Attachment B Bidder Checklist.doc

This is a Bidder Checklist attachment for a Request for Bid issued by the State of Wisconsin Department of Administration, Division of Enterprise Operations, State Bureau of Procurement. The bidding opportunity concerns Workers' Compensation Center for Medicare Reporting Compliance Services (CMS Reporting). The State of Wisconsin 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). Effective April 1, 2010, Wisconsin is required to submit reports of payments on specific workers' compensation claims to the U.S. Department of Health and Human Services, Center for Medicare and Medicaid Services (CMS). The reporting obligations encompass workers' compensation, self-insurance, no-fault insurance, and liability insurance claims.

The Bidder Checklist specifies mandatory documentation and acknowledgments required for bid submission, including completion of the DOA-3027 Confidential and Proprietary Information Form, DOA-3070 Cover Page, DOA-3333 Vendor Agreement for Wisconsin's Cooperative Purchasing Service, DOA-3477 Vendor Information, and DOA-3478 Vendor References. Bidders must certify compliance with all seven sections of the Request for Bid, including Introduction and Purpose, Bidder Qualifications and Requirements, Mandatory Required Specifications, Special Terms and Conditions, Pricing Structure and Price Sheet Instructions, Bid Procedure and Instructions, and Bid Acceptance and Award provisions. Bidders must also confirm receipt and compliance with all RFB amendments and submit the completed Attachment A Price Sheet. Omission of any required checklist items may result in bid rejection.