WCMBP_Section_J_Attachment_20_-_Contractor_Evaluation_Form_Template_AMD_5.doc

United States Department of Labor

(DOL)

Workers’ Compensation Medical Bill Process (WCMBP)

Attachment 20 –

Contractor Evaluation Form Template July 14, 2014 Office of Workers’ Compensation Programs (OWCP)

FACTOR RATINGS

Each factor will be rated using an adjectival rating system. The ratings are defined as:

· Exceptional: The Contractor’s performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the element or sub- element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

· Very Good: The Contractor’s performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub- element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor was effective.

· Satisfactory: The Contractor’s performance meets contractual requirements. The contractual performance of the element or sub- element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

· Marginal: The Contractor’s erformance does not meet some contractual requirements. The contractual performance of the element or sub- element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented.

· Unsatisfactory: The Contractor’s performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

Each factor will have a written narrative that describes, in detail, performance during the specified rating period. The use of performance and COR reports, audit results, and contractor plans and proposals for evaluating this period will be critical. The CEF should mirror the relevant data, plans, and proposals, and document the strengths and weaknesses found during each rating period. Based on the written narrative an adjectival rating will be assigned to each factor. Once all factors have been rated, the overall rating will be determined by the rating most used. In the event of a tie, the COR will provide an additional narrative (on an attached sheet of paper) thoroughly explaining/justifying the decision for the overall rating.

Contractor Evaluation Recommendation (Base YR Option YR 1)

To:

To:

3. Contractor Name/Address

4. Contract Number:

5. Contract Award Date

6. Place Of Performance:

7. COR Approval (Consider both positive and negative attributes in the factors below; provide a mandatory, written narrative describing the contractor’s strengths and weaknesses) Name:

Date:

Signature:

How successfully has the contractor met program quality objectives; e.g., , reliability, maintainability, inspectability, testability, and system safety? How effective is the contractor's control of the overall billing process, to include material control, mailroom planning, status and control, and performance?

Narrative:

Can the consultants’ work products and related documents, (trip reports indicating persons visited and subjects discussed, minutes of meetings, and collateral memoranda and reports) be used to prove that work performed is proper and does not violate law or regulation? Have there been quality issues impacting acceptance of deliverables? Have you documented the strengths and weaknesses?

Has the contractor followed the approved Subcontracting Management Plan? Did the contractor provide for open lines of communication about, and rapid response to, OWCP needs, requirements, and directions? Has the contractor managed pass through costs so as not to exceed the ceiling limit? How effectively has the contractor recruited, trained, and retained adequate staff in accordance with the Staffing and Training Plans? Were DOL suitability and security procedures followed for new staff? Are Key and Categorized Positions for this phase filled per Government requirements? Have there been patterns of resolved issues recurring during the rating period? Have you documented the strengths and weaknesses?

How effective has the contractor been at implementing the project schedule? Were implementation milestones and delivery schedules met? Has the contractor obtained all necessary approvals for analyses, audits, inspections, tests and other deliverables during the rating period? Have you documented the strengths and weaknesses?

Contractor Evaluation Determination

8. Overall Rating (Ensure you documented both overall strengths and weaknesses)

Date:

Signature:

Comments

Date:

Signature:

Comments

11. Contractor Approval (Authorized Negotiator only) Name:

Date:

Signature:

Rebuttal:

Date:

Signature:

Determination:

Original: Official Contract File (maintained by Contracting Officer) CC: COR File

FACTOR RATINGS

Each factor will be rated using an adjectival rating system. The ratings are defined as:

· Exceptional: The Contractor’s performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the element or sub- element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

· Very Good: The Contractor’s performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub- element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor was effective.

· Satisfactory: The Contractor’s performance meets contractual requirements. The contractual performance of the element or sub- element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

· Marginal: The Contractor’s performance does not meet some contractual requirements. The contractual performance of the element or sub- element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented.

· Unsatisfactory: The Contractor’s performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

Each factor will have a written narrative that describes, in detail, performance during the specified rating period. The use of performance and COR reports, audit results, and contractor plans and proposals for evaluating this period will be critical. The CEF should mirror the relevant data, plans, and proposals, and document the strengths and weaknesses found during each rating period. Based on the written narrative an adjectival rating will be assigned to each factor. Once all factors have been rated, the overall rating will be determined by the rating most used. In the event of a tie, the COR will provide an additional narrative (on an attached sheet of paper) thoroughly explaining/justifying the decision for the overall rating.

Contractor Evaluation Recommendation (Option Year 2)

To:

To:

3. Contractor Name/Address

4. Contract Number:

5. Contract Award Date

6. Place Of Performance:

7. COR Approval (Consider both positive and negative attributes in the factors below; provide a mandatory, written narrative describing the contractor’s strengths and weaknesses) Name:

Date:

Signature:

Has the contractor maintained operational certification and information security standards following implementation, in accordance with Government requirements? Were complete payment files transmitted according to weekly schedules? Did performance come within 10 percentage points of timeliness and accuracy requirements for reports, RV images, and documentation updates? How effectively has the contractor followed requirements for corrective action plans? Did the contractor provide for open lines of communication about, and rapid response to, OWCP needs, requirements, and directions? Has the contractor managed pass through costs so as not to exceed the ceiling limit? Have there been patterns of resolved issues recurring during the rating period? Has the contractor followed the approved Subcontracting Management Plan? Have you documented the strengths and weaknesses?

How effective has the contractor been in performing mailroom requirements? Did performance come within 10 percentage points of timeliness and accuracy requirements for document imaging and indexing? Were bill scan and data entry functions performed within 10 percentage points of timeliness and accuracy requirements? Were Quality Assurance measures adequate to ensure legible images and proper case number assignment of PII documents? Have you documented the strengths and weaknesses?

Was provider management handled according to Government requirements? Did the contractor enroll providers within 2 business days of the required timeframe? How effective has the contractor been in following the approved plan for outreach to educate and interact with providers in order to maintain enrollment volumes and increase EDI usage? What efforts have been made during this rating period to address high-impact provider issues? Have you documented the strengths and weaknesses?

Did changes implemented during this rating period meet requirements for timeliness, errors and defects? Have automated processing capabilities remained available with full functionality? Did the contractor have an effective plan for managing all electronic interfaces, which described their approach for enhanced capabilities and expanded usage? How effective has the contractor been in following the approved change management processes and procedures? Did the contractor propose any value engineering that would reduce manual processes? How effective has the implementation of value engineering proposals been? Have you documented the strengths and weaknesses?

Have any Key Positions been unfilled for more than 30 days? How effectively has the contractor ensured adequate staffing recruitment and training in accordance with the Staffing and Training Plans? Were DOL suitability and security procedures followed for new staff? Have there been patterns/recurrences of confidentiality, integrity, or PII issues during this rating period? Are Key and Categorized Positions filled per Government qualifications? Have you documented the strengths and weaknesses?

Have performance requirements for average speed of answer, average response time, and same-day response rates been maintained? Did the contractor provide required levels of accurate and complete information and referrals to federal staff? Did Quality Assurance measures indicate the Call Center provided prompt and courteous call handling during the rating period? Did the IVR remain available with full functionality? How effective has the contractor been in minimizing call abandonment rates due to prolonged answer times? Have you documented the strengths and weaknesses?

How effectively did the contractor make disposition and complete authorizations in accordance with timeliness and accuracy requirements? Were bill, prompt pay, RTP, and adjustment processing performed within 10 percentage points of accuracy and timeliness requirements? Did the contractor error rate stay within 3 percentage points of the Government requirement? What was the financial impact of contractor errors? Have there been patterns/recurring issues with edits and audits or bill pricing? Did the contractor appropriately apply claimant eligibility and treatment suite rules? Have fee schedule appeals, third-party liabilities, and deficient bills been appropriately handled? Have you documented the strengths and weaknesses?

8. Overall Rating (Ensure you documented both overall strengths and weaknesses)

Date:

Signature:

Comments

Date:

Signature:

Comments

11. Contractor Approval

Name:

Date:

Signature:

Rebuttal:

Date:

Signature:

Determination:

FACTOR RATINGS

Each factor will be rated using an adjectival rating system. The ratings are defined as:

· Exceptional: The Contractor’s performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the element or sub- element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

· Very Good: The Contractor’s performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub- element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor was effective.

· Satisfactory: The Contractor’s performance meets contractual requirements. The contractual performance of the element or sub- element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

· Marginal: The Contractor’s performance does not meet some contractual requirements. The contractual performance of the element or sub- element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented.

· Unsatisfactory: The Contractor’s performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

Each factor will have a written narrative that describes, in detail, performance during the specified rating period. The use of performance and COR reports, audit results, and contractor plans and proposals for evaluating this period will be critical. The CEF should mirror the relevant data, plans, and proposals, and document the strengths and weaknesses found during each rating period. Based on the written narrative an adjectival rating will be assigned to each factor. Once all factors have been rated, the overall rating will be determined by the rating most used. In the event of a tie, the COR will provide an additional narrative (on an attached sheet of paper) thoroughly explaining/justifying the decision for the overall rating.

Contractor Evaluation Recommendation (Option YR 3-)

To:

To:

3. Contractor Name/Address

4. Contract Number:

5. Contract Award Date

6. Place Of Performance:

7. COR Approval (Consider both positive and negative attributes in the factors below; provide a mandatory, written narrative describing the contractor’s strengths and weaknesses) Name:

Date:

Has the contractor maintained operational certification and information security standards in accordance with Government requirements? Has the contractor followed the approved Subcontracting Management Plan? Were deliverables submitted according to their delivery schedules and government requirements for reporting, payment files, and documentation updates? Did the contractor provide for open lines of communication about, and rapid response to, OWCP needs, requirements, and directions? Has the contractor managed pass through costs so as not to exceed the ceiling limit? How effective has the contractor been in following Government requirements for corrective action plans? Have there been patterns of resolved issues recurring during the rating period? Have you documented the strengths and weaknesses?

How effective has the contractor been in performing mailroom requirements? Were documents imaged and indexed in accordance with Government requirements? Have bill scan and data entry functions been performed according to Government requirements? Were Quality Assurance measures adequate to ensure legible images and proper case number assignment of PII documents? Have you documented the strengths and weaknesses?

(different from yr2)

How effective has the contractor been in following the approved plan for outreach to educate and interact with providers in order to maintain enrollment volumes and increase EDI usage? What efforts have been made during this rating period to address high-impact provider issues? Did the contractor manage provider enrollments according to Government requirements? Have you documented the strengths and weaknesses?

Did changes implemented during this rating period meet Government requirements? Have automated processing capabilities remained available with full functionality throughout the rating period? Did the contractor have an effective plan for managing all electronic interfaces, which described their approach for enhanced capabilities and expanded usage? How effective has the contractor been in following the approved change management processes and procedures? Did the contractor propose any value engineering that would reduce manual processes? How effective has the implementation of value engineering proposals been? Have you documented the strengths and weaknesses?

How effective has the contractor been in ensuring that adequate staff have been recruited, trained, and retained in accordance with the Staffing and Training Plans? Has staff met all annual training requirements? Were DOL suitability and security procedures followed for new staff? Have there been patterns/recurrences of confidentiality, integrity, or PII issues during this rating period? Are Key and Categorized Positions filled per Government requirements? Have you documented the strengths and weaknesses?

Have Government requirements for average speed of answer, average response time, and same-day response rates been maintained? Did Quality Assurance measures indicate the Call Center provided prompt and courteous call handling during the rating period? Did the contractor provide acceptable levels of accuracy and completeness of information and referrals to federal staff? Did the IVR remained available with full functionality during the rating period? How effective has the contractor been in minimizing call abandonment rates due to prolonged answer times? Have you documented the strengths and weaknesses? (different from yr2)

How effective has the contractor been in performing bill, prompt pay, point-of-sale, and adjustment processing according to Government requirements? How effectively has the contractor handled authorizations in accordance with Government requirements? What was the financial impact of contractor errors for the rating period? Have there been patterns/recurring issues with edits and audits or bill pricing during the rating period? Did the contractor appropriately apply claimant eligibility and treatment suite rules? Have fee schedule appeals, third-party liabilities, and deficient bills been appropriately handled? Have you documented the strengths and weaknesses?

8. Overall Rating (Ensure you documented both overall strengths and weaknesses)

Date:

Signature:

Comments

Date:

Signature:

Comments

11. Contractor Approval

Name:

Date:

Signature:

Rebuttal:

Date:

Signature:

Determination: