WCMBP_Section_B_-_Supplies_or_Services__Prices-Costs_AMD_5.doc

United States Department of Labor

(DOL)

Workers’ Compensation Medical Bill Process (WCMBP)

Section B Supplies or Services and Prices/Costs Revised July 1, 2014 Office of Workers’ Compensation Programs (OWCP)

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 (001-007) that specifies the set of project functions. The CLIN groups are identified in Table 1.

Table 1 CLIN Groups

CLIN groups are defined in the following sections.

B.2.1 Transition-In (CLINs 0001 and 1001 in Table 4) 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

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) (CLINs 0002, 1002, 2002, 3002, 4002, 5002 and 6002 in Table 4) 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

· 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 price bid 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 COTR 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 (CLINs 0003, 1003, 2003, 3003, 4003, 5003, and 6003 in Table 4) 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

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

· Enrollments: intake, responses, provider file maintenance, and call handling 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.2.4 Call Center (CLINs 0004, 1004, 2004, 3004, 4004, 5004, and 6004 in Table 4) 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

· 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 (CLINs 0005, 1005, 2005, 3005, 4005, 5005, and 6005 in Table 4) 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)

· 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 (CLIN 0006 in Table 4) 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.2.7 Service Enhancements (CLINs 0007, 1007, 2007, 3007, 4007, 5007 and 6007 in Table 4)

This CLIN group reports the price of labor hours for Service Enhancements during the period from the beginning of operations until contract termination.

CLINs 0007, 1007, 2007, 3007, 4007, 5007 and 6007 are Labor Hour CLINS and are to be used for approved service enhancements that are directed by the Government during operations, after the Go-Live date. The Government will award these CLINs on an as needed basis after the Go-Live date, in funding increments not to exceed the ceiling for each period of performance. Enhancements are defined in Section C, requirement number R0856. The labor hour ceiling for these CLINs shall equal 12,000 hours for each per period of performance.

CLIN 0007 is to be used only if the contractor’s proposed Go-Live date occurs earlier than 12 months. CLIN 1007 is to be used only if the contractor’s proposed Go-Live date occurs earlier than 24 months. The contractor shall pro-rate the proposed number of hours for these two CLINs only (CLINs 0007 and 1007) based on the contractor’s proposed Go-Live date (1,000 hours for each month of operations). If the contractor’s proposed Go-Live date occurs in Option Period 2, CLIN 0007 and CLIN 1007 shall not be used.

The Government will use the price bid for the Service Enhancement Labor Hour CLIN group on the awarded contract to define a “not to exceed” Service Enhancement Labor Hour CLIN group ceiling value for each period of performance. The contractor shall bill for Service Enhancement Labor Hours only when Service Enhancements are approved and directed by the Government. The contractor shall maintain the Service Enhancement Labor Hour CLIN group at or below the ceiling value, unless adjustments are negotiated with the Government.

Primary Cost Components

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

· 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).

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.

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

Table 2 Volume-Sensitive Pricing Elements

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 (0-6) that specifies the year of the contract as shown in Table 3. This identifier occurs as the 1st digit in the CLIN.

Table 3 Periods of Performance

The CLINs for the contract are defined in Table 4. The price reported by CLIN 0006 is not restricted to a single contract year. Rather, this CLIN reports the prices of the indicated pricing groups for all relevant contract years. This CLIN is to be used if/when there is transition-out to a new contractor. This CLIN can be used during any contract period.

Table 4 Contract Line Items

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.

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