEFITS MANAGEMENT SERVICES (PBM) Federal contract opportunity
Solicitation number
1605C3-24-R-00011
Issued by
Department of Labor Office of the Assistant Secretary for Administration and Management

About this file

Written by GovTribe AI ·

This document appears to be a technical exhibit for the Pharmacy Benefits Management Services (PBM) solicitation, which is a single-award fixed-price contract issued by the Department of Labor (DOL), Office of Workers' Compensation Programs (OWCP). The solicitation requires PBM services on behalf of the DOL. Key details include:

The due date for proposal submissions will be provided in a later amendment to the solicitation. Questions regarding the RFP must be submitted via email by October 21, 2024, using the provided Q&A spreadsheet template. Vendor questions will be responded to through amendments posted on sam.gov. The technical exhibit provided appears to contain details on durable medical equipment (DME) and diagnostic bills for all programs, but does not directly address the required PBM services or other solicitation requirements. No further information is provided in this document about the scope of work, pricing, set-asides, or other salient details of the PBM solicitation.

View the file

Other files for this federal contract opportunity

Other files attached to PHARMACY BENEFITS MANAGEMENT SERVICES (PBM), newest first.
File Type Posted
RFP PBM Amend 0004.pdf PDF
1605C3-24-R-00011 Amend 00003.pdf PDF
QAs Amend 0002- FINAL.pdf PDF
RFP PBM Amend 0002.pdf PDF
A19-J.14 - PWS TECHNICAL EXHIBIT 6 - FULL PASS THROUGH PRICING EXAMPLES.docx DOCX document
A19-J.17 - OWCP Award Term Plan-.docx DOCX document
PBM III QUESTION_AND_ANSWERS.xlsx XLSX spreadsheet
A19 - REVISED SOLICITATION 1605C3-24-R-00011.pdf PDF
A19-J.4 – PBM DISCOUNT REBATE FEES WORKBOOK rev.xlsx XLSX spreadsheet
A19-J.15 - DOL Cybersecurity Policy Portfolio.pdf PDF
A19-J16- DLMS 7 Chapter 1100.pdf PDF
A19-J.3 - QUESTION AND ANSWER SPREADSHEET.xlsx XLSX spreadsheet
A19-J.1 – PAST PERFORMANCE QUESTIONNAIRE.docx DOCX document
A19-J.10-PWS TECHNICAL EXHIBIT 3D-CY2023 PHARMACY TRANSACTIONS FOR THE LS PROGRAM.xlsx XLSX spreadsheet
A19-J.12- PWS TECHNICAL EXHIBIT 4- STAFF PORTAL DATA ELEMENTS (2).docx DOCX document
A19-J.8 -PWS TECHNICAL EXHIBIT 3B- CY2023 PHARMACY TRANSACTIONS FOR THE DEEOIC PROGRAM.xlsx XLSX spreadsheet
A19-J.7-PWS TECHNICAL EXHIBIT 3A- CY2023 PHARMACY TRANSACTIONS FOR THE DCMWC PROGRAM (1).xlsx XLSX spreadsheet
A19-J.5-PWS TECHNICAL EXHIBIT 1- PERFORMANCE REQUIREMENTS SUMMARY.docx DOCX document
RFP 1605C3-24-R-00011.pdf PDF
A19-J.6-PWS TECHNICAL EXHIBIT 2- DELIVERABLES SCHEDULE (1).docx DOCX document
A19-J.2 – SMALL BUSINESS SUBCONTRACTING PLAN TEMPLATE 9.29.24.xlsx XLSX spreadsheet
A19-J.13 -PWS TECHNICAL EXHIBIT 5- EXAMPLES OF FORMULARY FILES AND THEIR REQUIRED DATA (1).xlsx XLSX spreadsheet
A19-J.9 -PWS TECHNICAL EXHIBIT 3C- CY2023 PHARMACY TRANSACTIONS FOR THE FECA PROGRAM.xlsx XLSX spreadsheet
A19-J.4 – PBM DISCOUNT REBATE FEES WORKBOOK.xlsx XLSX spreadsheet
Show all 24

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FECA DME

ProgramTCNLine TCNOWCP Case Number (Redacted)Claimant ZIPFrom Date of ServiceTo Date of ServiceProcedure CodeModifierBilled UnitsPaid Date
FECA11023256038506000000123d79588-c8e5-41d6-900c-ea26f1a9bdd9296252023081920230819E0143NU12023-09-22 00:00:00
FECA11023256038507000000523d79588-c8e5-41d6-900c-ea26f1a9bdd9296252023082420230824E0163NU12023-09-22 00:00:00
FECA11023256038507000000323d79588-c8e5-41d6-900c-ea26f1a9bdd9296252023081820230818E0240NU12023-09-22 00:00:00
FECA11023256038507000000123d79588-c8e5-41d6-900c-ea26f1a9bdd9296252023083020230830E0244NU12023-09-22 00:00:00
FECA11023217046107000000140e0803a-10b4-491b-acb0-73f6931320f5377452023072120230721E0143NU12023-08-18 00:00:00
FECA11023217046108000000140e0803a-10b4-491b-acb0-73f6931320f5377452023072420230724E0165NU12023-08-18 00:00:00
FECA3002313804633900000012071f0fb-422c-4f02-9987-fba944a81034988262023051020230510E0114NU12023-05-26 00:00:00
FECA2002306703689700000018439acda-c587-4391-b964-e5ced819f352344762023020620230307E0217RR302023-03-17 00:00:00
FECA2002307505420300000018439acda-c587-4391-b964-e5ced819f352344762023031620230316E0730NU12023-03-24 00:00:00
FECA2002309704771700000018439acda-c587-4391-b964-e5ced819f352344762023030820230406E0217RR302023-04-21 00:00:00
FECA2002312801476700000018439acda-c587-4391-b964-e5ced819f352344762023040720230506E0217RR302023-05-19 00:00:00
FECA10023068045874000000101934b87-46d2-4739-9f1e-082dfaadc3fd031022023020320230203E0747NU12023-03-17 00:00:00
FECA20023345024031000000680c14a91-fc59-4749-b285-aa1b3dd50345315582023110620231106E1399NU12023-12-29 00:00:00
FECA10023175046220000000139dc22e4-6ca3-4dbf-abda-487df8b55b7b031042023060820230608E0114NU12023-07-07 00:00:00
FECA100232990645440000001e0af86b1-3928-461d-b473-cc21f6c659d5864452023091920230919E0730NU12023-11-03 00:00:00
FECA200230440127890000001bbe210c8-5b71-480b-8e19-26b9be5451fb853442023010820230207E1841RR12023-02-24 00:00:00
FECA200230720124850000001bbe210c8-5b71-480b-8e19-26b9be5451fb853442023020820230307E1841RR12023-03-24 00:00:00
FECA200230970431730000001bbe210c8-5b71-480b-8e19-26b9be5451fb853442023030820230407E1841RR12023-04-21 00:00:00
FECA10023073030054000000307d0790c-1e7a-474c-a3a6-c9fbcf091855038202023030720230307E0940NU12023-03-24 00:00:00
FECA10023073030054000000107d0790c-1e7a-474c-a3a6-c9fbcf091855038202023030720230307E0265NU12023-03-24 00:00:00
FECA3002322305551500000015d1592a0-881b-454d-8a3a-40e048ef3e16049112023080820230808E0114NU12023-08-25 00:00:00
FECA200233110375610000001a84b95ea-f2e7-4cc3-9df6-84ec68e7cbdd030772023102520231025E0114NU12023-11-17 00:00:00
FECA200230800141170000001dbc0f562-df59-4d5a-a4fa-901824d82ff8040272023030120230301E0218NU12023-03-31 00:00:00
FECA100230820381820000001d947755e-899e-4d05-8d16-28865273b29a328222023030820230308E0860NU12023-03-31 00:00:00
FECA300232850594900000001eefb46ca-3156-4d09-b158-e78f24ddb223840202023101020231010E0730NU12023-10-20 00:00:00
FECA1002306804690400000025a3f5f5d-5ff5-4829-9da8-55f5366a7f1f339282023022520230225E1399NU12023-04-07 00:00:00
FECA200230740416030000002ab9adb62-f89b-4d17-87f2-8ef5f9e46c46856412023031020230310E0731NU12023-03-24 00:00:00
FECA1002402404586300000016a3a956b-0a13-4228-87a2-39a19dddf3b40435130382023092220230922E0114NU12024-02-02 00:00:00
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FECA100232440691550000001617a7fec-44cb-4c5c-8fb4-5fbeb7920e07123022023081720230817E0114NU12023-09-15 00:00:00
FECA200230040441330000001afddfdeb-2bbe-4389-8391-5dec5482ec3d785422023010320230103E022512023-01-13 00:00:00
FECA200230050496240000001afddfdeb-2bbe-4389-8391-5dec5482ec3d785422023010520230105E022512023-01-13 00:00:00
FECA200230120372160000001afddfdeb-2bbe-4389-8391-5dec5482ec3d785422023011020230110E022512023-01-20 00:00:00
FECA200230120533570000001afddfdeb-2bbe-4389-8391-5dec5482ec3d785422023011220230112E022512023-01-20 00:00:00
FECA200230180417640000001afddfdeb-2bbe-4389-8391-5dec5482ec3d785422023011620230116E022512023-01-27 00:00:00
FECA200230190411110000001afddfdeb-2bbe-4389-8391-5dec5482ec3d785422023011820230118E022512023-01-27 00:00:00
FECA200230190470140000001afddfdeb-2bbe-4389-8391-5dec5482ec3d785422023011920230119E022512023-01-27 00:00:00
FECA1002326203766700000016671bcff-4ead-45f7-bef3-bf9b183a94d7043302023060620230606E0114NU12023-09-29 00:00:00
FECA100240380584840000002eacb3cdf-88ba-4d5a-a1b6-b95bfd3d93d1049012023121520231215E0114NU12024-02-16 00:00:00
FECA300232050261140000001a8c30684-10d0-4130-ad65-7325b8cf6946044012023052320230523E0114NU12023-08-04 00:00:00
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FECA300230270492980000001825f27d8-a2fb-485c-9fde-46bd3cd9992e120902023012020230120E021812023-02-10 00:00:00
FECA10023200028812000000131b5a505-f7a8-4161-88a3-48a32b1e42d5770732023061620230616E0730NU12023-07-28 00:00:00
FECA1002403602756300000058ab2c497-f957-48c8-95a2-25fbeff7dc76750712023112420231124E0114NU12024-02-16 00:00:00
FECA2002335202862500000038ab2c497-f957-48c8-95a2-25fbeff7dc76750712023121420231214E0100NU12023-12-29 00:00:00
FECA1002329904147500000010eb8efea-68c4-48b2-8c9a-27639c0e1f50054882023063020230630E0114NU12023-11-03 00:00:00
FECA110230730321090000002c73747d7-b9e5-4c3a-bc13-cb1fd9a07928064842023020620230206E139912023-03-24 00:00:00
FECA100230400595530000003b1c73c77-44cb-4459-af44-77d7acb51403060402023012720230127E0100NU12023-02-17 00:00:00
FECA10024080052043000000116cac5ed-f2f0-47f6-b605-e74a17321e53059032023101920231019E0218LT12024-03-29 00:00:00
FECA30023355053727000000527a854d4-daad-42e3-b9db-24114c1057aa306062023071820230718E0114NU12023-12-29 00:00:00
FECA2002306204445700000016e08d1f6-949e-4eef-b1ba-482c0abe1452021802023011820230213E0935RR272023-03-17 00:00:00
FECA2002306204700300000016e08d1f6-949e-4eef-b1ba-482c0abe1452021802023021420230216E0935RR32023-03-17 00:00:00
FECA2002308804167400000016e08d1f6-949e-4eef-b1ba-482c0abe1452021802023021720230315E0935RR272023-04-07 00:00:00
FECA2002309402389900000016e08d1f6-949e-4eef-b1ba-482c0abe1452021802023031620230316E0935RR32023-04-14 00:00:00
FECA2002314201371400000016e08d1f6-949e-4eef-b1ba-482c0abe1452021802023042220230521E1810RR12023-06-02 00:00:00
FECA2002317205479200000016e08d1f6-949e-4eef-b1ba-482c0abe1452021802023052220230621E1810RR12023-06-30 00:00:00
FECA2002323603689800000016e08d1f6-949e-4eef-b1ba-482c0abe1452021802023072420230824E1810RR12023-09-01 00:00:00
FECA2002329905083300000016e08d1f6-949e-4eef-b1ba-482c0abe1452021802023062320230723E1810RR12023-11-03 00:00:00
FECA2002329905169600000016e08d1f6-949e-4eef-b1ba-482c0abe1452021802023082520230925E1810RR12023-11-03 00:00:00
FECA2002329905211800000016e08d1f6-949e-4eef-b1ba-482c0abe1452021802023092620231026E1810RR12023-11-03 00:00:00
FECA2002333202559500000016e08d1f6-949e-4eef-b1ba-482c0abe1452021802023102720231126E1810RR12023-12-08 00:00:00
FECA2002336103240600000016e08d1f6-949e-4eef-b1ba-482c0abe1452021802023112720231227E1810RR12024-01-05 00:00:00
FECA2002403104648600000016e08d1f6-949e-4eef-b1ba-482c0abe1452021802023122820240127E1810RR12024-02-09 00:00:00
FECA10023128024225000000148538cb0-ef4d-4898-89ac-42841667645d019062023033020230330E1810RR12023-05-19 00:00:00
FECA10023158084833000000148538cb0-ef4d-4898-89ac-42841667645d019062023043020230430E1810RR12023-06-16 00:00:00
FECA10023222062016000000148538cb0-ef4d-4898-89ac-42841667645d019062023063020230630E1810RR12023-08-18 00:00:00
FECA100233400381720000001d68c5435-eac3-4112-9ca0-4840b1d1b6c60234313202023112020231120E0730NU12023-12-15 00:00:00
FECA300231940504460000001d68c5435-eac3-4112-9ca0-4840b1d1b6c60234313202023060920230609E0731NU12023-07-21 00:00:00
FECA3002403906196900000018b1f7d00-097b-46c6-a2fc-80191afb768a021172023080820230808E0730NU12024-02-16 00:00:00
FECA10023131038684000000155aecb3b-8067-4c04-9443-294bed816bd5021692023033020230330E0143NU12023-05-19 00:00:00
FECA100232220422240000001865e17e5-3fd1-4fa5-97a9-e453f5de35fc029162023042020230420E0114NU12023-08-18 00:00:00
FECA100241280452000000001de11af48-475f-481f-a5a1-05a28a2d818c820092023121820231218E0114NU12024-05-17 00:00:00
FECA10023341057809000000192415930-07aa-4723-9398-f5bf0abcd347330262023102520231124E0770RR302023-12-29 00:00:00
FECA300231870459830000001801ca1a4-7fb7-497b-966a-8a74251ed8e0015312023061420230614E0730NU12023-07-14 00:00:00
FECA100240330625850000001cbb6bdc7-41f6-4ab0-a429-bc9f2e88f20b010892023032120230321E0114NU12024-02-16 00:00:00
FECA1002405505620700000013c6c2696-b76f-4a4e-bb0e-39ebf052392c060662023122820231228E0748NU12024-03-08 00:00:00
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FECA200232480161490000001d55d2e55-0a5f-4533-986c-b59add6eccc8038582023073120230830E1818RR12023-09-15 00:00:00
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FECA200232790613370000001d55d2e55-0a5f-4533-986c-b59add6eccc8038582023083120230930E1818RR12023-10-20 00:00:00
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