Attachment D Bidder Response Form 2423-859.docx

DOCX document 35 KB Posted

Attached to
VA Online Billing Platform
Solicitation number
2423-859
Issued by
Adams County, Asotin County, Benton County, Chelan County, Clallam County, Clark County, Columbia County, Cowlitz County, Douglas County, Ferry County, Franklin County, Garfield County, Grant County, Grays Harbor County, Island County, Jefferson County, King County, Kitsap County, Kittitas County, Klickitat County, Lewis County, Lincoln County, Mason County, Okanogan County, Pacific County, Pend Oreille County, Pierce County, San Juan County, Skagit County, Skamania County, Snohomish County, Spokane County, Stevens County, Thurston County, Wahkiakum County, Walla Walla County, Whatcom County, Whitman County, Yakima County, Asotin City, Clarkston City, Clarkston Heights-Vineland CDP, West Clarkston-Highland CDP, Benton City, Chelan City, Chelan Falls CDP, Clallam Bay CDP, Lewisville CDP, Rock Island City, Pacific Beach CDP, Whidbey Island Station CDP, Mercer Island City, Pacific City, Bainbridge Island City, Kingston CDP, Kitsap Lake CDP, Kittitas City, Klickitat CDP, Okanogan City, Anderson Island CDP, Fort Lewis CDP, Fox Island CDP, Herron Island CDP, Ketron Island CDP, North Fort Lewis CDP, Raft Island CDP, Stevenson City, Hat Island CDP, Lake Stevens City, Snohomish City, Spokane City, Spokane Valley City, Puget Island CDP, Garfield Town, Yakima City, Washington

About this file

This document is a Bidder Response Form for a competitive solicitation issued by the Washington State Department of Social and Health Services (DSHS) for an online claim submission, tracking, processing and record retention platform regarding client services provided by DSHS to be reimbursed by the Veteran Administration. The solicitation seeks qualified contractors to provide these services. The response form consists of seven sections covering administrative, EO 18-03, Washington small business, certified Washington veteran-owned business, management, technical, and pricing/cost information. Bidders must respond to all questions in the order provided. Key requirements include experience with the Veterans Administration and online UB04 billing, secure data handling, real-time feedback on submissions, and comprehensive resources and assistance for DSHS staff.

The pricing section requires bidders to identify all allocated costs and total charges, as well as describe any assumptions affecting the proposed charges. Bidders must also propose a payment schedule corresponding to identified milestones and performance measures. This is a Washington state contract opportunity with various county and city jurisdictions involved. No specific award date, contract term, or renewal options are provided.

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Other files

File Type Posted
2423-859_Am1_Q-A.pdf PDF
Attachment A Sample Contract 2423-859.pdf PDF
RFQQ Solicitation 2423-859.pdf PDF
Att B Sample Bid Sub Ltr 2423-859.docx DOCX document
Att E Contractor Incl Plan 2423-859.docx DOCX document
Attachment C Cert and Assurances 2423-859.pdf PDF
2423-859_Am2_Q-A.pdf PDF

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Text version

Competitive Solicitation RFQQ # 2423-859 Attachment D, Bidder Response FormBidder Name _____________________

ATTACHMENT D: BIDDER RESPONSE FORM

This form is broken into Seven sections: Section 1. Administrative Response; Section 2. EO 18-03 Response; Section 3. Washington Small Business; Section 4. Certified Washington Veteran-owned Business; Section 5. Management Response; Section 6. Technical Response; and Section 7. Quotation/Cost Proposal. Bidders must respond to all questions in the order and in the expandable space provided. If a question requires Bidder to submit additional documents, please attach them to this document and label them clearly as part of your response to this Attachment D.

1
BIDDER INFORMATION (ADMINISTRATIVE RESPONSE)

Bidder’s response to the questions in this Section 1, combined with the information provided in Bidder’s Submittal Letter and Certifications and Assurances, comprise Bidder’s Administrative Response to this Solicitation. While the Administrative Response is not given a number score, the information provided as part of Bidder’s Administrative Response may cause the Bid to be disqualified and may be considered in evaluating Bidder’s qualifications and experience.

MAXIMUM TOTAL POINTS

a
Please indicate whether you employ or Contract with current or former state employees. If the answer is yes, provide the following information with respect to each individual: 1. name of employee or contractor; 2. the individual’s employment history with the State of Washington; 3. a description of the Individual’s involvement with the response to this Solicitation; and 4. the Individual’s proposed role in providing the services under this any Contract that may be awarded.
NOT SCORED

ANSWER:

b
Please list the names and contact information of three individuals you agree may serve as Bidder references and may freely provide information to DSHS regarding the reference’s experience and impressions of Bidder. In providing these names, Bidder represents that it shall hold both DSHS and the organizations and individuals providing a reference harmless from and against any and all liability for seeking and providing such reference.
NOT SCORED

ANSWER:

c
Please indicate whether your Response contains any variations from the requirements of the Solicitation Document. If the answer is yes, list each variation with specificity and include the pertinent page numbers containing the variation.
NOT SCORED

ANSWER:

d
Please indicate whether you are requesting that DSHS consider any exceptions and/or revisions to the sample contract language found in Attachment A. If so, state the page of Attachment A on which the text you request to change is found, and state the specific changes you are requesting. DSHS shall be under no obligation to agree to any requested changes, and will not consider changes to contract language or negotiate any new language not identified in response to this question.
NOT SCORED

ANSWER:

e
If Bidder considers any information that is submitted as part of its Response to be proprietary, please identify the numbered pages of Bidder’s Response containing such information and place the word “Proprietary” in the lower right hand corner of each of these identified pages.
NOT SCORED

ANSWER:

f
Please indicate whether you have had a contract terminated for cause or default within the past five (5) years. If so, please provide the terminating party’s name, address and telephone number and provide a summary describing the alleged deficiencies in Bidder’s performance, whether and how these alleged deficiencies were remedied and any other information pertinent to Bidder’s position on the matter. “Termination for Cause” refers to any notice to Bidder to stop performance due to Bidder’s asserted nonperformance or poor performance and the issue was either (a) not litigated; (b) litigated with a resulting determination in favor of the other party; or (c) is the subject of pending litigation.
NOT SCORED

ANSWER:

g
Please identify any prior contracts Bidder has entered into with the State of Washington within the past ten (10) years and identify the dates and nature of the contract and primary agency contact for each.

NOT SCORED

ANSWER:

h
Please indicate whether Bidder has been the subject of a lawsuit or administrative proceeding alleging a failure to comply with laws relating to the types of services Bidder proposes to provide pursuant to this Competitive Solicitation. If the answer is yes, please list the nature of the allegations, docket number, disposition and date (if applicable) and Bidder’s explanation of how it has changed its practices or operations relative to any alleged deficiencies since that proceeding was filed.

NOT SCORED

ANSWER:

i
Please describe your proposed plans for the use of Subcontractors in performing this Contract, listing each Subcontractor, its proposed role, and the estimated percentage of the Contract that will be performed by each Subcontractor. Please indicate whether each Subcontractor self-identifies or is certified as a Washington small business, a minority-owned business, a woman-owned business, a disadvantaged business enterprise, or a veteran-owned business. If the answer is yes, please identify the type of organization(s) and provide details of any certifications. Note that all Subcontractors must be approved by DSHS.

NOT SCORED

ANSWER:

J Please describe any programs, policies or activities of your organization that support human health and environmental sustainability in your business practices. If a program, policy or activity is specifically applicable to this Contract, please indicate so.

NOT SCORED

ANSWER:

2
BIDDER EO 18-03 CERTIFICATION
MAXIMUM TOTAL POINTS

EO

Are your employees required to sign, as a condition of employment, a mandatory individual arbitration clause and/or a class or collective action waiver?

Please Note: Points for this question will be awarded to bidders who respond that they do not require these clauses and waivers. If you certify here that your employees are NOT required to sign these clauses and waivers as a condition of employment, and you are the successful Bidder, a term will be added to your Contract certifying this response and requiring notification to DSHS if you later require your employees to agree to these clauses or waivers during the term of the Contract.

ANSWER:

3
BIDDER CERTIFICATION –WASHINGTON SMALL BUSINESS
MAXIMUM TOTAL POINTS

Are you a Washington Small Business as defined under RCW 39.26.010?

According to Chapter 39.26.010 RCW, to qualify as a Washington Small Business, Bidder must meet three requirements:

a. Location. Bidder’s principal office/place of business must be located in and identified as being in the State of Washington. A principal office or principal place of business is a firm’s headquarters where business decisions are made and the location for the firm’s books and records as well as the firm’s senior management personnel.

b. Size. Bidder must be owned and operated independently from all other businesses and have either: (a) fifty (50) or fewer employees; or (b) gross revenue of less than seven million dollars ($7,000,000) annually as reported on Bidder’s federal income tax return or its return filed with the Washington State Department of Revenue over the previous three consecutive years.

c. WEBS Certification. Bidder must have certified its Washington Small Business status in Washington’s Electronic Business Solution (WEBS).

ANSWER:

4
BIDDER CERTIFICATION – CERTIFIED WASHINGTON VETERAN-OWNED BUSINESS
MAXIMUM TOTAL POINTS

Are you a Certified Washington Veteran-Owned Business as defined under RCW 43.60A.190?

According to Chapter 43.60A.190 RCW, to qualify as a Certified Washington Veteran-Owned Business, Bidder must meet four requirements:

a. 51% Ownership. Bidder must be at least fifty-one percent (51%) owned and controlled by:

1. A veteran is defined as every person who at the time he or she seeks certification has received a discharge with an honorable characterization or received a discharge for medical reasons with an honorable record, where applicable, and who has served in at least one of the capacities listed in RCW 41.04.007;

2. A person who is in receipt of disability compensation or pension from the Department of Veteran’s Affairs; or

3. An active or reserve member in any branch of the armed forces of the United States, including the national guard, coast guard, and armed forces reserves.

b. Washington Incorporation/Location. Bidder must be either an entity that is incorporated in the state of Washington as a Washington domestic corporation or, if not incorporated, an entity whose principal place of business is located within the State of Washington.

c. WEBS Certification. Bidder must have certified its Veteran-Owned business status in Washington’s Electronic Business Solution (WEBS).

d. WDVA Certification. Bidder must have provided certification documentation to the Washington Department of Veterans’ Affairs WDVA) and be certified by WDVA and listed as such on WDVA’s website (WDVA – Veteran-Owned Businesses).

ANSWER:

5
BIDDER QUALIFICATIONS AND EXPERIENCE (MANAGEMENT RESPONSE)
MAXIMUM TOTAL POINTS

MANDATORY EXPERIENCE AND QUALIFICATIONS

A
Describe your experience working with the Veterans Administration specifically in the processing of online UB04 client billing documents via a clearinghouse that the VA will accept.
50

ANSWER:

B
Describe the record retention provided by the program your company provides. Describe how DSHS staff can access historical records in regards to pending, paid and denied submissions.
20

ANSWER:

C
Describe your company’s ability to successfully handle and keep sensitive client information secure. Describe how your company handles any potential threats to security and give examples of how security threats have been handled in the past.
50

ANSWER:

D
Describe the programs ability to provide real time feedback on submissions including but not limited to if submissions are accepted or rejected by the receiver and provide immediate feedback if submission contains formatting errors. In addition the platform must allow DSHS to edit and resubmit rejected claims rather than recreate the entire submission again and allow DSHS to copy/utilize prior submission information for new submissions and not recreate new submissons from scratch each time.
50

ANSWER:

E
Describe the resources and live expertise and assistance your company can provide DSHS employees when they have questions or are experiencing issues with the platform.
15

ANSWER:

F
Describe the onboarding process involved with getting DSHS staff trained and prepared to utilize your provided system.
15

ANSWER:

DESIRED EXPERIENCE AND QUALIFICATIONS

J
Please provide the names of the key team members you will assign to this Contract, if you are the Successful Bidder, and provide their proposed roles describing the relevant experience they possess. Bidder should note that if awarded a contract, it may not reassign its key personnel from the Project without prior approval of DSHS.
NOT SCORED

ANSWER:

6
BIDDER’s SOLUTION AND PROPOSED APPROACH (TECHNICAL RESPONSE)
MAXIMUM TOTAL POINTS
A
Does this service/application have a current SOC2 Type II Audit Report?

Is this service/application FedRAMP approved?

Have any other third-party information security audits been performed for the service/application?

ANSWER:

B
Does your service use a major cloud provider for application hosting? y/n

Does your service use NIST FIPS approved encryption standards for data-at-rest and data-in-transit? y/n Does your service have formal policies and standards for:

· Network segmentation? y/n

· Vulnerability and Patch Management y/n

· Malware Protection y/n

· Access and Authentication Management y/n

· Strong Password standards and enforcement y/n

· The Software Development Lifecycle y/n

· Change Management y/n

· Asset Management y/n

· System Logging and Monitoring y/n

· Intrusion Detection y/n

· Incident Response and Disaster Recovery y/n If selected as a potential vendor, would you be willing to share any audit reports, copies of your polices and standards and system diagrams with us for a formal security design review? We can sign an NDA if necessary. y/n

ANSWER:

7
BIDDER’S PROPOSED PRICING (QUOTATION OR COST RESPONSE)
MAXIMUM TOTAL POINTS
A
Please identify all allocated costs, together with the total charges Bidder is willing to accept in consideration of the full performance of the Contract.
50

ANSWER: TOTAL MAXIMUM BID AMOUNT:

FOR ALLOCATED COST DETAIL, ATTACH A SEPARATE SPREADSHEET OR DESCRIBE DETAILS BELOW

B
Please fully describe any assumptions Bidder has made that affect its proposed total charges, if those assumptions are not explicitly addressed in Attachment A, Sample Contract.
20

ANSWER:

C
Bidder should also propose a schedule of payments corresponding to its charges for successfully performing the tasks necessary to accomplish identified milestones corresponding to project objectives and performance measures within each phase. Bidders are required to collect and pay Washington State sales tax, if applicable.
30

ANSWER:

Attachement D Template update 07-20-2023 7

File details come from the government source that posted it. Updated .