FMLA - Form D.xlsx
XLSX spreadsheet 20 KB Posted
- Attached to
- RFP 34-22 FMLA 2nd & 3rd Opinions
- Solicitation number
- BD-22-1206-40000-42102-74209
- Issued by
- Suffolk County, Massachusetts
About this file
This document appears to be a Pricing Form D for a Request for Proposal (RFP) issued by the Massachusetts Bay Transportation Authority (MBTA) for Family and Medical Leave Act (FMLA) 2nd and 3rd Opinions. The RFP seeks pricing for specialty medical services including allergists, cardiologists, dentists, radiologists, and other medical providers to perform FMLA medical evaluations and provide opinions. Bidders must complete the pricing table by entering their proposed rates for each specialty. The RFP replaces a previous bid that was cancelled, COMMBUYS bid 22-1206-40000-40000-72464.
The pricing form indicates that the proposed rates must be inclusive of the doctor visit charge and any administrative fees, with no other fees or charges to be billed to the MBTA. The RFP does not provide any additional details on funding, term lengths, renewal options, or other salient contract information.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Amendment 1~4.docx | DOCX document | |
| RFP 34-22 FMLA Additional Opinions~1.docx | DOCX document | |
| FMLA Insurance Requirements~2.docx | DOCX document | |
| NOA~1.docx | DOCX document | |
| FMLA - Form B~3.xlsx | XLSX spreadsheet |
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Text version
Pricing
| Form D: Price Proposal | |
| Company Name: |
| Instructions: | |
| Bidders must fill in the highlighted column with cost billed to the MBTA for appointments in all of the specialties listed. | |
| * Rate is inclusive of charge for doctor visit as well any administrative fees. No other fees or charges will be sent to the MBTA. |
| FMLA Bid Form | ||
| Specialist | Rate * | |
| 1 | Allergist | |
| 2 | Burn Specialist | |
| 3 | Cardiology | |
| 4 | Chiropractor | |
| 5 | Dentist | |
| 6 | ENT/Otolaryngologist | |
| 7 | Gastroenterology | |
| 8 | General Surgery | |
| 9 | General Practitioner | |
| 10 | Hand Surgery | |
| 11 | Infectious Diseases | |
| 12 | Internal Medicine | |
| 13 | Neuro-Phycologist | |
| 14 | Neurosurgeon & Neurologist | |
| 15 | Obstetrics & Gynecology | |
| 16 | Occupational Medicine | |
| 17 | Oncology | |
| 18 | Ophthalmology | |
| 19 | Orthopedic | |
| 20 | Pain Management | |
| 21 | Physiatrist /Physical Medicine & Rehab | |
| 22 | Physical Therapist | |
| 23 | Podiatry | |
| 24 | Psychiatry | |
| 25 | Pulmonary | |
| 26 | Radiology | |
| 27 | Rheumatology | |
| 28 | Toxicology | |
| 29 | Urology | |
| 30 | Vascular |
File details come from the government source that posted it. Updated .