Attachment 2 RFR Response Form.docx
DOCX document 16 KB Posted
- Attached to
- MRC MEDSERVICES 09-16
- Solicitation number
- BD-17-1071-AO-CON01-10034
- Issued by
- Massachusetts
About this file
This document is an RFR (Request for Response) form for a contract opportunity with the Massachusetts Rehabilitation Commission (MRC) to provide medical services and consulting for MRC VR (Vocational Rehabilitation) consumers. The RFR outlines the required qualifications, experience, and capabilities of potential providers including licenses, certifications, geographical service areas, rate schedules, reporting and billing processes, and language proficiencies. Providers are required to submit proof of professional liability insurance and Supplier Diversity Office (SDO) certification. The contract term and renewal options are not specified.
The RFR references the Massachusetts Division of Health Care, Finance and Policy rate schedules, which will be adjusted as new rates and regulations are established. Pricing terms, set asides, incumbent providers, funding sources, and amounts are not provided in this document. Responses to the 8 evaluation criteria listed in the RFR form are required for consideration.
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| CORI Assurance Letter~6.docx | DOCX document | |
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| standard-contract-frm.doc | DOC document | |
| Contracting Qualification Form~5.docx | DOCX document | |
| Job Aid create-a-quote-in-commbuys~12.pdf | ||
| Supplier Diversity Program Form for Purchase of Service~3.xlsx | XLSX spreadsheet | |
| CORI Form-Individuals.pdf | ||
| Federally_Required_Disclosure_Form.pdf | ||
| Medical Services - Consultants BD10034 Awarded Vendors Stats.xlsx | XLSX spreadsheet | |
| Attachment 1 Cover Page.docx | DOCX document | |
| Contractor Authorization Signatory Listing~2.rtf | RTF text file | |
| FINAL EFT_FILLABLE FORM (2)~2.pdf | ||
| How to verify CORI instructions~1.doc | DOC document | |
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| Prompt Payment Discount Form~8.doc | DOC document | |
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Text version
ATTACHMENT 2
RFR RESPONSE FORM (OPTIONAL)
RFR - MEDICAL SERVICES/CONSULTANTS FOR MRC VR CONSUMERS
MRC MEDSERVICES 09-16
Provider Name:
Provider Address:
Provider Email:
Provider Phone:
RFR responses will be evaluated on the basis of the 8 criterion listed below. Please fill out each criteria in detail in the comment boxes or you may submit a written narrative. The use of attachments is acceptable.
| Criterion |
| Responses |
1. Describe and outline your qualifications, Licenses (including license number), Certifications and capabilities to provide medical and/or consulting services detailing the specific medical and/or consulting services to be provided. You should provide proof of Professional Liability Insurance.
1. Briefly outline your experience and number of years of experience providing specific medical or consulting services.
1. Identify and discuss your geographical service area capabilities.
1. Reference and state the rate schedule to be used for this RFR set forth by the Massachusetts Division of Health Care, Finance and Policy as amended. The rates will be adjusted as new rates and regulations are established or changed.
http://www.mass.gov/eohhs/gov/laws-regs/hhs/community-health-care-providers-ambulatory-care.html
1. Outline your process to submit timely clinical/service reports and information to MRC.
1. Outline their process to submit timely service billing.
1. Supplier Diversity Office (SDO) Certification: The contractor will submit proof of a SDO Certification.
1. Identify any language proficiency such as, but not limited to, American Sign Language (ASL), Spanish, French/Creole, Chinese, Khmer, Vietnamese, Portuguese, etc.
File details come from the government source that posted it. Updated .