WCMBP_Section_F_-_Deliveries_and_Performance_AMD_6.doc

United States Department of Labor

(DOL)

Workers’ Compensation Medical Bill Process (WCMBP)

Section F Deliveries or Performance Revised July 24, 2014 Office of Workers’ Compensation Programs (OWCP)

Table of Contents

Section

Page

5F.1 Clause Incorporation

5F.2 Periods of Performance

5F.3 Place of Performance

6F.4 FAR 52.242-15, Stop-Work Order (AUG. 1989)

7F.5 Delivery Schedule

13F.6 Waiver of Delivery Schedule: Express Intent to Forbear

13F.7 Notice to the Government of Delays

14F.8 Performance Incentives

16F.9 Performance Standards

16F.9.1 Contract Transition

16F.9.1.1 Implementation Milestones

16F.9.1.1.1 Significant Milestones

21F.9.1.1.2 Deliverables

21F.9.1.2 Ongoing Documentation Delivery

22F.9.1.3 Performance Deficiency Correction – Corrective Action Plan

22F.9.1.4 Ongoing Operational Certification

23F.9.1.5 Certification Deficiency Correction – Corrective Action Plan

23F.9.2 Information Security Standards

23F.9.2.1 Security Notification

24F.9.2.2 Security – Data Protection

24F.9.3 Staffing

24F.9.3.1 Staffing – Key Position

24F.9.4 Central Mailroom

24F.9.5 Document Imaging

25F.9.5.1 Document Imaging – Incoming

25F.9.5.2 Document Imaging – Processing

26F.9.6 Claimant Bill Development

26F.9.6.1 Document Processing

26F.9.7 Bill Scan / Data Entry

26F.9.7.1 Bill Scan / Data Entry Process

27F.9.7.2 Bill Scan / Data Entry Accuracy

27F.9.8 Bill Processing

27F.9.8.1 Bill Processing – Processing Time

28F.9.8.2 Bill Processing – Contractor Error

28F.9.8.3 Best Scan Possible

28F.9.9 Third Party Liability

29F.9.10 Prompt Payment Bill Processing

29F.9.10.1 Bill Processing – PPA Processing

29F.9.11 Return to Provider

29F.9.12 Edits and Audits

29F.9.13 Claimant Eligibility

29F.9.14 Provider Enrollment and Management

29F.9.14.1 Provider Enrollment Package Request

30F.9.14.2 Provider Enrollment

30F.9.14.3 Provider Enrollment Notification

30F.9.14.4 Provider Management

31F.9.14.5 Provider Expiring License Notification and Deactivation

31F.9.14.6 Provider Enrollment Package Images

32F.9.14.7 Call Center – Provider Inquiries

32F.9.15 Authorizations

32F.9.15.1 Authorization Disposition

32F.9.15.2 Authorization Image Transmission

33F.9.15.3 Authorization Level 2 Processing

33F.9.15.4 Authorization Level 3 Processing

33F.9.15.5 Authorization Completion

34F.9.15.6 Triage Nurse – Notification

34F.9.15.7 Triage Nurse – Provider Notification

35F.9.16 Treatment Suites

35F.9.17 Bill Pricing

35F.9.18 Pharmacy

35F.9.19 Bill Resolution

35F.9.20 Payment Files Process: RV/EFT and 1099

36F.9.20.1 Bill Payment – Remittance Voucher Imaging

36F.9.20.2 Bill Payment – 1099 Processing

37F.9.20.3 Bill Payment – 1099 -Timeliness

37F.9.20.4 Bill Payment – Payment File Transmission

37F.9.21 Fee Schedule Appeals

37F.9.22 Adjustment Processing

38F.9.22.1 Adjustments

38F.9.22.2 Adjustments Entry

38F.9.23 Fraud and Abuse Detection

38F.9.24 Reporting

39F.9.24.1 Management Reporting - Availability

39F.9.24.2 Performance Reporting

39F.9.24.3 Report-based Corrective Action Plans

40F.9.24.4 Invoice Reporting

40F.9.25 Change Management

40F.9.25.1 Change Management – Accuracy

41F.9.25.2 Change Management - Timeliness

41F.9.26 Communications

41F.9.26.1 Call Center – Speed of Answer

42F.9.26.2 Call Center – Response Accuracy

42F.9.26.3 Call Center –Average Response Time

42F.9.26.4 Call Center – Same Day Response

FAR References

Reference

Page

5FAR 52.252-2, Clauses Incorporated By Reference (FEB 1998)

5FAR 52.242-15, Stop-Work Order (AUG. 1989)

List of Tables Table

Page 7Table 1 WCMBP Plan Deliverables

9Table 2 WCMBP Recurring Deliverables

15Table 3 Positive Performance Incentives

15Table 4 Negative Performance Incentives

17Table 5 Significant Milestones and Acceptance Criteria

F.1 Clause Incorporation FAR 52.252-2, Clauses Incorporated By Reference (FEB 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer (CO) will make their full text available. Also, the full text of a clause may be accessed electronically at https://acquisition.gov/far/current/pdf/FAR.pdf.

All FAR references are formatted as illustrated in the incorporated clause below:

FAR 52.242-15, Stop-Work Order (AUG. 1989)

F.2 Periods of Performance The WCMBP contract, including the base contract and options, may encompass up to seven years of services. The period of performance will begin from the date of contract award:

· Base Year

· Option 1

· Option 2

· Option 3

· Option 4

· Award Term 1

· Award Term 2 The Government anticipates this contract to be effective for a 12-month period from the date of contract award, with the Government’s unilateral right to exercise up to six (6) option periods. Award Terms 1 and 2 are based on contract performance during Option Periods 1 through 4.

F.3 Place of Performance The Contractor shall perform all primary activities at the Contractor’s facilities, in locations specified in the fully-executed contract, using Contractor-supplied systems. The Contractor shall provide on-site resources for OWCP staff and representatives as stated in the Performance Work Statement (PWS), titled as Section C. The Contractor shall ensure that the contractor’s facilities, involved in bill processing and all other functions described in the PWS, meet two geographical requirements:

1. All facilities will be located in the continental U.S. and will be in compliance with the location requirements in Section 1.3.3 of the PWS.

2. All facilities will be within 180 minutes travel time by automobile from a commercial airport (as calculated by http://www.mapquest.com/directions/ [1]).

F.4 FAR 52.242-15, Stop-Work Order (AUG. 1989)

(a) The Contracting Officer may, at any time, by written order to the Contractor, require the Contractor to stop all, or any part, of the work called for by this contract for a period of 90 days after the order is delivered to the Contractor, and for any further period to which the parties may agree. The order shall be specifically identified as a stop-work order issued under this clause. Upon receipt of the order, the Contractor shall immediately comply with its terms and take all reasonable steps to minimize the incurrence of costs allocable to the work covered by the order during the period of work stoppage. Within a period of 90 days after a stop-work is delivered to the Contractor, or within any extension of that period to which the parties shall have agreed, the Contracting Officer shall either—

(1) Cancel the stop-work order; or

(2) Terminate the work covered by the order as provided in the Default, or the Termination for Convenience of the Government, clause of this contract.

(b) If a stop-work order issued under this clause is canceled or the period of the order or any extension thereof expires, the Contractor shall resume work. The Contracting Officer shall make an equitable adjustment in the delivery schedule or contract price, or both, and the contract shall be modified, in writing, accordingly, if—

(1) The stop-work order results in an increase in the time required for, or in the Contractor’s cost properly allocable to, the performance of any part of this contract; and

(2) The Contractor asserts its right to the adjustment within 30 days after the end of the period of work stoppage; provided, that, if the Contracting Officer decides the facts justify the action, the Contracting Officer may receive and act upon the claim submitted at any time before final payment under this contract.

(c) If a stop-work order is not canceled and the work covered by the order is terminated for the convenience of the Government, the Contracting Officer shall allow reasonable costs resulting from the stop-work order in arriving at the termination settlement.

(d) If a stop-work order is not canceled and the work covered by the order is terminated for default, the Contracting Officer shall allow, by equitable adjustment or otherwise, reasonable costs resulting from the stop-work order.

F.5 Delivery Schedule The Government expects the Contractor to provide deliverables throughout the period of performance of the WCMBP Contract. A majority of these deliverables are identified in the PWS but some of the deliverables are identified in other sections of this solicitation. The Contractor shall deliver the deliverables listed in Table 1, Table 2, Section C (PWS), and Section L (Instructions). Section J includes templates for selected reports and letters. A vendor library, that includes detailed descriptions of key deliverables, will be made available to the successful offeror.

Table 1 WCMBP Plan Deliverables

Deliver in Proposal

Deliver in Contract

Test Report and Results from Performance Testing

The Contractor shall submit the deliverables listed in Table 1 to the Government. These deliverables are organized and presented in Table 1 based on the WCMBP area for which the deliverable will be developed. The exact dates for the delivery of each deliverable will be defined when the Project Schedule is finalized. Table 2 lists the currently identified WCMBP Recurring Deliverables with the delivery intervals. This list is subject to change.

Table 2 WCMBP Recurring Deliverables Implementation Phase:

Operations Phase:

List of Reports generated by the WCMBP

DFEC

F.6 Waiver of Delivery Schedule: Express Intent to Forbear None of the following shall be regarded as an extension, waiver, and/or abandonment of the delivery schedule and/or a waiver of the Government’s right to terminate for default;

(i) Delay by the Government in terminating for default;

(ii) Acceptance of delinquent deliveries; and/or

(iii) Acceptance or approval of samples submitted either after default in delivery and/or in insufficient time for the Contractor to meet the delivery schedule.

Any assistance rendered to the Contractor on this contract and/or acceptance by the Government of delinquent goods or services hereunder, will be solely for the purpose of mitigating damages, and is not to be construed as an intention on the part of the Government to condone any delinquency, or as a waiver of any rights the Government may have under subject contract.

Notwithstanding the foregoing, this provision is not intended to permit the Government to extend its forbearance period in perpetuity. Accordingly, the Government’s right to terminate for default based on a particular failure(s) by the contractor must be exercised within a reasonable period of time, which is defined for purposes of this procurement contract as a period extending 6 years following the contractor’s receipt of a formal Cure Notice from the Contracting Officer specifying the failure (or failures) forming the basis for the termination decision.

F.7 Notice to the Government of Delays The Contractor shall immediately notify the CO and the COR in writing, giving pertinent details, in the event the Contractor:

· Encounters difficulty in meeting performance requirements

· Anticipates difficulty in complying with the contract delivery schedule or completion date

· Becomes aware that an actual or potential situation is delaying or threatens to delay the timely performance of this contract This notification is considered informational in character only, and this provision is not to be construed as a waiver by the Government of any delivery schedule or date, or any rights or remedies provided by law or under this contract.

F.8 Performance Incentives In addition to the Award Term(s) discussed in Section H, the contractor may qualify for Positive Performance Incentives for exceeding (i.e., satisfactorily completing prior to the scheduled date) certain performance metric standards, or may be assessed Negative Performance Incentives for failure to meet certain performance metrics. Negative Performance Incentives are necessary to protect the Government from the adverse effects of a contractor’s failure to adhere satisfactorily to the contract schedule. The failure to meet one performance metric may lead to failures to meet other such metrics, in a cascading effect. Any of these failures may cause the Government to incur additional costs that cannot be determined with certainty at the outset of the contract, but which may reasonably be approximated by the schedule of Negative Performance Incentives provided for here.

Amounts due the Government as Negative Performance Incentives may be assessed by deduction from any money payable to the Contractor pursuant to this contract, or by offset against any other money due the contractor from the United States. The Government will notify the Contractor in writing of any such assessment at least thirty (30) calendar days prior to the date the Government makes the deduction or offset. If no monies are due, or if the amounts due are insufficient to satisfy any assessed Negative Performance Incentives, the Government may enforce such Negative Performance Incentives by asserting Government claims for the amount of the assessments. Performance Incentives (both Positive and Negative) will be calculated on the basis of business days. A Negative Performance Incentive, arising from any failure to meet a performance metric, may be assessed separately or in combination with other assessments for other failures. Multiple assessments may relate to overlapping periods of time, so long as each assessment is calculated for just one failure.

Negative Performance Incentives will neither accrue nor be assessed when the contractor’s failure to meet a specified metric is due to Government-ordered suspension or Stop-Work, or to diminution or delay of service arising from causes beyond the control and without the fault or negligence of the Contractor. Examples of such causes include (1) acts of God or of the public enemy, (2) acts of the Government in either its sovereign or contractual capacity, (3) fires, (4) floods, (5) epidemics, (6) quarantine restrictions, (7) strikes, (8) freight embargoes, (9) unusually severe weather, and (10) Government-declared disasters. Although evaluation of the contractor’s performance against performance metrics will occur throughout the term of the contract, in order to allow for a ramp-up period, Negative Performance Incentives related to metrics assigned to the Operations Phase will accrue, but will not be enforced (i.e., assessed) until six (6) months after the Contractor is scheduled to assume responsibility for operations of the WCMBP. The Government may, in its sole discretion, reduce the amount of, or waive entirely, any assessment of Negative Performance Incentives. The exercise of such discretion in any instance(s) shall not be construed as a waiver of the Government’s right to enforce any Negative Performance Incentive in any other instance(s).

All Performance Metrics are listed in Section F.10. The Performance Metrics with Positive Performance Incentives are itemized in Table 3, along with the associated incentive payment.

Table 3 Positive Performance Incentives

The Performance Metrics with Negative Performance Incentives are itemized in Table 4 , along with the associated payment due to the Government.

Table 4 Negative Performance Incentives

F.9 Performance Standards The following sections define the performance metrics for the WCMBP program. The Contractor shall calculate and report on its performance against these metrics to the Government during WCMBP Operations. As discussed above, the Government may award positive incentive cash payment(s) or assess negative incentive deductions based on the Contractor’s performance against the performance metrics.

The performance metrics are arranged by functional area, similarly to the PWS. The PWS functional areas include references to appropriate metrics in this section.

Section H discusses the award of contract extension(s) - called Award Term(s) – based on the Contractor’s performance against the Award Term Plan (ATP).

F.9.1 Contract Transition F.9.1.1 Implementation Milestones F.9.1.1.1 Significant Milestones The Contractor shall meet all significant implementation milestones as set forth in the Contractor’s project schedule, and as approved and accepted by the Government according to the published criteria in Section E of this contract. Significant milestones include those that impact the overall implementation schedule critical path including:

Table 5 Significant Milestones and Acceptance Criteria

2. Functional Specification Document (FSD)

3. Requirements Traceability Matrix (RTM) for Requirements Phase (shows mapping for all requirements thru the RSD and FSD level)

4. Updated IMS if appropriate

5. Meeting minutes/action items

1. All requirements are included in the RSDs and all functional requirements are included in the FSDs, and the RSDs and FSDs have been reviewed and approved by the Government.

2. Mapping for all requirements through the RSD and FSD level has been documented in the RTM for Requirements Phase, and the RTM for Requirements Phase has been reviewed and approved by the Government.

3. Contractor has conducted a successful Preliminary Design Review for the Government:

· Preliminary designs and flows are presented by contractor

· Detailed timelines for completing detailed designs are reviewed and confirmed with each stakeholder to be accurate

· All follow-ups and risks that are generated from the PDR have been documented with plans for resolution/closure approved by the government.

4. Resolution / closure plans for all known action items that are not closed as of the milestone have been reviewed and approved by the Government. Each resolution / closure plan should state when and how the action item will be resolved / closed.

5. PDR meeting minutes have been approved by the government.

· Logical architecture

· Physical architecture

· Data model

· Security model

· Interfaces – External and Internal

· User roles

2. RTM for Design Phase (expands mapping for all requirements to the configuration item/allocated baseline level)

3. Updated IMS if appropriate

4. Meeting minutes/action items

1. System Architecture Description has been reviewed and approved by the Government.

2. Detailed technical designs have been completed and briefed to the Government.

3. Mapping for all requirements through the RSD, FSD, and configuration item/allocated baseline levels has been documented in the RTM for Design Phase, and the RTM for Design Phase has been reviewed and approved by the Government.

4. Contractor has conducted a successful Critical Design Review for the Government:

· All contractor organizations involved in Development and Testing are present and accounted for

· Detailed designs that each contractor organization is responsible for are discussed / reviewed, including

· Screen flows

· Screen designs

· Form and letter designs

· Report designs

· Detailed system interface designs

· Data mapping

· Detailed timelines for completing development and testing are reviewed and confirmed with each stakeholder to be accurate.

· All follow-ups and risks that are generated from the CDR have been documented with plans for resolution/closure approved by the government.

5. Resolution / closure plans for all known action items that are not closed as of the milestone have been reviewed and approved by the Government. Each resolution / closure plan should state when and how the action item will be resolved / closed.

6. CDR meeting minutes have been approved by the government.

2. SIT Test Artifacts, to include:

· Test Scenarios

· Test Cases

· Use Cases

· Test Scripts and Procedures

3. RTM for Development Phase (expands mapping for all requirements to the test scenario and test case level)

4. SIT TRR documentation

5. Bi-Monthly Functional Demo(s)

1. Bi-Monthly Functional Demo(s) showing increasing functionality achieved by the development teams have been conducted at agreed upon dates for Government.

2. The completed software was delivered into the test environment with functionality as specified in the FSDs.

3. All code in the development baseline is completed, unit tested, and signed off by the Contractor development team

4. Unit test documentation as defined in the Contractor’s Unit Test process completed for each component tested provided in the TRR documentation

5. All software components are under CM control and stored in the version controlled repository

6. SIT TRR successfully conducted and the meeting minutes have been approved by the government.

7. Unit testing is complete and results are available for Government review

8. SIT Plan is complete and has been approved by DOL

9. Resolution / closure plans for all known action items that are not closed as of the milestone have been reviewed and approved by the Government. Each resolution / closure plan should state when and how the action item will be resolved / closed.

10. SIT Test artifacts have been approved by the Government

2. Parallel Test Artifacts

3. Parallel TRR Documentation

4. Parallel Test Report

5. Performance and Volume Test Artifacts

6. Performance and Volume TRR Documentation

7. Performance and Volume Test Report

8. RTM for Testing Phase (expands mapping for all requirements to the test scenario and test case level with test result documented)

Systems Integration Test (SIT)

1. All SIT test cases executed with disposition as “passed” or “failed” by the Contractor.

2. All SIT defects have been documented and available for government review.

3. Any other SIT exit criteria, as described in the DOL approved SIT test plan, have been met

4. SIT Test results generated and reviewed with DOL, and any test results that DOL does not concur with are documented with mitigation plan agreed upon by DOL and the Contractor

5. No severity level 1 or 2 defects open. Severity level 3 and 4 defects are prioritized and have a corrective action plan stating what the Contractor will do and when the defect will be fixed or when a work around will be identified.

Performance & Volume Test (P&V)

6. All P&V test cases executed with disposition as “passed” or “failed” by the Contractor.

7. All P&V defects have been documented and available for government review.

8. Any other P&V exit criteria, as described in the DOL approved P&V test plan, have been met

9. P&V Test results generated and reviewed with DOL, and any test results that DOL does not concur with are documented with mitigation plan agreed upon by DOL and the Contractor

10. No severity level 1 or 2 defects open. Severity level 3 and 4 defects are prioritized and have a corrective action plan stating what the Contractor will do and when the defect will be fixed or when a work around will be identified.

Parallel Test

11. All parallel test cases executed with disposition as “passed” or “failed” by the Contractor.

12. All parallel test defects have been documented and available for government review.

13. Any other parallel test exit criteria, as described in the DOL approved parallel test plan, have been met

14. Parallel Test results generated and reviewed with DOL, and any test results that DOL does not concur with are documented with mitigation plan agreed upon by DOL and the Contractor

15. No severity level 1 or 2 defects open. Severity level 3 and 4 defects are prioritized and have a corrective action plan stating what the Contractor will do and when the defect will be fixed or when a work around will be identified.

16. GAT TRR successfully conducted

1. All GAT test cases executed with a disposition as “passed” or “failed” by the Contractor. With written Government approval, test cases can have a disposition as “waived” or “deferred” within GAT.

2. Defects corrected during GAT are regression tested, documented, and available for government review.

3. Any other GAT exit criteria, as described in the DOL approved GAT test plan, have been met

4. GAT Test results generated and reviewed with DOL, and any test results that DOL does not concur with are documented with mitigation plan agreed upon by DOL and the Contractor

5. No severity level 1 or 2 defects open. Severity level 3 and 4 defects are prioritized and have a corrective action plan stating what the Contractor will do and when the defect will be fixed or when a work around will be identified.

2. Operational Certification Statement

3. Operations Readiness Review documentation

1. Operational Certification Checklist completed and approved by DOL

2. Operations Readiness Review conducted successfully

3. Operational Certification Statement completed and submitted to DOL

2. DOL has granted approval in writing for system Go Live

Applicable Phase(s): Implementation Phase

Applicable Requirement(s): Applicable to numerous milestone-related requirements throughout Attachment 3 – Performance Work Statement, and E.2.1.

Method of Measurement: As Scheduled – The Government will track and monitor the Contractor’s compliance with agreed upon dates.

Performance Metric: All deliverables listed for the milestone are 100% timely and accepted by the Government and all acceptance criteria listed for the milestone have been satisfied as confirmed by the Government Positive Performance Incentive: For each business day, before the agreed date for the Operational Go-Live event that the Contractor’s full operational WCMBP capability is certified by the Government as ready to perform the Operational Requirements, the Government will pay a positive incentive of $5,000 for each business day, up to a maximum of 30 (business) days.

Negative Performance Incentive: The negative performance incentive will be $149,000 for each business day after the go live date. , For purposes of this section only, Business Days are defined as: weekdays Mon-Fri (Federal Holidays excluded). If there is a contract change to the Go-Live date, then this negative incentive will apply to the changed milestone date.

F.9.1.1.2 Deliverables The Contractor shall submit acceptable deliverables on time, as set forth in the Contractor’s project schedule and as approved by the Government. Acceptance is according to the published criteria in Section E of this contract.

Applicable Phase(s): Implementation Phase

Applicable Requirement(s): Applicable to numerous deliverable-related requirements throughout Attachment 3 – Performance Work Statement, and E.2.1.

Method of Measurement: Timely delivery and quality deliverable– The Government will review deliverables for acceptance (quality deliverable), and track and monitor the Contractor’s compliance with agreed upon dates.

Performance Metric: Deliverables are 100% timely and accepted by the Government

Positive Performance Incentive: None

Negative Performance Incentive: None F.9.1.2 Ongoing Documentation Delivery The Contractor shall deliver acceptable updates to the following documentation within 5 business days of the start of each Federal fiscal quarter:

· Requirements Specification

· Central Bill Process Medical Bill Operations Manual

Applicable Phase(s): Implementation and Operations Applicable Requirement(s): Addresses requirements including, but not limited to C.R0021 – C.R0024, E.2.1.

Method of Measurement: Quarterly – The Government will review deliverables for acceptance, and monitor the Contractor’s compliance with all dates.

Performance Metric: Deliverables are 100% timely and accepted by the Government Positive Performance Incentive: None

Negative Performance Incentive: None

F.9.1.3 Performance Deficiency Correction – Corrective Action Plan Upon identification by the Government of a deficiency in performance, the Contractor shall develop a corrective action plan for delivery within three (3) business days, unless otherwise provided under separate contract provisions, for the metric(s) in question. The Contractor shall modify and finalize the corrective action plan within one (1) workday after receiving Government feedback.

Applicable Phase(s): Implementation and Operations Applicable Requirement(s): Addresses requirements including, but not limited to C.R0038 Method of Measurement: Periodic – The Government will monitor the Contractor’s performance.

Performance Metric: Deliverables are 100% timely Positive Performance Incentive: None

Negative Performance Incentive: None

F.9.1.4 Ongoing Operational Certification The Contractor shall maintain its operational certification, including compliance with all FISMA requirements, according to the Government’s specifications, with regard to the Contractor’s operations, including supporting systems, processes, call center, reporting, Federal security requirements, disaster recovery site, documentation, staffing, etc.

Applicable Phase(s): Operations

Applicable Requirement(s): Addresses requirements including, but not limited to C.R0124, C.R0142 Method of Measurement: Ongoing – The Government will monitor the Contractor’s compliance.

Performance Metric: Government certification of operational capability is maintained at 100% Positive Performance Incentive: None

Negative Performance Incentive: None F.9.1.5 Certification Deficiency Correction – Corrective Action Plan The Contractor shall immediately notify the Government when any deficiency is identified that may negatively impact certification or recertification requirements. The Contractor shall develop and submit corrective action plan(s) for the deficiency(s) within three (3) business days and modify and finalize the corrective action plan within one (1) workday after receiving Government feedback. Upon approval of the corrective action plan by the Government, the Contractor shall correct the deficiency(s) without negative performance incentives being assessed. If the Government determines that deficiency(s) is so substantial as to significantly degrade operations, the Government’s Certification will be removed.

Applicable Phase(s): Operations Applicable Requirement(s): Addresses requirements including, but not limited to R0038 Method of Measurement: Ongoing – The Contractor monitors WCMBP performance Performance Metric: Notice provided upon identification of deficiency in 100% of instances Positive Performance Incentive: None

Negative Performance Incentive: None

F.9.2 Information Security Standards The following performance metrics are associated with security requirements.

F.9.2.1 Security Notification As documented in Section 3.2.2 of the PWS, the Contractor shall use a Government-approved report form to notify the Government of all security incidents involving Personally Identifiable Information (PII) within one (1) hour of becoming aware of the incident Applicable Phase(s): Implementation and Operations Applicable Requirement(s): Addresses requirements including, but not limited to C.R0175, C.R0176 Method of Measurement: Periodic – The Government will monitor the timeliness of the Contractor’s reports of known incidents against time of occurrence. Additional documentation related to time of incident confirmation may be considered if provided by the Contractor.

Performance Metric: Notice is 100% timely Positive Performance Incentive: None

Negative Performance Incentive: None

F.9.2.2 Security – Data Protection The Contractor shall protect the Personally Identifiable Information (PII) of all claimants, providers, and Government employees from unauthorized disclosure.

Applicable Phase(s): Implementation and Operations Applicable Requirement(s): Addresses requirements including, but not limited to C.R0153-C.R0159 Method of Measurement: Monthly – the Government will monitor reports for any occurrence of unauthorized disclosure.

Performance Metric: Zero (0) unauthorized disclosures of PII Positive Performance Incentive: None

Negative Performance Incentive: The Contractor shall take corrective actions, as determined by the Government on a case by case basis, in redress of unauthorized PII disclosures that are determined to be the fault of the Contractor.

F.9.3 Staffing The following Performance Metrics are associated with staffing requirements.

F.9.3.1 Staffing – Key Position The Contractor shall ensure that no Key Positions remain unfilled due to attrition or scheduled leave for more than 30 consecutive calendar days

Applicable Phase(s): Implementation and Operations Applicable Requirement(s): Addresses requirements including, but not limited to C.R0208 Method of Measurement: Periodic – The Government will monitor backfill times for Key Positions as vacancies occur.

Performance Metric: Zero (0) Key Positions unfilled due to attrition or scheduled leave for more than 30 consecutive calendar days Positive Performance Incentive: None

Negative Performance Incentive: None F.9.4 Central Mailroom There are no Performance Metrics associated with mailroom requirements.

F.9.5 Document Imaging The following Performance Metrics are associated with imaging requirements.

F.9.5.1 Document Imaging – Incoming The Contractor shall ensure that all OWCP mail received is opened, scanned, indexed, and made available to the Government within a monthly average of 2 business days.

Applicable Phase(s): Operations Applicable Requirement(s): Addresses requirements including, but not limited to C.R0238 – C.R0295, C.R0422, C.R1011--C.R1012, C.R1039 --C.R1041, C.R1092 -- C.R1094, C.R1104—CR1118 Method of Measurement: Monthly – The Government will monitor performance reports for timeliness and completion rate of OWCP mail handling, imaging/indexing, and transmittal.

Performance Metric: 100% of the documents received have been processed through the processing procedures, required to make the document available to the Government, within a monthly average of 2 business days.

· OWCP documents are considered ‘available when placed on the landing zone for pick up by DOL and uploaded onto the Government network.

· Bill-related documents are considered available when loaded into the Contractor’s document repository and corresponding data transmitted to the bill processing system.

· Return to Provider (RTP) / Return to Claimant (RTC) letters are considered available when loaded into the Contractor’s document repository and accessible for viewing to authorized users.

Positive Performance Incentive: None

Negative Performance Incentive: None.

F.9.5.2 Document Imaging – Processing The Contractor shall maintain, during each reporting period, the accuracy levels specified in the PWS of 99.5% for document key fields and 98% accuracy for all other fields

Applicable Phase(s): Operations Applicable Requirement(s): Addresses requirements including, but not limited to C.R0286 Method of Measurement: Monthly – The Government assessment of performance reports based on the Contractor’s daily quality control monitoring of all documents imaged using a minimum 2% random sample.

Performance Metric: Reporting period accuracy levels of 99.5% for document key fields, and 98% accuracy for all other fields Positive Performance Incentive: None

Negative Performance Incentive: None F.9.6 Claimant Bill Development The following Performance Metrics are associated with claimant bill development requirements.

F.9.6.1 Document Processing The Contractor shall ensure that all OWCP document mail is processed and data is transmitted to the Government within a monthly average of 2 business days from receiving the mail into the contractor’s facility.

Applicable Phase(s): Operations Applicable Requirement(s): Addresses requirements including, but not limited to C.R0278 Method of Measurement: Monthly – The Government will monitor performance reports for timeliness and completion rate of OWCP document handling, imaging/indexing, and transmittal.

Performance Metric: 100% of OWCP documents received have been processed through the processing procedures, required to make the document available to the Government, within a monthly average of 2 business days.

Positive Performance Incentive: None

Negative Performance Incentive: None F.9.7 Bill Scan / Data Entry The following Performance Metrics are associated with bill scan / data entry requirements.

F.9.7.1 Bill Scan / Data Entry Process The Contractor shall ensure that all bills received are opened, scanned, and made available to the Government within a monthly average of 2 business days Applicable Phase(s): Operations Applicable Requirement(s): Addresses requirements including, but not limited to C.R0238 – C.R0247, C.R0316 – C.R0346, C.R1039, C.R1040, C.R1104 Method of Measurement: Monthly – The Government’s assessment of performance reports.

Performance Metric: 100% bills received are processed through appropriate data entry procedures within a monthly average of 2 business days of receipt.

Positive Performance Incentive: None

Negative Performance Incentive: None F.9.7.2 Bill Scan / Data Entry Accuracy The Contractor shall maintain reporting period accuracy levels of 99.5% for bill data entry in key fields, and 98% accuracy for all other fields. Key fields include but are not limited to:

· Pay to Provider

· Date of Service

· Procedure Codes

· Claimant ID

· Units

· Charges

· Diagnosis for all bill types

· Medicare Number

· For UB bills also Blocks 50B (Payer), 67, 80 and Revenue Codes

Applicable Phase(s): Operations Applicable Requirement(s): Addresses requirements including, but not limited to C.R0342 Method of Measurement: Monthly – The Government’s assessment of performance reports based on the Contractor’s daily quality control monitoring of each receipt date using a minimum 2% random sample by bill type.

Performance Metric: Reporting period accuracy levels of 99.5% for bill data entry in key fields, and 98% accuracy for all other fields.

Positive Performance Incentive: None

Negative Performance Incentive: None F.9.8 Bill Processing The following Performance Metrics are associated with bill processing requirements.

F.9.8.1 Bill Processing – Processing Time The Contractor shall pay or deny bills (excluding Prompt Pay & Determination bills) within 28 calendar days of receipt. Contractor’s processing time does not include time spent by the Government to review bills.

Applicable Phase(s): Operations Applicable Requirement(s): Addresses requirements including, but not limited to C.R0377 Method of Measurement: Monthly – The Government’s assessment of performance reports Performance Metric:…