Attachment L-1 Revised 14 Jun 11.docx

ATTACHMENT L-1:

TEAM COMPOSITION WORKSHEET

1. Provide the required information on the offeror (Prime) below. If the offeror is a Joint Venture, list the name of the Joint Venture on the first line and provide the details for the two (2) companies forming the Joint Venture on the other two lines.

Note: Total prime workload must be greater than or equal to 50% of contract workload.

2. Provide the requested information on all teaming partners/subcontractors. If more space is needed, use an additional copy of this sheet and number accordingly (i.e., Page 1 of 2).

Note: Total teaming Partner/subcontractor workload must be less than or equal to 50% of contract workload.

ATTACHMENT L-1: TEAM COMPOSITION WORKSHEET, Page 2

3. Indicate which services the teaming partner/subcontractor will provide. Only list one teaming partner/subcontractor per category. If there is more than one subcontractor, list the one that will do the majority of the effort with the Prime.

Clerical labor categories (i.e., secretary, appointment clerk, office clerk)

Certified labor categories (i.e., medical coding professionals, transcriptionists, records technicians)

Specialized labor categories (i.e., beneficiary services/PEBLO, tumor registrar, referral management personnel, utilization managers, third party collection clerks)

Technical labor categories (i.e., logistics, supply, equipment technicians, public health, safety specialists)

Full Services

Patient Appointing Service

Medical Records Service

Medical Coding & Auditing Service

Medical Transcription Service

Referral Management Services