ESBD_528473_1781710612309_Price Form.docx
DOCX document 44 KB Posted
- Attached to
- Claims Audit Services
- Solicitation number
- TRS000646
- Issued by
- Travis County, Austin City, Texas
About this file
This is a Price Form for Claims Audit Services in Texas. The document serves as the pricing submission template for bidders responding to the state's request for audit services related to claims processing and validation. The form establishes the structure through which qualified vendors must submit their pricing proposals, including labor rates, fee schedules, and cost methodologies for the delivery of comprehensive claims audit services. The specific contract term, renewal options, response deadlines, and site visit requirements would be detailed in the associated Scope of Work and contract documents, with this form functioning as the standardized pricing vehicle for all bidders to ensure consistent cost comparison across proposals.
The Price Form establishes uniform pricing submission requirements to facilitate objective evaluation of vendor proposals on a level playing field. This standardized approach allows the state to directly compare costs across multiple bidders using identical line items and calculation methods. The form likely includes provisions for various service tiers, hourly rates for different personnel classifications, per-audit fees, or other relevant cost structures specific to claims audit service delivery. Any set-asides, incumbent considerations, or funding source allocations would be documented in the main procurement documents, with this form providing the mechanism for transparent cost disclosure and evaluation in accordance with Texas purchasing regulations.
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Other files
| File | Type | Posted |
|---|---|---|
| ESBD_528473_1781710611009_Claims Audit Services_Draft_Contract.docx | DOCX document | |
| ESBD_528473_1781710611799_TRS000646_Claims Audit Services_Solicitation.docx | DOCX document |
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Text version
Price Form
Prices are inclusive of all fees and travel-related expenses.
Travel: TRS will not reimburse Respondent for any travel, meals, lodging, or other related expenses under this Contract.
No additional amount will be paid for any costs or charges incurred by the Contractor, which are not listed on the price form, unless specifically agreed to in writing by TRS.
Respondent shall only fill out the service(s) section(s) that it intends to propose on. TRS will assume that Respondent is not proposing on any service(s) left blank within the Price Form submitted.
A. Medical Claims Audit Services and Prescription Drug Claim & Pharmacy Rebate Audit Services The rates for audit cycle 1 and audit cycle 2 are locked in and can only change in the event that TRS modifies the current number of entities or plans being audited, or modifies the quantity of claims to be audited. Any such rate changes for audit cycles 1 and 2 must be specifically agreed to in writing by the parties as an amendment to this Contract before such rates become effective and binding upon TRS. All adjustments to the pricing are subject to TRS’ approval as referenced above. Rates for audit cycles 3 through 6 are for the audits anticipated to be conducted during the optional renewal periods. Rates for audit cycles 3 through 6 are only effective and binding upon TRS if the Contract is extended into the renewal periods.
1. Medical Claims Audit Services Fees to provide medical claims auditing services regarding the administration and health claims adjudication by TRS’ Health Plan Administrator (HPA) as described in the Scope of Work.
Medical Claims Audits
| Audit Cycle |
| Plan to be Audited |
| Entities Audited |
| Fee |
| 1. |
| TRS-Care |
| HPA |
TRS-ActiveCare
| 2. |
| TRS-Care |
| HPA |
TRS-ActiveCare
| 3. |
| TRS-Care |
| HPA |
TRS-ActiveCare
| 4. |
| TRS-Care |
| HPA |
TRS-ActiveCare
| 5. |
| TRS-Care |
| HPA |
TRS-ActiveCare
| 6. |
| TRS-Care |
| HPA |
TRS-ActiveCare
Total
2. Prescription Drug Claim & Pharmacy Rebate Audit Services Fees to provide pharmacy claims and rebate auditing services regarding the administration and prescription drug claims adjudication by TRS’ Pharmacy Benefit Manager (PBM) as described in the Scope of Work.
Prescription Drug Claim & Pharmacy Rebate Audit Services
| Audit Cycle |
| Plan to be Audited |
| Entities Audited |
| Fee |
| 1. |
| TRS-Care |
| PBM |
TRS-ActiveCare
| 2. |
| TRS-Care |
| PBM |
TRS-ActiveCare
| 3. |
| TRS-Care |
| PBM |
TRS-ActiveCare
| 4. |
| TRS-Care |
| PBM |
TRS-ActiveCare
| 5. |
| TRS-Care |
| PBM |
TRS-ActiveCare
| 6. |
| TRS-Care |
| PBM |
TRS-ActiveCare
Total
B. Clinical Validation Review Services Fees to provide clinical validation review services regarding the administration and health claims adjudication by TRS’ Health Plan Administrator (HPA) as described in the Scope of Work.
| Services |
| Contingency Fee Rate |
Clinical Validation Review
C. Optional/Ad Hoc Services Fees for any Optional/Ad Hoc Services are as follows. TRS may engage Contractor for Optional/Ad Hoc Services by issuing a Statement of Work to be signed by both parties (see SOW document for procedure). Fees for Services listed as “TBD” will be included in each final signed Statement of Work. Optional/Ad Hoc Services are related to claim audits of our administrators, and may focus on certain aspects of claim adjudications or operational risks that impact claim adjudication, such as member eligibility, implementation of claim edits, or utilization management.
Contractor may propose optional audit services, or alternative methods for accomplishing the medical claim audit, pharmacy claim and rebate audit, or clinical validation reviews.
OPTIONAL/AD HOC SERVICES RATES
| Classification/Services |
| Fees |
[Contractor to insert any additional Optional and/or Supplemental Services]
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