Attachment A - Cost Proposal.pdf
PDF 153 KB Posted
- Solicitation number
- RFP 2025-P09
- Issued by
- Hidalgo County, Texas
About this file
This document is a Request for Proposal (RFP) 2025-P09 for Workers Compensation Insurance & Administrative Services, presented as a Cost Proposal form (Attachment A). The form is designed for potential vendors to submit detailed pricing for various workers compensation claims administration services, including incident and medical claims processing, field services, investigation, medical case management, utilization review, medical bill audits, healthcare networks, rehabilitation services, and related administrative functions. The proposal requires vendors to provide pricing structures including fees per claim, flat fees, and hourly rates for different service categories.
The cost proposal template includes three primary sections for pricing: Claims Administration (with categories for Workers Compensation, Incident, Medical Only, and Indemnity claims), Annual Fixed Fee Option for the life of the contract, and an "Other Fees/Cost" section for any additional services not previously listed. The document also includes a Safety Rebate section and a standard certification statement affirming the bidder's authorization to execute the contract, confirming the bid was not prepared in collusion with other bidders, and requiring the submission of company contact information. Vendors are instructed that failure to complete and return this form will result in the rejection of their proposal.
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Text version
RFP 2025-P09 Workers Compensa�on Insurance & Administra�ve Services Atachment A: Cost Proposal
(This form MUST be completed and returned for your proposal to be considered responsive. Failure to complete and return will result in the rejec�on of the proposal.)
Services Claims Administra�on Fee Per Allocated Expenses
Workers Compensa�on Incident
Medical Only Indemnity
Annual Fixed Fee Op�on – Life of Contract Pricing Fee Per
Claim Flat Fee Fee Per
Hour
Field Services/Inves�ga�on Medical Case Management U�liza�on Review/Pre-Authoriza�on Medical Bill Audits Healthcare Networks Rehabilita�on/Voca�onal Case Services
On-Line Computer Services Atending TDI Hearings Take Over Costs Workers Compensa�on
- Run-Off Costs
- Field Case
Management/Telephonic
Atorney /Hearing Fees Private Inves�gators DWC Aus�n Representa�ve
Other Fees/Cost – List any addi�onal fees not included above
Descrip�on of Services Fee Per Claim
Flat Fee Fee Per Hour
Safety Rebate Annual Safety Rebate $
The undersigned authority affirms that they are duly authorized to execute this contract, that this bid has not been prepared in collusion with any other bidder, and that the content of this bid has not been communicated to any other bidder prior to the official opening of this bid.
Company Name: _______________________________________________________________
Printed Name: ________________________________________________________________
Signature: ____________________________________________________________________
Email Address: ________________________________________________________________
Phone: _______________________________________________________________________
File details come from the government source that posted it. Updated .