Amendment_1_Attachment_2-Updated_Attachment_J._18_Basis_of_Estimate.xlsx
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- DME MAC Jurisdiction B
- Solicitation number
- HHSM-500-2014-RFP-0069
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Instructions
| HHSM-500-2014-RFP-0069 | BASIS OF ESTIMATE |
| Attachment J.18 | August 14, 2014 |
| BASIS OF ESTIMATE INSTRUCTIONS | |
| PURPOSE: The purpose of the Basis of Estimate (BOE) is to assist the Centers for Medicare & Medicaid Services (CMS) in its evaluation of the Offeror’s technical and business proposals. Specifically, the BOE and other relevant historical data available to CMS will be used as a baseline tool for measuring and understanding how the Offeror proposes to perform the Statement of Work (SOW) requirements in contrast to how the Offeror has historically performed similar Medicare Administrative Contractor (MAC) work. Unexplained or unsupported variances between an Offeror’s proposed productivity rates, total number of hours and skill mix and its historically experienced productivity rates, total number of hours and skill mix with similar work as a MAC may result in a technical finding and/or a cost realism adjustment pursuant to Federal Acquisition Regulation (FAR) 15.404-1(d). | |
| INSTRUCTION: The Offeror shall complete the BOE for the Base Year and Option Years 1 through 4. A tab is provided for each option period. In order to assist the Offeror in completing this BOE, CMS has provided instructions for populating the template. In addition, CMS has provided a sample calculation for the Offeror under the Example Tab. |
NOTE: The Offeror shall submit the TOTAL proposed staffing (inclusive of existing staff, direct and indirect labor, inter-organizational transfers, subcontracts, etc., as applicable) to perform the work from implementation through contract end. The Offeror shall use the BOE format provided, inclusive of any formulas or formatting. The Offeror is instructed to copy-paste additional rows, as necessary, including any formulas and formatting from a similar row.
Column A, Row 4 The Offeror will fill in its company name on each worksheet in the space provided next to "OFFEROR NAME".
| Column A, | ||
| SOW WBS Crosswalk | PURPOSE: The purpose of this column is to enable CMS to sort on proposed labor by function to allow for meaningful crosswalks between the BOE and the Offeror's contract line item number (CLIN) templates and Technical Proposal. |
INSTRUCTION: The Offeror shall identify the Work Breakdown Structure (WBS) at the level necessary to provide meaningful distinctions for the associated hours by labor category. WBS levels are counted starting with the “letter” level, for instance “D,” so, for example D.1.2.6 is the fourth level of the WBS for that function.
| Please note the further breakout required for the following areas: |
| * Claims Processing (D.1) - the Offeror shall propose hours at (at least) the third level of the WBS. |
| * Redeterminations (D.2) - the Offeror shall propose hours at (at least) the fourth level of the WBS, or third level only if the fourth is not available. |
| * Medical Review (E.4) - the Offeror shall propose hours at these specified WBS: E.4.12, E.4.7.2, E.4.7.3, E.4.7.4, E.4.7.5, E.4.7.6, E.4.7.7, E.4.7.8, E.4.7.9, E.4.7.10, E.4.7.11, E.4.7.12, E.4.7.13, E.4.7.14, E.4.7.16, and E.4.7.18. |
| For all other Medical Review direct labor hours, the Offeror shall identify the WBS level necessary to provide meaningful distinction for the associated hours by labor category. |
| Column B, | |||
| SLIN Crosswalk | PURPOSE: The purpose of this column is to enable the Government to sort on proposed labor by sub-line item (SLIN) and allow for meaningful crosswalks between the BOE and the Offeror's CLIN templates and Technical Proposal. | ||
| INSTRUCTION: The Offeror shall identify the SLIN for the associated workload category. |
| Column C, | |||
| Workload Category | PURPOSE: The purpose of this column is to identify the overall workload performed or supported by the proposed level of effort. | ||
| INSTRUCTION: The Offeror shall use the workload category names provided. When copy-pasting additional rows into a section, the Offeror will ensure this column contains the appropriate workload category for the labor described in the rest of the row. (See Example tab.) |
| Column D, | |||
| Workload Subcategory | PURPOSE: The purpose of this column is to identify the driver of the proposed level of effort for the workload. CMS defines labor in two ways - "productive" and "non-productive." CMS defines "productive" labor as that labor that is solely dependent on workload volume; as workload volume increases, productive labor hours increase at a proportionate rate. Conversely, CMS defines "non-productive" labor as labor that is not solely driven by workload volume. Rather, "non-productive" labor may be fixed labor with no ties to workload fluctuations, or it may be labor that increases based on other factors, such as manager hours that are based on management to staff ratios. | ||
| INSTRUCTION: The Offeror shall use the workload subcategory names provided by CMS to identify the driver for a given productive labor category. In the event that workload does not drive the proposed level of effort for a given labor category, the Offeror shall classify its non-productive labor categories with the label "Non-Workload Estimating Factor" and group these rows at the end of the respective workload category section. (See Example tab.) | |||
| NOTE: There is a blank “Non-Workload Estimating Factor” row available at the end of each workload category section to be used (or deleted) as necessary to capture the "non-productive" labor categories that support a workload. |
| PROPOSAL | |||
| Column E, | |||
| RFP Workload | PURPOSE: The purpose of this column is to ensure the Offeror uses the Government's workload assumptions when estimating the proposed level of effort. | ||
| INSTRUCTION: The Government has pre-populated this column with the Government's workload assumptions. The Offeror shall not change the Request for Proposal (RFP) workloads in this column. The Offeror shall leave this column blank for a row relating to “Non-Workload Estimating Factor” (a non-productive labor category). |
| Column F, | |||
| Total Proposed/Derived Workload | PURPOSE: The purpose of this column is to understand the few instances in which the Offeror is proposing or deriving a workload that differs from the RFP workload. For most workload subcategories, the total proposed/derived workload will mirror the RFP workload, given that workload assumptions are mandatory for bidding purposes, with the exception of Medical Review. However, certain workloads, namely Claims Processing and Provider Telephone Inquiries, are impacted by various processes that allow for automation or self-service, thus reducing the workload to be processed by the productive labor categories. This column allows CMS to understand the application of that automation or self-service to the RFP workload. | ||
| INSTRUCTION: For most workload subcategories the Offeror will not change the mandatory RFP workloads already provided in this column. (If the Offeror does change a mandatory RFP workload in this column, it MUST also provide an explanation in Column N.) For Claims Processing, Provider Telephone Inquiries, Provider Outreach and Education, and Medical Review, the Offeror shall identify its derived/proposed workloads based on the RFP volumes and disclose its other assumptions (in Column N). Please see below for further detail on how to complete the total proposed/derived workloads for these four identified workload categories. The Offeror shall leave this column blank for any row(s) relating to “Non-Workload Estimating Factor” (a non-productive labor category). |
| Claims Processing |
| The Offeror shall enter the suspended claims volumes in this column. See below for more information on suspended claims. |
In claims processing the majority of claims are processed through the standard system, with only a percentage of claims suspending for manual review. It is the volume of claims requiring manual review (suspended claims) that drives the level of effort to be identified in the BOE. That level of effort will vary based on each Offeror's approach to installing automated edit reviews, or the Offeror's proposed suspense rate.
| Claims Suspense Rates are defined as follows: |
| 1. Suspense Rate (Electronic) - The percentage of all electronically submitted claims that suspend from automated claims processing – inclusive of ViPS Medicare System (VMS) processing logic and MAC-specific processing logic - that require intervention of a person to resolve the claim to completion, whether as payment or a denial. Note: This figure should NOT include claims which are rejected or returned by the Common Electronic Data Interchange (CEDI) contractor. This figure also should NOT include claims suspended for medical review. |
| 2. Suspense Rate (Paper) - The percentage of all submitted Paper claims that suspend from automated claims processing – inclusive of VMS and MAC-specific processing logic - that require intervention of a person to resolve the claim to completion, whether as payment or a denial. Note: This figure should include the volume of paper claims which suspend for staff review as part of any optical character recognition (OCR) scanning process. This figure should NOT include claims suspended for medical review. |
| Provider Telephone Inquiries |
| The Offeror shall enter the volume of provider telephone inquiries to be answered by a person in this column. See below for more information on self-service solutions. |
A portion of provider telephone inquiries will be addressed via self-service solutions, such as an interactive voice response (IVR) or an internet portal. It is the volume of provider telephone inquiries to be answered by the productive labor category that drives the level of effort to be identified in the BOE. That level of effort will vary based on each Offeror's approach to using self-service technologies.
| Provider Outreach and Education Activities (PM and MIP Provider Customer Service Workloads) |
| The Offeror shall enter the types and volumes of provider outreach and education activities in this column. See below for more information on the assumptions to be used for these proposed workloads. |
The Offeror shall use the jurisdiction-specific DMEPOS supplier populations shown in Attachment J-19, Government-Provided Proposal Assumptions to determine the workload appropriate for each type of provider outreach and education activity. There are no minimum requirements for this function, so the Offeror must develop its own strategy for how it can best service the provider population.
| Medical Review |
| The medical review (MR) workloads provided in the RFP are not mandatory; rather, the Offeror may propose its own workloads based on its proposed Medical Review Strategy. Therefore, the workloads provided by the Offeror on this Basis of Estimate should mirror its proposed workloads to support its MR Strategy. The Offeror shall enter its proposed workloads by category in this column to support its proposed Medical Review Strategy. (Please see instructions for column A for more detail on the WBS breakout required for Medical Review.) |
NOTE FOR PREPAY COMPLEX REVIEWS, COMPLEX PROBE REVIEWS, and POSTPAY COMPLEX REVIEWS: These RFP workloads are provided at the overall review type level. The Offeror shall use these overall RFP workloads to calculate its distribution of workload across the specific review types, such as provider and service-specific. All workload distributions must equal the total proposed workload for the overall review type, as described in the Offeror’s proposed MR strategy.
| Column G, | |||
| Position/Labor Category (Proposed) | PURPOSE: The purpose of this column is to disclose the labor categories that will perform or support a given workload subcategory. (This includes both productive and non-productive labor categories.) The Government may consider this information in determining the reasonableness of the Offeror's proposed labor (skill) mix. | ||
| INSTRUCTION: For each workload subcategory, the Offeror shall identify all the labor categories required to perform the functional requirements of the statement of work. Each labor category shall be displayed using a separate row. This may require the Offeror to insert additional rows. The Offeror shall copy and paste all formulas and formatting into each inserted row. In the event that the Offeror wishes to display separate productivities for the same labor category to process the same workload subcategory, the Offeror shall display all productivities sequentially in the BOE. For example, if the Offeror has a Claims Analyst position that processes claims in State A and State B, the Offeror may display separate productivities by State for the Claims Analyst in the BOE. However, if the Offeror displays separate productivities, the Offeror shall display those productivities and associated hours on sequential rows (e.g., row 57 and row 58). Similarly, if the Offeror wants to display separate productivities for a single labor category based on varying difficulty in a workload subcategory, the Offeror shall ensure that those productivities are also listed sequentially in the BOE (e.g., row 57 and 58). |
POSITION DESCRIPTIONS: For each labor category identified in the BOE the Offeror shall also complete the Position Description tab of this template to describe the specific job tasks, qualifications, and experience for each proposed labor category. The instructions for completing the position descriptions are found at the end of this Instructions tab.
| Column H, | |||
| % Workload Processed by Labor Category (Proposed) | PURPOSE: The purpose of this column is to explain to CMS the percentage of the workload to be processed by the respective labor category. This is especially useful in understanding how a particular workload subcategory is allocated across more than one productive labor category, where applicable. For example, the Offeror may use Claims Analysts I and II to process claims that suspend for manual review. Claims Analyst I may handle the easier claims, while Claims Analyst II may handle the more difficult claims. Therefore, each labor category would not process 100% of the claims, but a subset specific to their tasks (e.g., 75% of claims go to Claims Analyst I and 25% go to Claims Analyst II). | ||
| INSTRUCTION: For each workload subcategory the Offeror shall identify the percentage of the annual workload to be processed by the respective labor category. The Offeror shall only identify a percentage in this column if the Offeror defines that position as "productive." The Offeror shall leave this column blank for a row relating to “Non-Workload Estimating Factor” (a non-productive labor category). |
| Column I, | |||
| Workload Distribution (Proposed) | PURPOSE: The purpose of this column is to understand the distribution of workload across more than one productive labor category. | ||
| INSTRUCTION: The Offeror shall not alter the contents of this column, as these cells will auto-populate once data is entered in the previous column. The Offeror shall leave this column blank for a row relating to “Non-Workload Estimating Factor” (a non-productive labor category). |
| Column J, | |||
| Annual Productive Hours (Proposed) | PURPOSE: The purpose of this column is to understand the proposed annual productive hours used to calculate the full-time equivalents (FTEs) for the respective labor category. | ||
| INSTRUCTION: The Offeror shall provide the proposed annual productive hours for each labor category identified. |
| Column K, | |||
| Hourly Production per FTE (Proposed) | PURPOSE: The purpose of this column is to identify the proposed productivity driving the hours for the productive labor category. CMS may verify the Offeror's proposed productivity against its history and its proposed approach discussed in the Offeror's technical proposal. | ||
| INSTRUCTION: For any productive labor category identified, the Offeror shall provide the workload that can be accomplished by one (1) FTE in one (1) hour. The Offeror shall leave this column blank for a row relating to “Non-Workload Estimating Factor” (a non-productive labor category). |
| Column L, | |||
| Total Hours (Proposed) | PURPOSE: The purpose of this column is to identify the proposed hours for a specific labor category to perform or support a given workload subcategory. CMS may verify total hours proposed with the Offeror's history, as well as its business and technical proposal to ensure consistency. | ||
| INSTRUCTION: For productive labor categories the Offeror shall not alter the contents of this column, as these cells will auto-populate once data is entered in previous columns. For a row relating to “Non-Workload Estimating Factor” (a non-productive labor category), the Offeror shall enter the total hours proposed for the labor category to support the workload subcategory. The Offeror should ensure the total hours proposed for a workload category crosswalk to the Offeror's history shown in the BOE, as well as historic data available in CMS Analysis, Reporting, and Tracking system (ART) for both productive and non-productive labor categories. The Offeror should describe and provide rationale for any variances in Column N. |
| Column M, | |||
| Total FTEs (Proposed) | PURPOSE: The purpose of this column is to identify the total proposed FTEs for a specific labor category to perform or support a given workload subcategory so that the Government can crosswalk the rationale for the proposed FTEs to the FTEs identified in the Offeror's technical approach. | ||
| INSTRUCTION: The Offeror shall not alter the contents of this column, as these cells will auto-populate once data is entered in previous columns. The Offeror should ensure the total FTEs shown for a workload category crosswalk to the Offeror's CLIN templates and Technical Proposal. |
| BASIS OF ESTIMATE | |||
| Column N, | |||
| Basis of Estimate | PURPOSE: The purpose of this column is to provide a summary, narrative explanation to CMS to support the proposal elements in light of the Offeror’s history, including the proposed/derived workload, the proposed hours and productivity, and the proposed labor (skill) mix. | ||
| INSTRUCTION: The Offeror shall provide a summary, narrative explanation in this column to ensure CMS has an adequate understanding of the Offeror’s proposal in light of the Offeror’s own history. The Offeror may also provide additional narrative in support of this summary in Volume II, Tab C, Offeror Proposal Assumptions. If additional narrative is provided in the Offeror Proposal Assumptions, the Offeror shall include a page reference to the additional narrative within the summary in this column. |
The Offeror shall use historic data as its baseline for the effort proposed on this contract. Therefore, the Offeror shall disclose the following information in Column N as it relates to the Offeror’s history:
NOTE: Offerors that do not currently perform DME MAC work, but which perform similar work (such as AB MAC work), should still utilize their historical data baseline relating to these similar (non-DME MAC) work activities to support their proposal. These Offerors shall provide an explanation in the BOE (Column N), including all material assumptions and/or analyses used by the Offeror to cross-walk their historical labor mix, hours and production experience relating to the similar (non-DME MAC) historical work activity to their proposed labor mix, hours and production levels for the similar DME MAC work activity. These Offerors may also provide additional narrative in support of their proposed labor mix, hours and production levels in Volume II, Tab C, Offeror Proposal Assumptions. If additional narrative is provided in the Offeror Proposal Assumptions, the Offeror shall include a page reference to the additional narrative within the summary in this Column N.
| 1. WORKLOAD - WORKLOAD DISTRIBUTION – PRODUCTIVITY – HOURS. The Offeror shall specify the basis of its proposed/derived workload, workload distribution, hours, and productivity for each labor category identified, such as historic experience or an innovation and/or process improvement proposed for this contract, with a focus on any variances from its history for these proposed elements. |
| Impacts and Changes to Level of Effort: The Offeror shall describe any impacts on or changes to its historic level of effort that resulted in changes to its proposed level of effort. Impacts may include, but are not limited to the following: |
| - Proposed technical solutions for the contract, such as an innovation and/or process improvement proposed for this contract, |
| - Improvements implemented during the 12-month period used to derive the historic data, |
| - One-time occurrences/temporary requirements that occurred during the 12-month historic timeframe, but are not part of this contract, and/or |
| - Trends in performance (actual and/or anticipated). |
| This section also explains why variances exist between an Offeror's proposal and its history, such as the elimination of historic labor categories, as well as any variances between the history shown in the BOE and the historic data available to CMS, such as from the Contractor Management Information System (CMIS) and CMS ART. |
| 2. SOURCE. The Offeror shall identify the contract name and the system from which the historic data was derived. The Offeror shall also identify the time period used. |
| Time period. The Offeror shall use a minimum of 12 consecutive months of historic hours and production data as the baseline for this contract (i.e., the Offeror's most recent performance). If the Offeror chooses to use a productivity baseline period of less than 12 months’ duration, the Offeror shall provide detailed rationale to support the use of the shorter baseline period for its proposed productivity metrics. Moreover, when electing a shorter baseline period, the Offeror shall still provide its historic month-by-month hours and production performance for the full 12 consecutive months’ time span, highlighting the months actually used by the Offeror for the basis of estimate so that CMS may view the proposed limited historic baseline in the context of a full 12 consecutive months’ worth of performance. The Offeror should place this additional data in Volume II, Tab C, Offeror Proposal Assumptions. |
| 3. SUSPENSE RATES AND SOURCE: For the Bills/Claims workload subcategories, the Offeror shall specify the proposed suspense rates used in development of their Bills/Claims productivity estimates for both Electronic and Paper claims (see Example tab). The Offeror shall also provide in Volume II, Tab C, Offeror Proposal Assumptions, the historical data for the same 12-month historic period used, including the following: |
| 1. Electronic Suspense Rate – Part B (reported as a percentage) |
| 2. Paper Suspense Rate – Part B (reported as a percentage) |
| 4. SELF-SERVICE RATES AND SOURCE: For the provider telephone inquiry workload, the Offeror shall provide the proposed Self-Service Rates (inclusive of the IVR and Web-portal handle rates) used in the development of their telephone inquiry level of effort estimates. The Offeror shall also provide in Volume II, Tab C, Offeror Proposal Assumptions, the following historical data points for the same 12-month historic period, including the following: |
| 1. IVR Handle Rate (as reported in the Provider Inquiries Evaluation System) - Part B, reported as a percentage |
| 2. Web-Portal Utilization Rate – Part B, reported as the percentage of inquiries handled to completion through the Offeror’s web portal |
| HISTORY - BASELINE | An Offeror should repeat (copy/paste) its 12-month history baseline data from the Base Year tab (CLIN 0002) into the tabs for all of the Option Years (CLINs 0003-0006). | ||
| Column O, | |||
| Historic Workload | PURPOSE: The purpose of this column is to demonstrate workload differences between the proposed workload and the Offeror's historic workload so CMS can understand potential impacts of the history on the level of effort proposed. CMS may verify the Offeror's stated historic workloads against historic data available to CMS. | ||
| INSTRUCTION: The Offeror shall identify the historic workload (12 month baseline) for the respective labor subcategory that impacted its proposed productivity and level of effort. The Offeror shall leave this column blank for a row relating to “Non-Workload Estimating Factor” (a non-productive labor category). |
| Column P, | |||
| % Workload Processed by Labor Category (Historic) | PURPOSE: The purpose of this column is to explain to CMS the percentage of the workload that was processed by the respective labor category. This is especially useful in understanding how a particular workload subcategory was allocated historically across multiple productive labor categories, where applicable. For example, the Offeror may have used Claims Analysts I and II to process claims that suspended for manual review. Claims Analyst I may have handled the easier claims, while Claims Analyst II may have handled the more difficult claims. Therefore, each labor category would not have processed 100% of the claims, but a subset specific to their tasks (e.g., 75% of claims went to Claims Analyst I and 25% went to Claims Analyst II). | ||
| INSTRUCTION: For each workload subcategory the Offeror shall identify the percentage of the historic workload (12 month baseline) that was processed by the respective labor category, where applicable. The Offeror shall only identify a percentage in this column if the Offeror defined that position as "productive." The Offeror shall leave this column blank for a row relating to “Non-Workload Estimating Factor” (a non-productive labor category). |
| Column Q, | |||
| Workload Distribution (Historic) | PURPOSE: The purpose of this column is to understand the distribution of historic workload across more than one productive labor category. | ||
| INSTRUCTION: The Offeror shall not alter the contents of this column, as these cells will auto-populate once data is entered in the previous column. The Offeror shall leave this column blank for a row relating to “Non-Workload Estimating Factor” (a non-productive labor category). |
| Column R, | |||
| Annual Productive Hours (Historic) | PURPOSE: The purpose of this column is to understand the historic annual productive hours used to calculate the FTEs for the respective labor category. | ||
| INSTRUCTION: The Offeror shall provide the historic annual productive hours for each position identified. |
| Column S, | |||
| Hourly Production per FTE (Historic) | PURPOSE: The purpose of this column is to identify the historic productivity (12 month baseline) driving hours for the productive labor category so that CMS can make meaningful comparisons between the Offeror's history and its proposal. | ||
| INSTRUCTION: For any productive" labor category identified the Offeror shall provide the historic workload that was accomplished by one (1) FTE in one (1) hour using this column. The Offeror shall leave this column blank for a row relating to “Non-Workload Estimating Factor” (a non-productive labor category). |
| Column T, | |||
| Total Hours (Historic) | PURPOSE: The purpose of this column is to identify the historic hours (12 month baseline) for a specific labor category to perform or support a given workload subcategory. CMS may verify the Offeror's stated historic total hours against data available in CMS ART. | ||
| INSTRUCTION: The Offeror shall identify the total historic labor hours for the respective labor category to perform the associated workload. The Offeror should ensure the total hours shown for a workload category or subcategory align with the hours charged historically in CMS ART. The Offeror should explain in Column N any variances between the total historic hours shown and historic data available in CMS ART and/or other data available to CMS. |
| Column U, | |||
| Total FTEs (Historic) | PURPOSE: The purpose of this column is to identify the total historic FTEs for a specific labor category to perform or support a given workload subcategory so that CMS can make meaningful comparisons and understand how an Offeror's proposed technical approach may lead to FTE counts that differ from an Offeror's historic experience. | ||
| INSTRUCTION: The Offeror shall not alter the contents of this column, as these cells will auto-populate when all other columns are completed. |
| POSITION DESCRIPTION INSTRUCTIONS |
| The instructions below are specific to the Position Descriptions tab found after the Option Year 4 tab. |
PURPOSE: The purpose of the position description tab is two-fold. First, this tab provides the Government with the necessary information to assess the reasonableness of the proposed labor (skill) mix to accomplish the SOW requirements. Second, this tab explains to the Government changes in the types of labor an Offeror historically used to process the work as compared to the types of labor proposed to do the work, which assists the Government in validating historic level of effort.
| INSTRUCTION: For each labor category identified in the BOE, the Offeror and/or subcontractor(s) shall provide a description of the activities performed and the minimum required education and/or experience requirements. The Offeror shall provide a description of activities performed specific to each SOW WBS line item. When the same labor category is identified for multiple SOW WBS line items (e.g., Analyst I is proposed for D.1.2 and D.2.1.1), the Offeror shall provide a separate line/row for each SOW WBS item performed by the labor category. The Offeror shall submit this information (as prescribed in the Position Description tab) as part of its Basis of Estimate. |
| The Offeror shall also clarify any changes to its proposed labor categories (mix of staff) from its history (the 12-month period of historic data the Offeror used to determine level of effort and productivity). Reasons for differences may include, but are not limited to: |
| * Elimination of category based on proposed approach |
| * Elimination of category based on solution implemented in current operations within the 12-month timeframe |
| * Consolidation of associated activities within another labor category |
| * Revision to labor category name |
The Offeror shall capture any changes in labor mix using Columns E and F of the Position Descriptions tab only when there is a change in labor category. The Offeror shall use Column E to capture the name/classification of the history labor category and use Column F to provide a summary rationale for the change between the Offeror's proposed labor category name/classification and the Offeror's history. If the Offeror has eliminated a historic labor category, the Offeror shall identify this labor category in Column E, provide a rationale for the elimination in Column F, and identify the function it was eliminated from in Column C. The Offeror should also identify page references to its Proposal where additional narrative exists explaining the change.
BASIS OF ESTIMATE
Page &P
Example
| The Claims Processing example below is for illustration purposes only. | ||||||||||||||||||||
| OFFEROR NAME: | ||||||||||||||||||||
| DME MAC Basis of Estimate - Base Year | DO NOT ALTER THE CONTENTS OF THE SHADED CELLS. THESE CELLS WILL AUTO-POPULATE WHEN VALUES ARE ENTERED INTO ADJACENT CELLS. | |||||||||||||||||||
| PROPOSAL | HISTORY/BASELINE | |||||||||||||||||||
| SOW WBS Crosswalk | SLIN Crosswalk | Workload Category | Workload Subcategory | RFP Workload | Total Proposed/Derived Workload | Position/ Labor Category (Proposed) | % Workload Processed by Labor Category (Proposed) | Workload Distribution (Proposed) | Annual Productive Hours (Proposed) | Hourly Productivity per FTE (Proposed) | Total Hours (Proposed) | Total FTEs (Proposed) | BASIS OF ESTIMATE | Historic Workload | % Workload Processed by Labor Category (Historic) | Workload Distribution (Historic) | Annual Productive Hours (Historic) | Hourly Productivity per FTE (Historic) | Total Hours (Historic) | Total FTEs (Historic) |
| D.1.2 | AC | Bills/Claims Part B | Bills/Claims - EMC | 44,667,081 | 2,233,354 | Claims Analyst I - WI | 50% | 1,116,677 | 788.00 | 75.00 | 14,889.03 | 18.89 | SUSPENSE RATE: EMC suspense rate of 5% based on implemented edits in March 2014 (see page 15, Tab F.1, Volume III) |
SOURCE: CMS ART MSR Reports for July 2013 through June 2014; specific month by month suspense rates are included on page 15, Tab C, Volume II.
PRODUCTIVITY: Increased productivity by 15 units per hour based on projected productivity trend. As of additional edits implemented in March 2014, Claims Analysts are processing at a rate of 68 claims/hr. We anticipate the trend to continue, resulting in 75 claim/hr for Base Year operations.
| SOURCE: JX DME MAC contract, CMS ART July 2013 through June 2014 - the specific data by month along with our anticipated forecast and rationale is included on pages 15-18 of Tab C, Volume II. | 2,579,684 | 50.00% | 1,289,842 | 788.00 | 60.00 | 21,497.37 | 27.28 | |||||||
| D.1.2 | AC | Bills/Claims Part B | Bills/Claims - EMC | 44,667,081 | 2,233,354 | Claims Analyst I - FL | 50% | 1,116,677 | 788.00 | 75.00 | 14,889.03 | 18.89 | SUSPENSE RATE: EMC suspense rate of 5% based on implemented edits in March 2014 (see page 15, Tab F.1, Volume III) |
SOURCE: CMS ART MSR Reports for July 2013 through June 2014; specific month by month suspense rates are included on page 15, Tab C, Volume II.
PRODUCTIVITY: Increased productivity by 15 units per hour based on projected productivity trend. As of additional edits implemented in March 2014, Claims Analyst's are processing at a rate of 68 claims/hr. We anticipate the trend to continue, resulting in 75 claim/hr for Base Year operations.
| SOURCE: JX DME MAC contract, CMS ART July 2013 through June 2014 - the specific data by month along with our anticipated forecast and rationale is included on pages 15-18 of Tab C, Volume II. | 2,579,684 | 50.00% | 1,289,842 | 788.00 | 60.00 | 21,497.37 | 27.28 | |||||||
| D.1.2 | AC | Bills/Claims Part B | Bills/Claims - Paper | 1,555,516 | 311,103 | Claims Analyst I | 65% | 202,217 | 788.00 | 65.00 | 3,111.03 | 3.95 | PRODUCTIVITY: Based on historic experience | |
| SOURCE: JX DME MAC contract, CMS ART July 2013 - June 2014 | 347,999 | 65.00% | 226,199 | 788.00 | 65.00 | 3,479.99 | 4.42 | |||||||
| D.1.2 | AC | Bills/Claims Part B | Bills/Claims - Paper | 1,555,516 | 311,103 | Claims Analyst II | 35% | 108,886 | 788.00 | 50.00 | 2,177.72 | 2.76 | PRODUCTIVITY: Based on historic experience | |
| SOURCE: JX DME MAC contract, CMS ART July 2013 - June 2014 | 347,999 | 35.00% | 121,800 | 788.00 | 50.00 | 2,435.99 | 3.09 | |||||||
| D.1.1 | AC | Bills/Claims Part A | Non-Workload Estimating Factor | Service Center A - Support I | 788.00 | 1,250.00 | 1.59 | HOURS: Paper claims are imaged into the system. These costs are allocated in our service center. An explanation of how we allocated these cost in provided on page 2 of Volume II, Tab C. | ||||||
| SOURCE: JX DME MAC contract, CMS ART, July 2013 through June 2014 | 788.00 | 1,575.00 | 2.00 | |||||||||||
| D.1.2 | AC | Bills/Claims Part B | Non-Workload Estimating Factor | Systems Analyst V | 788.00 | 1,300.00 | 1.65 | HOURS: Hours based on historic experience on our JX DME MAC contract. | ||||||
| SOURCE: JX DME MAC contract, CMS ART, July 2013 through June 2014 | 788.00 | 1,300.00 | 1.65 | |||||||||||
| D.1.2 | AC | Bills/Claims Part B | Non-Workload Estimating Factor | Quality Analyst II | 788.00 | 500.00 | 0.63 | HOURS: Hours based on historic experience on our JX DME MAC contract. | ||||||
| SOURCE: JX DME MAC contract, CMS ART, July 2013 through June 2014 | 788.00 | 500.00 | 0.63 | |||||||||||
| D.1.2 | AC | Bills/Claims Part B | Non-Workload Estimating Factor | Claims Analyst, Sr. | 788.00 | 7,014.00 | 8.90 | HOURS: Based on our historic experience, 1 claims analyst senior positions is needed for every 5 claims analyst positions. | ||||||
| SOURCE: JX DME MAC contract, CMS ART - July 2013 through June 2014. | 788.00 | 9,782.00 | 12.41 | |||||||||||
| D.1.2 | AC | Bills/Claims Part B | Non-Workload Estimating Factor | Claims Lead | 788.00 | 240.00 | 0.30 | HOURS: Based on improved uses of internal dashboards, we have seen an ongoing downward trend in the hours needed for the claims lead position. Currently, the claims lead is charging 60 hours per month, which is down from 80 hours per month in January 2014. We project that our dashboard improvements will continue to reduce the "on-hand" activities of the claims lead to only 40 hours per month. | ||||||
| SOURCE: JX DME MAC contract, CMS ART - July 2013 through June 2014. The month by month data along with our projected efficiency gains for this position are on Page 19, Tab C, Volume II. | 788.00 | 800.00 | 1.02 |
BASIS OF ESTIMATE
Page &P
Base Year
| HHSM-500-2014-RFP-0069 | BASIS OF ESTIMATE | ||||||||||||||||||||
| Attachment J.18 | Enter date finalized | ||||||||||||||||||||
| OFFEROR NAME: | |||||||||||||||||||||
| DME MAC Basis of Estimate - Base Year | DO NOT ALTER THE CONTENTS OF THE SHADED CELLS IN COLUMNS E, F, I, L, M, Q AND U. (THESE CELLS WILL AUTO-POPULATE WHEN VALUES ARE ENTERED INTO ADJACENT CELLS.) SEE INSTRUCTIONS TAB FOR MORE INFORMATION ON THESE COLUMNS. | ||||||||||||||||||||
| NOTE: The estimated base period used to calculate the workloads below are as follows: Part B workload is 6 months. | PROPOSAL | HISTORY/BASELINE | |||||||||||||||||||
| SOW WBS Crosswalk | SLIN Crosswalk | Workload Category | Workload Subcategory | RFP Workload | Total Proposed/Derived Workload | Position/ Labor Category (Proposed) | % Workload Processed with Direct Labor (Proposed) | Workload Distribution (Proposed) | Annual Productive Hours (Proposed) | Hourly Productivity per FTE (Proposed) | Total Hours (Proposed) | Total FTEs (Proposed) | BASIS OF ESTIMATE | Historic Workload | % Workload Processed with Direct Labor (Historic) | Workload Distribution (Historic) | Annual Productive Hours (Historic) | Hourly Productivity per FTE (Historic) | Total Hours (Historic) | Total FTEs (Historic) | |
| Bills/Claims Part B | Electronic Claims | ||||||||||||||||||||
| * Base Year includes 2,158,855 Part B Claims | 10,067,508 | Enter suspended claims workload | ERROR:#VALUE! | ERROR:#VALUE! | ERROR:#VALUE! | 0 | ERROR:#DIV/0! | ||||||||||||||
| Bills/Claims Part B | Paper Claims | 41,901 | Enter suspended claims workload | ERROR:#VALUE! | ERROR:#VALUE! | ERROR:#VALUE! | 0 | ERROR:#DIV/0! | |||||||||||||
| Bills/Claims Part B | Non-Workload Estimating Factor | ERROR:#DIV/0! | ERROR:#DIV/0! | ||||||||||||||||||
| Reopenings Part B | Clerical Error Reopenings | 154,943 | 154,943 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| Reopenings Part B | Non-Clerical Error Reopenings | 24,236 | 24,236 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| Reopenings Part B | Non-Workload Estimating Factor | ERROR:#DIV/0! | ERROR:#DIV/0! | ||||||||||||||||||
| Appeals Part B | Part B Redeterminations (Claims Cleared) | ||||||||||||||||||||
| * Base Year includes 5,649 Part B Redeterminations Pending | 97,221 | 97,221 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | ||||||||||||||
| Appeals Part B | QIC Requests Supported (Case Files Forwarded) | 17,056 | 17,056 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| Appeals Part B | Effectuations of Part B Redetermination Decisions (Claims) | 37,560 | 37,560 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| Appeals Part B | Effectuations of Part B QIC Decisions (Claims) | 3,413 | 3,413 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| Appeals Part B | Effectuations of Part B ALJ Decisions (Claims) | 1,933 | 1,933 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| Appeals Part B | Non-Workload Estimating Factor | ERROR:#DIV/0! | ERROR:#DIV/0! | ||||||||||||||||||
| RAC Adjustments Part B (Claims) - SLIN 000X AC | Automated and Complex Adjustments | 30,000 | 30,000 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| RAC Adjustments Part B (Claims) - SLIN 000X AC | RAC Redeterminations | 2,112 | 2,112 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| RAC Adjustments Part B (Claims) - SLIN 000X AC | RA QIC Case File Requests | 492 | 492 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| RAC Adjustments Part B (Claims) - SLIN 000X AC | RA QIC/ALJ Effectuations | 36 | 36 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| RAC Adjustments Part B (Claims) - SLIN 000X AC | Non-Workload Estimating Factor | ERROR:#DIV/0! | ERROR:#DIV/0! | ||||||||||||||||||
| ALJ Hearing Participation/Support | |||||||||||||||||||||
| ALJ Hearing Participation/Support | |||||||||||||||||||||
| Note: See Assumptions for more detail on this requirement. | 60 | 60 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | ||||||||||||||
| ALJ Hearing Participation/Support | Non-Workload Estimating Factor | ERROR:#DIV/0! | ERROR:#DIV/0! | ||||||||||||||||||
| PM Beneficiary Inquiries Part B | Complex Beneficiary Inquiry Responses | ||||||||||||||||||||
| * Base Year includes 0 Complex Beneficiary Inquiry Responses pending | 1,847 | 1,847 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | ||||||||||||||
| PM Beneficiary Inquiries Part B | Complex 2nd Level Screenings | 1,671 | 1,671 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| PM Beneficiary Inquiries Part B | Non-Workload Estimating Factor | ERROR:#DIV/0! | ERROR:#DIV/0! | ||||||||||||||||||
| Freedom of Information Act (FOIA) requests | |||||||||||||||||||||
| (Includes requests for Duplicate MSNs and RA requests) | FOIA requests (Part B) | 303 | 303 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| Freedom of Information Act (FOIA) requests | |||||||||||||||||||||
| (Includes requests for Duplicate MSNs and RA requests) | Non-Workload Estimating Factor | ERROR:#DIV/0! | ERROR:#DIV/0! | ||||||||||||||||||
| PM Provider Customer Service Part B | Provider Outreach and Education Activities | ||||||||||||||||||||
| Note: See Assumptions for more detail on this requirement | See Assumptions | Enter workloads based on provider populations | ERROR:#VALUE! | ERROR:#VALUE! | ERROR:#VALUE! | 0 | ERROR:#DIV/0! | ||||||||||||||
| PM Provider Customer Service Part B | Non-Workload Estimating Factor | ERROR:#DIV/0! | ERROR:#DIV/0! | ||||||||||||||||||
| MIP Provider Customer Service Part B | Provider Outreach and Education Activities | ||||||||||||||||||||
| Note: See Assumptions for more detail on this requirement | See Assumptions | Enter workloads based on provider populations | ERROR:#VALUE! | ERROR:#VALUE! | ERROR:#VALUE! | 0 | ERROR:#DIV/0! | ||||||||||||||
| MIP Provider Customer Service Part B | Non-Workload Estimating Factor | ERROR:#DIV/0! | ERROR:#DIV/0! | ||||||||||||||||||
| Provider Inquiries Part B | Telephone Inquiries - Including IVRs (Handled) | ||||||||||||||||||||
| (Includes EDI Inquiries) | 535,377 | Enter inquiries workload answered by FTEs | ERROR:#VALUE! | ERROR:#VALUE! | ERROR:#VALUE! | 0 | ERROR:#DIV/0! | ||||||||||||||
| Provider Inquiries Part B | Written Inquiries (Received) | ||||||||||||||||||||
| * Base Year includes 1,310 Part B Written Inquiries Pending | 12,540 | 12,540 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | ||||||||||||||
| Provider Inquiries Part B | Congressionals (Received) | 144 | 144 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| Provider Inquiries Part B | Web Portal Inquiries | 132 | 132 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| Provider Inquiries Part B | Non-Workload Estimating Factor | ERROR:#DIV/0! | ERROR:#DIV/0! | ||||||||||||||||||
| Provider Inquiries - PRRS Part B | Written Inquiries (Received) | ||||||||||||||||||||
| * Base Year includes 116 PRRS Part B Written Inquiries Pending | 1,193 | 1,193 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | ||||||||||||||
| Provider Inquiries - PRRS Part B | Non-Workload Estimating Factor | ERROR:#DIV/0! | ERROR:#DIV/0! | ||||||||||||||||||
| PM Non MSP Overpayment Demand Letters Sent | Part B Demands | 100,873 | 100,873 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| PM Non MSP Overpayment Demand Letters Sent | Non-Workload Estimating Factor | ERROR:#DIV/0! | ERROR:#DIV/0! | ||||||||||||||||||
| PM Non MSP Overpayments - Part B | Voluntary Refunds | 491 | 491 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| PM Non MSP Overpayments - Part B | Solicited Checks | 931 | 931 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| PM Non MSP Overpayments - Part B | Non-MSP collections - debt collection and referral | 7,825 | 7,825 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| PM Non MSP Overpayments - Part B | Non-Workload Estimating Factor | ERROR:#DIV/0! | ERROR:#DIV/0! | ||||||||||||||||||
| RAC Non MSP Overpayments - Part B | RAC Demands | 3,819 | 3,819 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| RAC Non MSP Overpayments - Part B | RAC Solicited Checks | 74 | 74 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| RAC Non MSP Overpayments - Part B | Non-Workload Estimating Factor | ERROR:#DIV/0! | ERROR:#DIV/0! | ||||||||||||||||||
| Change Management | Draft Change Requests | 250 | 250 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| Change Management | Finalized and Issued Change Requests requiring Shared System Changes | 51 | 51 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| Change Management | Finalized and Issued Change Requests not requiring Shared System Changes | 22 | 22 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| Change Management | Technical Direction Letters | 87 | 87 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| Change Management | Early Involvement Calls | 19 | 19 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| Change Management | Non-Workload Estimating Factor | ERROR:#DIV/0! | ERROR:#DIV/0! | ||||||||||||||||||
| MIP MSP Prepay Part B | Claims Edits Resolved / "I" Records Resolved | 118 | 118 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| MIP MSP Prepay Part B | Follow-up with COBC | 49 | 49 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| MIP MSP Prepay Part B | Non-Workload Estimating Factor | ERROR:#DIV/0! | ERROR:#DIV/0! | ||||||||||||||||||
| MIP Benefit Integrity Part B Workload | ZPIC Support Requests-Non Law Enforcement | 178 | 178 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| MIP Benefit Integrity Part B Workload | ZPIC Support Requests- Law Enforcement | 11 | 11 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| MIP Benefit Integrity Part B Workload | Number of QIC Support Services Provided | 23 | 23 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| MIP Benefit Integrity Part B Workload | Number of edits installed at the request of the ZPIC | 4 | 4 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| MIP Benefit Integrity Part B Workload | Number of Overpayment recoupment actions received from the ZPIC | 1 | 1 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| MIP Benefit Integrity Part B Workload | ZPIC Suspensions Received | 0 | 0 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| MIP Benefit Integrity Part B Workload | Effectuation of ZPIC Decisions | 0 | 0 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| MIP Benefit Integrity Part B Workload | Non-Workload Estimating Factor | ERROR:#DIV/0! | ERROR:#DIV/0! | ||||||||||||||||||
| MIP MSP Postpay Part B | Provider/Supplier Duplicate Primary Payments | 990 | 990 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| MIP MSP Postpay Part B | General MSP Inquiries Resolved (related to debt) | 221 | 221 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| MIP MSP Postpay Part B | Debt Collection and Referrals | 3 | 3 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| MIP MSP Postpay Part B | General MSP Inquiries Resolved (NOT related to debt) | 269 | 269 | 0 | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 | ERROR:#DIV/0! | |||||||||||||
| MIP MSP Postpay Part B | Non-Workload Estimating Factor | ERROR:#DIV/0! | ERROR:#DIV/0! | ||||||||||||||||||
| MIP Medical Review (MR) Part B | Existing LCDs Revised | 28 | Enter workload according to MR strategy | ERROR:#VALUE! | ERROR:#VALUE! | ERROR:#VALUE! | 0 | ERROR:#DIV/0! | |||||||||||||
| MIP Medical Review (MR) Part B | New LCDs Developed | 2 | Enter workload according to MR strategy | ERROR:#VALUE! | ERROR:#VALUE! | ERROR:#VALUE! | 0 | ERROR:#DIV/0! | |||||||||||||
| MIP Medical Review (MR) Part B | All other MR activities/workload not specified below | Complete columns G, J, and L. | ERROR:#DIV/0! | ERROR:#DIV/0! | |||||||||||||||||
| MIP Medical Review (MR) Part B | Defending MR Decisions at ALJ Hearings | 0 | Enter workload according to MR strategy | ERROR:#VALUE! | ERROR:#VALUE! | ERROR:#VALUE! | 0 | ERROR:#DIV/0! | |||||||||||||
| MIP Medical Review (MR) Part B | Routine Review | 34,137 | Enter workload according to MR strategy | ERROR:#VALUE! | ERROR:#VALUE! | ERROR:#VALUE! | 0 | ERROR:#DIV/0! | |||||||||||||
| MIP Medical Review (MR) Part B | Medical Review Reopening | 3,660 | Enter workload according to MR strategy | ERROR:#VALUE! | ERROR:#VALUE! | ERROR:#VALUE! | 0 | ERROR:#DIV/0! | |||||||||||||
| MIP Medical Review (MR) Part B | Prepay Complex Reviews - Provider Specific | 21,730 (Total for Prepay Complex Reviews) | Enter workload according to MR strategy | ERROR:#VALUE! | ERROR:#VALUE! | ERROR:#VALUE! | 0 | ERROR:#DIV/0! | |||||||||||||
| MIP Medical Review (MR) Part B | Prepay Complex Reviews - Service Specific | 21,730 (Total for Prepay Complex Reviews) | Enter workload according to MR strategy | ERROR:#VALUE! | ERROR:#VALUE! | ERROR:#VALUE! | 0 | ERROR:#DIV/0! | |||||||||||||
| MIP Medical Review (MR) Part B | Probe Reviews - Prepay Complex - Provider Specific | 369 (Total for Probe Reviews) | Enter workload according to MR strategy | ERROR:#VALUE! | ERROR:#VALUE! | ERROR:#VALUE! | 0 | ERROR:#DIV/0! | |||||||||||||
| MIP Medical Review (MR) Part B | Probe Reviews - Prepay Complex - Service Specific | 369 (Total for Probe Reviews) | Enter workload according to MR strategy | ERROR:#VALUE! | ERROR:#VALUE! | ERROR:#VALUE! | 0 | ERROR:#DIV/0! | |||||||||||||
| MIP Medical Review (MR) Part B | Probe Reviews - Postpay Complex - Provider Specific | 369 (Total for Probe Reviews) | Enter workload according to MR strategy | ERROR:#VALUE! | ERROR:#VALUE! | ERROR:#VALUE! | 0 | ERROR:#DIV/0! | |||||||||||||
| MIP Medical Review (MR) Part B | Probe Reviews - Postpay Complex - Service Specific | 369 (Total for Probe Reviews) | Enter workload according to MR strategy | ERROR:#VALUE! | ERROR:#VALUE! | ERROR:#VALUE! | 0 | ERROR:#DIV/0! | |||||||||||||
| MIP Medical Review (MR) Part B | Postpay Complex Reviews - Provider Specific | 0 (Total for Postpay Reviews) | Enter workload according to MR strategy | ERROR:#VALUE! | ERROR:#VALUE! | ERROR:#VALUE! | 0 | ERROR:#DIV/0! | |||||||||||||
| MIP Medical Review (MR) Part B | Postpay Complex Reviews - Service Specific | 0 (Total for Postpay Reviews) | Enter workload according to MR strategy | ERROR:#VALUE! | ERROR:#VALUE! | ERROR:#VALUE! | 0 | ERROR:#DIV/0! | |||||||||||||
| MIP Medical Review (MR) Part B | Advanced Determination of Medicare Coverage | 1,151 | Enter workload according to MR strategy | ERROR:#VALUE! | ERROR:#VALUE! | ERROR:#VALUE! | 0 | ERROR:#DIV/0! | |||||||||||||
| MIP Medical Review (MR) Part B | Data Analysis | 63 | Enter workload according to MR strategy | ERROR:#VALUE! | ERROR:#VALUE! | ERROR:#VALUE! | 0 | ERROR:#DIV/0! | |||||||||||||
| MIP Medical Review (MR) Part B | Medical Review Edit Development | 0 | Enter workload according to MR strategy | ERROR:#VALUE! | ERROR:#VALUE! | ERROR:#VALUE! | 0 | ERROR:#DIV/0! | |||||||||||||
| MIP Medical Review (MR) Part B | Provider Compliance Group Directed Reviews | 0 | Enter workload according to MR strategy | ERROR:#VALUE! | ERROR:#VALUE! | ERROR:#VALUE! | 0 | ERROR:#DIV/0! |
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