Attachment A Price Sheet.xlsx

This is a price sheet attachment for a Workers' Compensation Center for Medicare Reporting Compliance Services (CMS Reporting) bid issued by the State of Wisconsin, Department of Administration, Bureau of State Risk Management (GovTribe ID: AD180727). The State seeks a contractor to ensure compliance with federal reporting requirements established under Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA), which mandates workers' compensation reporting to the U.S. Department of Health and Human Services, Center for Medicare and Medicaid Services (CMS). The services consist of two primary deliverables: querying claims with CMS as an initial submission and submitting completed quarterly files to CMS following the initial query. Bidders are required to provide a price per claim for each of these two parts on this mandatory price sheet.

Pricing is required for all items marked in green on the sheet, and all bids with incomplete pricing will be rejected. The price sheet is designed to be all-inclusive for both parts, with no additional costs for CMS services, fees of any kind, or startup costs to be borne by the State. Bidders must enter their price per claim for Part 1 (querying claims) and Part 2 (submitting quarterly files), with a total price per claim to be calculated. The format requires bidders to specify their costs in a structured format, with the total price per claim appearing to default to $0.00 unless completed by the bidder.