Attachment 6 - Beneficiary Quantities and Unit Pricing.pdf
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- Attached to
- ClaimsCore Combined Synopsis/Solicitation
- Solicitation number
- 75FCMC26R0022
About this file
This is an attachment to a federal task order that establishes the pricing methodology for Medicare Claims Processing Software services. Attachment 6 defines the estimated beneficiary quantities and fixed unit prices used to calculate firm-fixed prices for six contract line items (CLINs 0004, 0006, 0008, 0010, 0012, and 0014) that are subject to annual prospective price adjustment under a True-Up Clause. CLIN 0002 is expressly excluded from adjustment. The pricing structure uses a Per Member Per Month (PMPM) model, with unit prices applied to software services based on unique beneficiaries processed monthly through the contractor's system. The estimated annual quantity is calculated by multiplying the projected average monthly beneficiary count by twelve months.
For CLIN 0004 (period 11/05/2027–11/04/2028), the estimated average monthly beneficiaries total 33,564,990, representing 827,055,202 annual beneficiaries, though the unit price and calculated annual CLIN price are listed as "TBD." The remaining CLINs (0006 through 0014) covering subsequent one-year periods through 11/04/2033 have placeholder values marked "XXXX" pending proposal submission. The contractor must submit an updated Attachment 6 in MS Excel format no later than 90 days before each period's end, including actual average monthly beneficiary counts, revised projections for forthcoming option periods, supporting basis of estimate documentation, historical volume trends, and identification of anticipated changes affecting beneficiary population. Following CMS review, the Contracting Officer may adjust CLIN prices for the subsequent option period via unilateral modification on a prospective basis only, with no retrospective adjustments permitted for differences between estimated and actual quantities.
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Attachment 6 – True-Up: Beneficiary Quantities and Unit Pricing for Medicare Claims Processing Software
1. Purpose This Attachment establishes the estimated beneficiary quantities 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 Order.
2. Applicable CLINs The beneficiary quantities 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)).
- 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.
- The estimated annual quantity reflects the projected average monthly beneficiary count multiplied by twelve (12) months.
4. Estimated Beneficiary Quantities and Unit Prices The table below identifies the estimated beneficiary quantities and unit prices applicable to the CLINs subject to adjustment.
Calculated Annual CLIN Price Formula:
Estimated Average Monthly Beneficiaries × Unit Price × 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 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 volumes
- Historical beneficiary volume trends from the current period of performance
- Identification of any anticipated changes in beneficiary population 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.
Estimated Beneficiary Quantities and Unit Prices Table
CLIN Period of Performance Estimated Avg.
Monthly Beneficiaries*
Estimated Annual
Beneficiaries*
Unit Price
(PMPM)
Calculated Annual
(extended) CLIN Price
0004 11/05/2027 –11/04/2028 33,564,990 827,055,202 TBD TBD
0006 11/05/2028 – 11/04/2029 XXXX XXXX XXXX XXXX
0008 11/05/2029 – 11/04/2030 XXXX XXXX XXXX XXXX
0010 11/05/2030 – 11/04/2031 XXXX XXXX XXXX XXXX
0012 11/05/2031 – 11/04/2032 XXXX XXXX XXXX XXXX
0014 11/05/2032 – 11/04/2033 XXXX XXXX XXXX XXXX
*For the solicitation/proposal purposes, CMS is using a 2025 monthly National Average.
| Attachment 6 – True-Up: Beneficiary Quantities and Unit Pricing for Medicare Claims Processing Software |
| 1. Purpose |
| 2. Applicable CLINs |
| 3. Unit Pricing Assumptions |
| 4. Estimated Beneficiary Quantities and Unit Prices |
| 5. Annual True-Up Submission Requirements |
| 6. Price Adjustment Process |
| Estimated Beneficiary Quantities and Unit Prices Table |
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