D.6 Subcontractor Proposal Checklist.docx

DOCX document 17 KB Posted

Attached to
RAC Region 2
Solicitation number
75FCMC21R0018
Issued by

About this file

This document contains a subcontractor proposal checklist for the Recovery Audit Program Region 2 solicitation. The checklist requests information from potential subcontractors such as the prime offeror's name, the subcontractor's company details, parent company information if a newly formed entity, a list of proposed subcontractors, business size classification, tax identification number, DUNS number, CAGE code, and hours for exempt and non-exempt employees. The related federal contract opportunity is for audit services to reduce Medicare improper payments through detection and correction of improper fee-for-service Medicare claims paid by A/B Medicare Administrative Contractors in Region 2, excluding certain claim types. The Recovery Audit Contractor will review claims, recoup overpayments, pay underpayments, support the appeals process, and report review statuses by updating the RAC Data Warehouse and providing monthly reports. The opportunity is issued by the Department of Health and Human Services Centers for Medicare and Medicaid Services.

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E.2 QA RFP 75FCMC21R0018 RAC 2.xlsx XLSX spreadsheet
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D.3 Past Performance Questionnaire.docx DOCX document
D.4 Responsibility Questionnaire.docx DOCX document
D.5 Prime Proposal Checklist.docx DOCX document
E.1 Proposed Contingency Fee.xlsx XLSX spreadsheet
D.2 Contractor - Offeror Conflict of Interest.docx DOCX document
RFP 75FCMC21R0018 RAC Region 2.docx.pdf PDF
E.2 Q&A Template.xlsx XLSX spreadsheet
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D.7 Non Disclosure Statement.docx DOCX document
D.1 RAC Region 2 SOW FINAL.pdf PDF
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Attachment D.675FCMC21R0018
RAC Region 2

Proposal Checklist - Subcontractor

You are requested to complete the following checklist to allow CMS to more readily identify various aspects of your proposal. Please check the appropriate items and provide an explanation, if necessary.

1) Prime Offeror’s Name: _________________________________

2) Company name, address, point of contact and telephone number

3) If a newly formed company, provide name and address of parent companies forming the new entity and cage codes:

a. __________________b.__________________
____________________________________
____________________________________

4) List of proposed subcontractors (if applicable):

a. _____________________________________

b. _____________________________________

c. _____________________________________

5) In accordance with the North American Industry Code 561440, indicate the business size of the prime entity/company.

□ Large Business

□ Small Business – check additional categories as applicable:

____ Disadvantaged
____ Woman-owned
____ Veteran-owned
____ HUBZone

6) TIN # _______________

7) DUNS# _______________

8) Cage Code _____________

9) Productive Hours for Exempt and Non-Exempt Employees ________

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