Appendix 2 Submission Checklist.docx
DOCX document 23 KB Posted
- Attached to
- Procuring auditing services or health care claims processing and related activities for t
- Solicitation number
- BD-16-1049-GIC00-07GIC-00000005281
- Issued by
- Suffolk County, Massachusetts
About this file
This document is an RFR (Request for Response) Submission Checklist from the Commonwealth of Massachusetts Group Insurance Commission (GIC). The checklist outlines the requirements for submitting a proposal to provide auditing services or health care claims processing and related activities for the state of Massachusetts. Vendors must submit both an electronic response through the COMMBUYS website and hardcopies of the proposal to the GIC's offices by 12:00 noon ET on October 7, 2015. The hardcopy proposal must include 3 unbound copies with original blue ink signatures, 5 bound copies each of the Technical Proposal and Cost Proposal, and a CD containing the proposal and all attachments. The proposal must include all required state forms and certifications, including the Commonwealth Standard Terms & Conditions, Standard Contract Form, Business Associate Agreement, and Contractor Authorized Signatory Listing Form.
The Cost Proposal must be submitted separately from the Technical Proposal and must not include any cost information. The proposal must also include bidder qualifications, sample audit reports, and minimum data set requests. Proposals received after the deadline will not be accepted. This RFR is for the procurement of auditing services or health care claims processing and related activities for the state of Massachusetts.
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Other files
| File | Type | Posted |
|---|---|---|
| GICPND1601_RFR for Claims Audit Services.docx | DOCX document | |
| Appendix 1 Instructions for Vendors Responding to Bids.pdf | ||
| Exhibit 2 Consultant Tasks.doc | DOC document | |
| GICPND1601 Notice of Intent.docx | DOCX document | |
| GICPND1601 Bidders Questions for posting 9-28-15.docx | DOCX document | |
| GICPND1601 Bidders Questions.docx | DOCX document | |
| Exhibit 1 Sample Cost Proposal Layout.xlsx | XLSX spreadsheet | |
| Prompt_Payment_Discount_Form.doc | DOC document | |
| GICPND1601 CommBUYS Documentation.zip | ZIP file | |
| Appendix 3 GIC July 2015 Enrollment Data.xlsx | XLSX spreadsheet |
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Appendix #2: RFR Submission Checklist
RFR SUBMISSION CHECKLIST
(Specifications described in Section E of this RFR)
You must submit both an electronic response through the COMMBUYS website and hardcopies of your proposal to the GIC’s offices by 12:00 noon ET on October 7, 2015. Proposals will be considered only if both the COMMBUYS electronic response and the GIC’s copies are received before this deadline.
To the GIC: Vendors must submit 3 unbound proposals which include all the required state forms and certifications listed below. One unbound proposal must contain all original forms with blue ink signatures; the other two can be photocopies of the blue ink set. Each of the 3 transmittal letters must be originals, signed in blue ink.
In addition, vendors must submit five bound copies each of the Technical Proposal (please do not include copies of the required state forms and certifications) and the Cost Proposal, as well as one CD containing the proposal and all attachments.
Technical Proposal materials must be bound separately from the Cost Proposal Materials. In addition, bidders must not include any cost information in the Technical Proposal.
IMPORTANT NOTE: The proposal copies for the GIC MUST BE delivered to the GIC’s office on the fourth floor of 19 Staniford Street by noon on October 7, 2015, and to no other location. Proposals left in any other location, including the ground floor lobby of 19 Staniford Street, the building’s loading dock, or it’s mail room are not guaranteed to be delivered to the GIC before the deadline. Proposals received after 12:00 noon on October 7, 2015 will not be accepted.
| Item |
| Instructions |
| Included |
| Transmittal Letter |
| Originals signed with blue ink |
Required State Forms and Certifications These forms can be obtained on COMMBUYS. Subcontractors and/or joint vendors must each submit signed originals of all required state contract forms and certifications in the proposal. Include the Required State Forms and Certifications in only the unbound copies.
| Commonwealth Standard Terms & Conditions |
| Originals signed with blue ink |
| Standard Contract Form and Instructions |
| Originals signed with blue ink |
| Business Associate Agreement |
| Originals signed with blue ink |
Contractor Authorized Signatory Listing Form (There are 2 pages to this form) Originals signed with blue ink
| Verification of Taxpayer Identification Number and Certification (W-9) |
| Originals signed with blue ink |
| Supplier Diversity Program, Form 1 (SDP Plan Commitment) |
| Originals signed with blue ink |
| Authorization for Electronic Funds Transfer |
| Originals signed with blue ink |
| Prompt Payment Discount |
| Originals signed with blue ink |
| Certification – Consultant Conflict of Interest |
| Originals signed with blue ink |
Responses to Essay Questions (See Section II of this RFR)
Additional Requested Materials
Bidder Qualification (see Section III of this RFR):
· Firm References
· Project Manager References
· Technical Lead References
· Key Audit Team Members – for each person, provide the information requested in Section III of this RFR
Sample Audit Report
Minimum Data Set Request(s) from the Bidder and the Subcontractor (if any) (see pages 20 – 21 of this RFR)
Cost Proposal (as explained in Section IV of this RFR – a sample layout is included as Exhibit #1)
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