Section_B_-_Supplies_or_Services__Prices-Costs.pdf

United States Department of Labor

(DOL)

Workers’ Compensation Medical Bill Process

(WCMBP)

Section B

Supplies or Services and Prices/Costs

Office of Workers’ Compensation Programs (OWCP)

Section B - Supplies or Services and Prices/Costs

B-1

B.1 PRICES

The contractor shall include all applicable Federal, state, and local taxes in all prices.

The contractor shall submit prices that comply with all definitions and instruction regarding price in this section.

The Government will consider any services, promotional item, material, or supplies required in the performance of this contract or in future task orders for which a price is not specifically identified in the price tables to be included in the price of another item or provided at no charge to the Government, except as otherwise provided for in this contract or future task order.

B.2 CLIN GROUPS

CLIN groups represent the price of sets of related requirements from the Performance Work Statement (PWS) in Section C (Description/Specifications/Statement of Work).

A CLIN group is represented by a numeric identifier (001-006) that specifies the set of project functions. The CLIN groups are identified in Table 1.

Table 1 CLIN Groups

CLIN Group Value

Transition-In 001

Other Direct Costs (ODC) 002

Bill Processing 003

Call Center 004

Mailroom 005

Transition-Out 006

CLIN groups are defined in the following sections.

B.2.1 Transition-In

This CLIN group reports the price of implementation of functional requirements and transition into the contract during the period from contract award until the beginning of operations: Go-Live.

Primary Cost Components

The requirements for this CLIN group include, but are not limited to, the following:

Implementation activities, such as: requirements development and review, development, testing, training, data migration, in support of authorizations, bill processing, call center, enrollments, mailroom, and other core requirements

Transition-In activities, such as: startup activities, planning & estimating, Project Management Plan, Work Breakdown Structure, and the Risk Management Plan

B-2

Supporting Cost Components

Supporting cost components, both labor and non-labor, are captured in this CLIN group, relative to the degree of support needed for the CLIN group’s primary requirements.

These include, but are not limited to, the following:

Program and project management, and administration

Quality Assurance

Risk Management

Reporting

Change Management (for all Implementation Phase changes)

Security

Disaster Recovery

Training: The cost of training preparation and training execution for Government, Provider, and Offeror staff, as well as Providers and Claimants

Data storage and database administration

Interface operations and maintenance, including, but not limited to:

Data/voice lines, exclusive of dedicated data lines to Government facilities

Secure communication system maintenance

Electronic Data Interchange (EDI)

Interactive Voice Response (IVR)

Electronic Portal

Hardware operations and maintenance: including, but not limited to:

Upgrades

Licenses

Hosting charges

Software operations and maintenance: including, but not limited to:

Upgrades to medical coding and reference products

Upgrades to call management products

Upgrades to application and system products

Licenses

Hosting Charges

B.2.2 Other Direct Costs (ODC)

This CLIN group reports the price of Other Direct Costs during the period from contract award until contract termination.

These costs include:

Annual independent auditor

B-3

Postage and freight, including shipping on documents returned to District Offices (as requested by the Government)

Post Office Box fees

Printing materials and supplies for all processing

Special outsourced printing (as requested by the Government)

Travel made by the contractor, at the Government’s request, for purposes of meeting or communicating with the Government, providers, and/or claimants

Communication lines to Government facilities

Reference materials for Government use (see Section J Attachment 24)

Within this solicitation, the term “Other Direct Costs” (ODC) is reserved for specific, non-labor costs incurred by the contractor that are paid directly by the Government. Only the costs listed above are considered by the Government to be ODCs, and therefore applicable to this CLIN group. Any other non-labor costs that are proposed (as part of a CLIN’s price build-up) are referred to as “non-labor costs” and included in the price build-up for the relevant non-ODC CLIN.

The Government will use the pricing for the ODC CLIN group on the awarded contract to define a “not to exceed” ODC CLIN group ceiling value for each period of performance. The contractor shall maintain the ODC CLIN group at or below the ceiling value, unless adjustments are negotiated with the Government.

The contractor shall charge no overhead, G&A, or fee associated with ODCs.

The contractor shall ensure that all travel prices are in accordance with the Federal Travel Regulations. The contractor shall obtain written authorization for specific instances of travel from the Contracting Officer or COR prior to incurring any travel expenses. When calculating the current per diem rates the contractor shall refer to the U.S. General Services Administration (GSA) website for Travel Management.

B.2.3 Bill Processing

This CLIN group reports the price of operation for Bill Processing during the period from the beginning of operations until contract termination.

Primary Cost Components

The core requirements for this CLIN group include, but are not limited to, the following:

Bill processing, adjustments, bill data entry/KFI, returned bills (RTPs, RTCs), remittance vouchers (RVs), check traces, appeals, coding, resolutions, research, liaisons, accounts receivable, fraud and abuse detection, related clerical, and 1099s

Pharmacy point-of-sale (POS) claims processing, call support and pharmacist

Treatment Suite update (inclusive of OWCP Treatment Suite builder/viewer support)

Outreach

B-4

Authorizations: intake, data entry, returns, and call-handling

Enrollments: intake, responses, provider file maintenance, and call handling

Service Enhancements: A pool of 12,000 hours per operational year to cover enhancements requested by the Government. The total pool of enhancement hours will be prorated based on the number of months of operations during years of mixed implementation and operation (e.g. 3 months operations = 3000 hours).

Supporting Cost Components

Supporting cost components, both labor and non-labor, are apportioned to this CLIN group, relative to the degree of support needed for the CLIN group’s primary requirements. These include, but are not limited to, the following:

Program and project management, and administration

Quality Assurance

Risk Management

Reporting

Change Management (for all Service Enhancement changes)

Security

Disaster Recovery

Training: The cost of training preparation and training execution for Government, Provider, and Offeror staff, as well as Providers and Claimants

Data storage and database administration

Interface operations and maintenance, including, but not limited to:

Data/voice lines, exclusive of dedicated data lines to Government facilities

Secure communication system maintenance

Electronic Data Interchange (EDI)

Interactive Voice Response (IVR)

Electronic Portal

Hardware operations and maintenance: including, but not limited to:

Upgrades

Licenses

Hosting charges

Software operations and maintenance: including, but not limited to:

Upgrades to medical coding and reference products

Upgrades to application and system products

Licenses

Hosting charges

B-5

B.2.4 Call Center

This CLIN group reports the price of operation for Call Center during the period from the beginning of operations until contract termination.

Primary Cost Components

The core requirements for this CLIN group include, but are not limited to, the following:

Intake and initiation of calls

Nurses (excluding Treatment Suite Nurses)

Coding

Correspondence

Help desk

Research

Supporting Cost Components

Supporting cost components, both labor and non-labor, are apportioned to this CLIN group, relative to the degree of support needed for the CLIN group’s primary requirements. These include, but are not limited to, the following:

Program and project management, and administration

Quality Assurance

Risk Management

Reporting

Security

Disaster Recovery

Training: The cost of non-CBT training preparation and training execution for Government, Provider, and Offeror staff, as well as Providers and Claimants

Data storage and database administration, including extracts based upon Government request

Interface operations and maintenance, including, but not limited to:

Data/voice lines, exclusive of dedicated data lines to Government facilities

Secure communication system maintenance

Electronic Data Interchange (EDI)

Interactive Voice Response (IVR)

Electronic Portal

Hardware operations and maintenance: including, but not limited to:

Upgrades

Licenses

B-6

Hosting charges

Software operations and maintenance: including, but not limited to:

Upgrades to call management products

Upgrades to application and system products

Licenses

Hosting charges

B.2.5 Central Mailroom

This CLIN group reports the price of operation for the Central Mailroom during the period from the beginning of operations until contract termination.

Primary Cost Components

The core requirements for this CLIN group include, but are not limited to, the following:

Physical Document Management: Receipt preparation of incoming mail and bills, scanning documents, indexing mail (hardcopy), and temporary and long-term document storage, document destruction, handling document returns to District Offices and/or the Federal Records Center (FRC)(shipping included separately under ODC)

Electronic Document Management: Storing images, indexing mail (electronic), storage management

Supporting Cost Components

Supporting cost components, both labor and non-labor, are apportioned to this CLIN group, relative to the degree of support needed for the CLIN group’s primary requirements. These include, but are not limited to, the following:

Program and project management, and administration

Quality Assurance

Risk Management

Reporting

Security

Disaster Recovery

Training: The cost of training preparation and training execution for Government, Provider, and Offeror staff, as well as Providers and Claimants

Data storage and database administration

Interface operations and maintenance, including, but not limited to:

Data/voice lines, exclusive of dedicated data lines to Government facilities

Secure communication system maintenance

Electronic Data Interchange (EDI)

B-7

Electronic Portal

Hardware operations and maintenance: including, but not limited to:

Upgrades

Licenses

Hosting charges

Software operations and maintenance: including, but not limited to:

Upgrades to application and system products

Licenses

Hosting charges

B.2.6 Transition-Out

This CLIN group reports the price of activities for Transition-Out during the transfer of operations to a subsequent contractor.

Primary Cost Components

The core requirements for this CLIN group include, but are not limited to, the following:

R0044, R0126 through R0141

Supporting Cost Components

Supporting cost components, both labor and non-labor, are apportioned to this CLIN group, relative to the degree of support needed for the CLIN group’s primary requirements. These include, but are not limited to, the following:

Program and project management, and administration

Quality Assurance

Risk Management

Reporting

Security

Training: The cost of training preparation and training execution for Government and Contractor staff, as well as Providers and Claimants

B.3 PRICING ELEMENTS

Pricing elements are components of a CLIN group that combine to determine the price of the CLIN group. These pricing elements can be either volume-sensitive or volume-insensitive. Volume-insensitive elements are the components of a CLIN group whose price is not significantly influenced by operational processing volumes. Volume-sensitive elements are components whose price is significantly influenced by operational processing volumes. A CLIN group may have both volume-sensitive and volume-insensitive pricing elements that contribute to its price.

B-8

Table 2 identifies the volume-sensitive components and the CLIN group to which they belong.

Table 2 Volume-Sensitive Pricing Elements

Volume-Sensitive Element CLIN Group Unit of Measure

Bills Processed - Originals Bill Processing Bills

Mailroom Documents – Bills Mailroom Bill Documents

Mailroom Documents – Non-Bills Mailroom Mail Documents

The volume-sensitive elements are defined in the following sections.

Bills Processed - Originals

The total count of all original medical bills received for all programs that are processed as original submissions (not adjustments).

Mailroom Documents – Bills

The total count of original hard copy bill documents for all programs that are received via the central mailroom, successfully scanned as electronic images, indexed and processed as original submissions (not adjustments). This element does not include non-bill documents.

Mailroom Documents – Non-Bills

The total count of original hard copy non-bill mail documents for all programs that are received via the central mailroom, successfully scanned as electronic images, indexed and processed as original submissions (not adjustments). This element does not include medical bills.

The contractor shall provide prices for all Contract Line Items (CLINs), including Award Term CLINs. The Government reserves the right to accept or reject any CLIN at contract award. The Government reserves the right to award additional terms, based on the requirements of Section H (Special Contract Requirements)

Each CLIN is named with an identifier that represents the combination of factors that comprise the CLIN. A CLIN identifier consists of:

A label (“CLIN”)

The identifier of the Period of Performance

The identifier of the CLIN Group

A period of performance, as defined in Section F (Deliverables or Performance), is represented by a single character identifier (0-7) that specifies the year of the contract as shown in Table 3. This identifier occurs as the 1st digit in the CLIN

Table 3

B-9

Table 3 Periods of Performance

Name Identifier

All years 0

Base Period 1

Option Year 1 2

Option Year 2 3

Option Year 3 4

Option Year 4 5

Award Term Year 1 6

Award Term Year 2 7

The CLINs for the contract are defined in Table 4. Two CLINs use the Period of Performance identifier “0”, which is defined as “all years”. The prices reported by these CLINs are not restricted to a single contract year. Rather, these two CLINs report the prices of the indicated pricing groups for all relevant contract years. They are:

CLIN0001: Transition-In

CLIN0006: Transition-Out

Table 4 Contract Line Items

CLIN ID Pricing Group Period of Performance

CLIN0001 Transition-In Base Period

CLIN0006 Transition-Out Award Year 2

CLIN1002 Other Direct Costs Base Period

CLIN1003 Bill Processing Base Period

CLIN1004 Call Center Base Period

CLIN1005 Mailroom Base Period

CLIN2002 Other Direct Costs Option Year 1

CLIN2003 Bill Processing Option Year 1

CLIN2004 Call Center Option Year 1

CLIN2005 Mailroom Option Year 1

CLIN3002 Other Direct Costs Option Year 2

CLIN3003 Bill Processing Option Year 2

CLIN3004 Call Center Option Year 2

CLIN3005 Mailroom Option Year 2

CLIN4002 Other Direct Costs Option Year 3

CLIN4003 Bill Processing Option Year 3

CLIN4004 Call Center Option Year 3

CLIN4005 Mailroom Option Year 3

CLIN5002 Other Direct Costs Option Year 4

B-10

CLIN5003 Bill Processing Option Year 4

CLIN5004 Call Center Option Year 4

CLIN5005 Mailroom Option Year 4

CLIN6002 Other Direct Costs Award Year 1

CLIN6003 Bill Processing Award Year 1

CLIN6004 Call Center Award Year 1

CLIN6005 Mailroom Award Year 1

CLIN7002 Other Direct Costs Award Year 2

CLIN7003 Bill Processing Award Year 2

CLIN7004 Call Center Award Year 2

CLIN7005 Mailroom Award Year 2

B.4 VOLUME-SENSITIVE DATA AND PROJECTED OPERATIONAL

VOLUMES

The following sections reference operational data from the current OWCP bill payment services. Data supporting section B.4.2 can be found in Section J.

B.4.1 Volume-Sensitive Operational Data

The “Volume Sensitive Operational Data” (Attachment 18) spreadsheet provides estimated future operational bill processing volumes. The contractor shall use Attachment 18 as a basis for pricing.

Out-year volume estimates included with this solicitation are only estimates. These estimates are not a representation by the Government to the offeror that conditions affecting the requirements will remain stable.

B.4.2 Projected Operational Volumes

The “Attachment 18.1 - WCMBP Projected Operational Volumes” (Attachment 18.1) spreadsheet provides projected operational volumes for years 2016-2027. The contractor shall use Attachment 18.1 as a basis for pricing.

B.5 MEDICAL BENEFIT IDENTIFICATION CARDS

Identification cards for the DEEOIC and DMCWC programs are to be produced by the Contractor as described in the PWS. The DEEOIC program averages 30 identification cards per day x 20 business days = 600 cards per month (approximately 7200 cards per year). This may increase due to additional illness being developed and accepted. The DCMWC program averages 100 MBICs per month (approximately 1200 MBICs per year).

B.6 CALL CENTER OPERATIONAL DATA

The “Weekly Call Minute Detail Data” (Attachment 19) spreadsheet provides operational call center data. The contractor shall use Attachment 19 as a basis of pricing.