ATTACHMENT B - PAST PERFORMANCE QUESTIONNAIRE.docx
DOCX document 26 KB Posted
- Solicitation number
- 36C10G22R0015
About this file
This document is a past performance questionnaire for a contractor providing Medicare pricing services to the Department of Veterans Affairs. The contractor is required to price healthcare claim data using Medicare payment methodologies to validate the payment accuracy of claims paid through VA Community Care. The questionnaire requests ratings of the contractor's performance in areas such as overall quality, delivery, service quality, problem resolution, and personnel. It also asks whether any cure notices, show causes, payment suspensions, or termination actions were issued in the past three years. Respondents are asked if they would award the contractor another contract based on performance and if any adverse issues were discussed with the contractor. Information is also requested on the contract period, dollar value, and services provided.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C10G22R0015 0002.docx | DOCX document | |
| ATTACHMENT F - Sample Claims.xlsx | XLSX spreadsheet | |
| 36C10G22R0015 0001.docx | DOCX document | |
| ATTACHMENT C - QUESTIONS SPREADSHEET_ ANSWERS.xlsx | XLSX spreadsheet | |
| ATTACHMENT E -QASP.pdf | ||
| 36C10G22R0015 0001.docx | DOCX document | |
| 36C10G22R0015.docx | DOCX document | |
| ATTACHMENT A - PRICING SPREADSHEET.xls | XLS spreadsheet | |
| ATTACHMENT D - PWS.pdf | ||
| ATTACHMENT C - QUESTIONS SPREADSHEET.xlsx | XLSX spreadsheet |
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Text version
ATTACHMENT B: PAST PERFORMANCE QUESTIONNAIRE (PPQ)
Request for Proposal (RFP) No.: 36C10G22R0015 Title: Medicare Pricer
TO: Adam Vulgamore, Contract Specialist AGENCY: Strategic Acquisition Center, Fredericksburg E-MAIL: Adam.Vulgamore@va.gov
INFORMATION REQUEST: PAST PERFORMANCE
The Department of Veterans Affairs is currently in the process of awarding a competitive service contract. “Insert Contractor Name” has provided this Questionnaire to you for a reference regarding “Insert Contractor Name” record of past performance under Contract No. “Insert Contract Number”
Send completed questionnaires to Adam.Vulgamore@va.gov and Terri.Duenas@va.gov
NOTE TO OFFERORS: If the Questionnaire is provided for subcontractor’s reference, the offeror’s name below must include both the prime and subcontractor names (e.g. contractor X, who is a subcontractor to offeror Y for this solicitation).
Contractor’s Name:
Name of Person Completing the Evaluation:
Telephone: E-mail:
Title:
Company/Organization:
Please rate the contractor in each of the following areas. Note: there is room for comments where you deem remarks would be helpful to our evaluation.
· Not Applicable: N/A
· 1: Performance clearly below the contract performance standard or requirement
| · 2: | Performance occasionally does not meet minimum contract performance standard or requirement |
| · 3: | Performance that meets the minimum contract performance standard or requirement |
| · 4: | Performance that meets and occasionally exceeds the contract performance standard or requirement |
| · 5: | Performance that almost always exceeds the contract performance standard or requirement |
| 1. Overall quality/satisfaction |
| N/A |_| |
| 1 |_| |
| 2 |_| |
| 3 |_| |
| 4 |_| |
| 5 |_| |
Overall satisfaction with the Contractor’s performance.
| 2. Delivery performance |
| N/A |_| |
| 1 |_| |
| 2 |_| |
| 3 |_| |
| 4 |_| |
| 5 |_| |
Delivery performance includes delivery consistency, on time performance, and flexibility in responding to emerging issues and implementing required solutions.
| 3. Satisfaction with the quality of service delivered |
| N/A |_| |
| 1 |_| |
| 2 |_| |
| 3 |_| |
| 4 |_| |
| 5 |_| |
Rate the effectiveness and applicability of the plans and strategies delivered and the actual implementation of those.
| 4. Satisfaction with problem resolution |
| N/A |_| |
| 1 |_| |
| 2 |_| |
| 3 |_| |
| 4 |_| |
| 5 |_| |
This includes the contractor’s ability to solve problems, the speed in which they handle problems, and their effective delivery of resolutions.
| 5. Satisfaction with the quality of contractor personnel |
| N/A |_| |
| 1 |_| |
| 2 |_| |
| 3 |_| |
| 4 |_| |
| 5 |_| |
Rate the quality of the contractor’s staff in executing the project work scope.
6. Have you issued a cure notice, show cause notice, suspension of progress payments or other letters directing the correction of a performance problem in the past 3 years?
|_| Yes |_| No If Yes, please explain.
7. Have you terminated this contractor for default within the past 3 years, or are there any pending termination actions? |_| Yes |_| No If Yes, please explain.
8. Based on the contractor’s overall performance, would you award them another contract?
|_| Yes |_| No If No, please explain.
9. Have you discussed any adverse past performance problems with the Contractor and given them an opportunity to comment? |_| Yes |_| No Please explain.
10. Do you file past performance information in a database that the Contracting Officer may search?|_| Yes |_| No Please explain.
11. If the contract had options, were those options exercised? |_| Yes |_| No Please explain.
12. What was the contract period of performance (i.e., when were services provided)?
13. What was the dollar value of the contract performed by the contractor?
14. Provide a brief description of the services provided by the contractor for this contract.
Please attach any past performance database reports or other material you deem appropriate to a full understanding of the Contractor’s past performance by the evaluator. Please provide information on any adverse performance by the contractor and the corrective actions taken.
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