J.37 CLIN 0004 Cost Proposal Template - Option Year 2 (PM, MIP, RAC).xlsx

XLSX spreadsheet 126 KB Posted

Attached to
Part A/Part B Medicare Administrative Contractor (MAC) Jurisdiction L (JL)
Solicitation number
75FCMC20R0008
Issued by

About this file

Written by GovTribe AI ·

This is a solicitation for a Part A and Part B Medicare Administrative Contractor to provide health insurance benefit administration services for Jurisdiction L. The contractor will process and pay Medicare claims and support the Medicare Fee-For-Service program for Delaware, Maryland, New Jersey, Pennsylvania, Washington D.C., and parts of Virginia. Services include claims processing, payment, Medicare Integrity Program support, Recovery Audit Program operations, appeals of initial claims determinations, and program management. The Centers for Medicare and Medicaid Services intends to award a contract to provide these specified services.

View the file

Other files

File Type Posted
J.23 Government Provided Proposal Assumptions (GPPA) redline Amend 2.docx DOCX document
J.23 Government Provided Proposal Assumptions (GPPA) clean Amend 2.docx DOCX document
75FCMC20R0008 Amend 2.pdf PDF
JL Solicitation 75FCMC20R0008 Sections B-M CLEAN Amend 1.pdf PDF
Q and A RFP 75FCMC20R00008.xlsx XLSX spreadsheet
J.34 CLIN 0001 Cost Proposal Template - Implementation clean Amend 1.xlsx XLSX spreadsheet
J.37 CLIN 0004 Cost Proposal Template - Option Year 2 (PM, MIP, RAC) clean Amend 1.xlsx XLSX spreadsheet
J.23 Government Provided Proposal Assumptions (GPPA) redline Amend 1.docx DOCX document
J.48 CLIN 0015 Cost Proposal Template - Option Year 5 (MPIP) clean Amend 1.xlsx XLSX spreadsheet
J.43 CLIN 0010 Cost Proposal Template - Base Year (MPIP) clean Amend 1.xlsx XLSX spreadsheet
J.22 Basis of Estimate redline Amend 1.xlsx XLSX spreadsheet
J.22.A Historic & Proposed FTE, Hours & Gross Cost Instructions & Narrative redline Amend 1.docx DOCX document
J.46 CLIN 0013 Cost Proposal Template - Option Year 3 (MPIP) clean Amend 1.xlsx XLSX spreadsheet
J.1 Statement of Work (SOW) clean Amend 1.docx DOCX document
J.33 Cost Template Summary Sheet clean Amend 1.xlsx XLSX spreadsheet
J.21 Proposal Self-Check Tool clean Amend 1.xlsx XLSX spreadsheet
J.49 CLIN 0016 Cost Proposal Template - Option Year 6 (MPIP) clean Amend 1.xlsx XLSX spreadsheet
J.22.A Historic & Proposed FTE, Hours & Gross Cost Instructions & Narrative clean Amend 1.docx DOCX document
JL Solicitation 75FCMC20R0008 Sections B-M REDLINE Amend 1.pdf PDF
J.45 CLIN 0012 Cost Proposal Template - Option Year 2 (MPIP) clean Amend 1.xlsx XLSX spreadsheet
J.40 CLIN 0007 Cost Proposal Template - Option Year 5 (PM, MIP, RAC) clean Amend 1.xlsx XLSX spreadsheet
J.41 CLIN 0008 Cost Proposal Template - Option Year 6 (PM, MIP, RAC) clean Amend 1.xlsx XLSX spreadsheet
J.22 Basis of Estimate clean Amend 1.xlsx XLSX spreadsheet
J.38 CLIN 0005 Cost Proposal Template - Option Year 3 (PM, MIP, RAC) clean Amend 1.xlsx XLSX spreadsheet
J.42 CLIN 0009 Cost Proposal Template - Outgoing Contractor Workload Transition Activities clean Amend 1.xlsx XLSX spreadsheet
J.36 CLIN 0003 Cost Proposal Template - Option Year 1 (PM, MIP, RAC) clean Amend 1.xlsx XLSX spreadsheet
J.1 Statement of Work (SOW) redline Amend 1.docx DOCX document
J.47 CLIN 0014 Cost Proposal Template - Option Year 4 (MPIP) clean Amend 1.xlsx XLSX spreadsheet
J.35 CLIN 0002 Cost Proposal Template - Base Year (PM, MIP, RAC) clean Amend 1.xlsx XLSX spreadsheet
J.23 Government Provided Proposal Assumptions (GPPA) clean Amend 1.docx DOCX document
J.21 Proposal Self-Check Tool redline Amend 1.xlsx XLSX spreadsheet
J.39 CLIN 0006 Cost Proposal Template - Option Year 4 (PM, MIP, RAC) clean Amend 1.xlsx XLSX spreadsheet
J.44 CLIN 0011 Cost Proposal Template - Option Year 1 (MPIP) clean Amend 1.xlsx XLSX spreadsheet
75FCMC20R0008.pdf PDF
J.22.A Historic & Proposed FTE, Hours & Gross Cost Instructions & Narrative.docx DOCX document
J.24 Attestations.docx DOCX document
J.45 CLIN 0012 Cost Proposal Template - Option Year 2 (MPIP).xlsx XLSX spreadsheet
J.10 Contractor Business Ethics COI and Compliance Program Requirements.docx DOCX document
J.1.B List of Key Acronyms.docx DOCX document
J.33 Cost Template Summary Sheet.xlsx XLSX spreadsheet
J.35 CLIN 0002 Cost Proposal Template - Base Year (PM, MIP, RAC).xlsx XLSX spreadsheet
J.23.A GPPA Audit & Reimbursement Tables.xlsx XLSX spreadsheet
J.42 CLIN 0009 Cost Proposal Template - Outgoing Contractor Workload Transition Activites.xlsx XLSX spreadsheet
J.2 Deliverable Schedule.docx DOCX document
J.1 Statement of Work (SOW) - Jurisdiction L.docx DOCX document
J.7 AB MAC Award Fee Plan and Self Assessment Template.docx DOCX document
J.9 Non-Disclosure Statement.docx DOCX document
J.40 CLIN 0007 Cost Proposal Template - Option Year 5 (PM, MIP, RAC).xlsx XLSX spreadsheet
J.43 CLIN 0010 Cost Proposal Template - Base Year (MPIP).xlsx XLSX spreadsheet
J.1.A List of Key Definitions.docx DOCX document
Show 40 more

Latest 50 of 79 listed here. See the rest on GovTribe.

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file
Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

CLIN-0004 Consolidated SLIN

COST TEMPLATE - Attachment J.37
(Provide a cost spreadsheet for each CLIN proposed)
CLIN 0004 ConsolidatedSLIN 0004AA (PM)SLIN 0004AB (MIP)SLIN 0004AC (RAC)SLIN 0004AD (VA)ReservedSLIN 0004AL
A/B SERVICESTotal FTEsProgram Management (PM)Medicare Integrity Program (MIP)Support of Recovery Audit Program OperationsVA Remittance Advice Project (JH only)Future UseRecords Storage and Retrieval Costs (J5 only)GRAND TOTAL
HoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursTotal
COST ELEMENTS
Direct Labor
0$00$00$00$00$00$00$0.00
0$00$00$00$00$00$00$0.00
0$00$00$00$00$00$00$0.00
0$00$00$00$00$00$00$0.00
Add Other Appropriate Labor Categories (note: labor categories should match WBS)0$00$00$00$00$00$00$0.00
0$00$00$00$00$00$00$0.00
0$00$00$00$00$00$00$0.00
0$00$00$00$00$00$00$0.00
0$00$00$00$00$00$00$0.00
0$00$00$00$00$00$00$0.00
Subtotal Direct Labor0$00$00$00$00$00$00$0.00

Fringe Benefits (at ____%) $0 $0 $0 $0 $0 $0 $0.00

Total Direct Labor $0 $0 $0 $0 $0 $0 $0.00

Travel (See separate schedule. Total should match)$0$0$0$0$0$0$0.00
SUBCONTRACTORS
Subcontractor Name0$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$0.00
Total Subcontractor0$00$00$00$00$00$00$0.00

Other Direct Costs (See separate schedule. Total should match.) $0 $0 $0 $0 $0 $0 $0.00

SUBTOTAL ALL DIRECT COSTS $0 $0 $0 $0 $0 $0 $0.00

Indirect Costs (at ______ %) $0 $0 $0 $0 $0 $0 $0.00

TOTAL OTHER BEFORE FEE $0 $0 $0 $0 $0 $0 $0.00

Base Fee (at ____%)$0$0$0$0$0$0$0.00
Award Fee (at ______%)$0$0$0$0$0$0$0.00
Fixed Fee (at ______%)$0$0$0$0$0$0$0.00

TOTAL OTHER AFTER FEE $0 $0 $0 $0 $0 $0 $0.00

Complementary Credits$0$0.00
Note: Comp. credit information will be provided by CMS prior to final proposal revision. Offerors should not propose amounts at this time.
GRAND TOTAL$0$0$0$0$0$0$0.00
20190930
v2-10 20180824

75FCMC20R0008

PART A & PART B (A/B) MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)

Confidential Procurement Sensitive

CLIN-0004

COST TEMPLATE - Attachment J.37
(Provide a cost spreadsheet for each CLIN proposed)
CLIN 0004SLIN 0004 PM ASLIN 0004 MIP ASLIN 0004 PM BSLIN 0004 MIP BSLIN 0004 RAC ASLIN 0004 RAC BSLIN 0004SLIN 0004SLIN 0004SLIN 0004AL
A/B SERVICESTotal FTEsPart A/Program Management (PM)Part A/Medicare Integrity Program (MIP)Part B/Program Management (PM)Part B/Medicare Integrity Program (MIP)Part A/Support of Recovery Audit Program OperationsPart B/Support of Recovery Audit Program OperationsReservedReservedReservedRecords Storage and Retrieval Costs for Non-J5 Legacy A Records (J1, J4, J12) Jurisdiction 5 onlyGRAND TOTAL
HoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursTotal
COST ELEMENTS
Direct Labor
0$00$00$00$00$00$00$00$00$00$00$0.00
0$00$00$00$00$00$00$00$00$00$00$0.00
0$00$00$00$00$00$00$00$00$00$00$0.00
0$00$00$00$00$00$00$00$00$00$00$0.00
Add Other Appropriate Labor Categories (note: labor categories should match WBS)0$00$00$00$00$00$00$00$00$00$00$0.00
0$00$00$00$00$00$00$00$00$00$00$0.00
0$00$00$00$00$00$00$00$00$00$00$0.00
0$00$00$00$00$00$00$00$00$00$00$0.00
0$00$00$00$00$00$00$00$00$00$00$0.00
0$00$00$00$00$00$00$00$00$00$00$0.00
Subtotal Direct Labor0$00$00$00$00$00$00$00$00$00$00$0.00

Fringe Benefits (at ____%) $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Total Direct Labor $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Travel (See separate schedule. Total should match)$0$0$0$0$0$0$0$0$0$0$0.00
SUBCONTRACTORS
Subcontractor Name0$00$00$00$00$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$00$00$00$00$0.00
Total Subcontractor0$00$00$00$00$00$00$00$00$00$00$0.00

Other Direct Costs (See separate schedule. Total should match.) $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

SUBTOTAL ALL DIRECT COSTS $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Indirect Costs (at ______ %) $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

TOTAL OTHER BEFORE FEE $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Base Fee (at ____%)$0$0$0$0$0$0$0$0$0$0$0.00
Award Fee (at ______%)$0$0$0$0$0$0$0$0$0$0$0.00
Fixed Fee (at ______%)$0$0$0$0$0$0$0$0$0$0$0.00

TOTAL OTHER AFTER FEE $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Complementary Credits$0$0$0.00
Note: Comp. credit information will be provided by CMS prior to final proposal revision. Offerors should not propose amounts at this time.
GRAND TOTAL$0$0$0$0$0$0$0$0$0$0$0.00
v.1.58 05042016

75FCMC20R0008

PART A & PART B (A/B) MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)

Confidential Procurement Sensitive

TRAVEL

COST TEMPLATE - Attachment J.37
TRAVEL SUMMARY
CLIN 0004
Purpose of TripSOW WBS
CrosswalkLabor Category Taking TripTrip OriginDestination# People
(A)# Trips
(B)# Days
(C)# Nights
(D)Lodging Rate
(E)Lodging
(F=E*D*A)M&IE
(G)Total Lodging

and M&IE

(H=F+G)Airfare
(I)Car Rental
(J)Misc
(K)Local

Mileage

(L)Total Per Trip
(M=H+I+J+K+L)Total For All Trips

(N=M*B )

$ -$ -$ -$ -
$ -$ -$ -$ -
$ -$ -$ -$ -
$ -$ -$ -$ -
$ -$ -$ -$ -
$ -$ -$ -$ -
$ -$ -$ -$ -
$ -$ -$ -$ -
$ -$ -$ -$ -
$ -$ -$ -$ -
$ -$ -$ -$ -
$ -$ -$ -$ -
$ -$ -$ -$ -
$ -$ -$ -$ -
$ -$ -$ -$ -
$ -$ -$ -$ -
$ -$ -$ -$ -
$ -$ -$ -$ -
$ -$ -$ -$ -
TOTAL TRAVEL$ -
Travel Assumptions:

75FCMC20R0008

PART A & PART B (A/B) MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)

Confidential Procurement Sensitive

ODC

COST TEMPLATE - Attachment J.37
(Provide an ODC Spreadsheet for each CLIN Proposed)
CLIN 0004 A/B SERVICESSLIN 0004 PM ASLIN 0004 MIP ASLIN 0004 PM BSLIN 0004 MIP BSLIN 0004 RAC ASLIN 0004 RAC BSLIN 0004 VA ASLIN 0004 VA BSLIN 0004 ReservedSLIN 0004AL Rec. StorageGRAND
Cost ElementAmountAmountAmountAmountAmountAmountAmountAmountAmountAmountTOTAL
$0.00
Add costs by category$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
TOTAL ODCs$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00

75FCMC20R0008

PART A & PART B (A/B) MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)

Confidential Procurement Sensitive

SLIN-0004 PM A

COST TEMPLATE - Attachment J.37
(Provide a cost spreadsheet for each CLIN proposed)
SLIN 0004 PM AC.1.4.4C.5.3C.5.4C.5.5C.5.7C.5.8C.5.9C.5.10C.5.11C.5.23C.5.27C.6C.7IZ
A/B SERVICESTotal FTEsHome Health and Hospice RequirementsInfrastructure RequirementsAdministrative RequirementsProvider EnrollmentProvider Customer Service ProgramClaims ProcessingReopenings of Medicare Initial Claims DeterminationsAppeals of Medicare Initial Claims DeterminationsFM of Trust Fund DollarsProgram Management OfficeSupport & Coordination with SMRC OperationsInterface RequirementsJurisdiction Specific RequirementsCREDITSAWARD FEEGRAND TOTAL
Program ManagementHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursTotal
COST ELEMENTS
Direct Labor
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
Add Other Appropriate Labor Categories (note: labor categories should match WBS)0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
Subtotal Direct Labor0$00$00$00$00$00$00$00$00$00$00$00$00$00$0.00

Fringe Benefits (at ____%) $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Total Direct Labor $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Travel$0$0$0$0$0$0$0$0$0$0$0$0$0$0.00
SUBCONTRACTORS
Subcontractor Name0$00$00$00$00$00$00$00$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$00$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$00$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$00$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$00$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$00$00$00$00$00$00$00$0.00
Total Subcontractor0$00$00$00$00$00$00$00$00$00$00$00$00$00$0.00

Other Direct Costs $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

SUBTOTAL ALL DIRECT COSTS $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Indirect Costs (at ______ %) $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

TOTAL OTHER BEFORE FEE $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Base Fee (at ____%)$0$0$0$0$0$0$0$0$0$0$0$0$0$0.00
Award Fee (at ______%)$0$0.00
Fixed Fee (at ______%)$0$0$0$0$0$0$0$0$0$0$0$0$0$0.00

TOTAL OTHER AFTER FEE $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Complementary Credits$0$0.00
Note: Comp. credit information will be provided by CMS prior to final proposal revision. Offerors should not propose amounts at this time.
GRAND TOTAL0.00$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0.00

75FCMC20R0008

PART A & PART B (A/B) MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)

Confidential Procurement Sensitive

SLIN-0004 MIP A

COST TEMPLATE - Attachment J.37
(Provide a cost spreadsheet for each CLIN proposed)
SLIN 0004 MIP AC.1.4.4C.5.6C.5.7C.5.11C.5.12C.5.13C.5.14C.5.15C.6C.7Z
A/B SERVICESTotal FTEsHome Health and Hospice RequirementsLCDsProvider Customer Service ProgramFM of Trust Fund DollarsMedical ReviewCoordination with PSCs/ZPICsMSPProvider OversightInterface RequirementsJurisdiction Specific RequirementsAWARD FEEGRAND TOTAL
Medicare Integrity ProgramHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursTotal
COST ELEMENTS
Direct Labor
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
Add Other Appropriate Labor Categories (note: labor categories should match WBS)0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
Subtotal Direct Labor0$00$00$00$00$00$00$00$00$00$00$0.00

Fringe Benefits (at ____%) $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Total Direct Labor $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Travel$0$0$0$0$0$0$0$0$0$0$0.00
SUBCONTRACTORS
Subcontractor Name0$00$00$00$00$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$00$00$00$00$0.00
Total Subcontractor0$00$00$00$00$00$00$00$00$00$00$0.00

Other Direct Costs $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

SUBTOTAL ALL DIRECT COSTS $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Indirect Costs (at ______ %) $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

TOTAL OTHER BEFORE FEE $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Base Fee (at ____%)$0$0$0$0$0$0$0$0$0$0$0.00
Award Fee (at ______%)$0$0.00
Fixed Fee (at ______%)$0$0$0$0$0$0$0$0$0$0$0.00

TOTAL OTHER AFTER FEE $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Complementary Credits
Note: Comp. credit information will be provided by CMS prior to final proposal revision. Offerors should not propose amounts at this time.
GRAND TOTAL0.00$0$0$0$0$0$0$0$0$0$0$0$0.00

75FCMC20R0008

PART A & PART B (A/B) MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)

Confidential Procurement Sensitive

SLIN-0004 PM B

COST TEMPLATE - Attachment J.37
(Provide a cost spreadsheet for each CLIN proposed)
SLIN 0004 PM BC.5.3C.5.4C.5.5C.5.7C.5.8C.5.9C.5.10C.5.11C.5.23C.5.27C.6C.7IZ
A/B SERVICESTotal FTEsInfrastructureAdministrative RequirementsProvider EnrollmentProvider Customer Service ProgramClaims ProcessingReopenings of Medicare Initial Claims DeterminationsAppeals of Medicare Initial Claims DeterminationsFM of Trust Fund DollarsProgram Management OfficeSupport & Coordination with SMRC OperationsInterface RequirementsJurisdiction Specific RequirementsCREDITSAWARD FEEGRAND TOTAL
Program ManagementHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursTotal
COST ELEMENTS
Direct Labor
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
Add Other Appropriate Labor Categories (note: labor categories should match WBS)0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
Subtotal Direct Labor0$00$00$00$00$00$00$00$00$00$00$00$00$0.00

Fringe Benefits (at ____%) $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Total Direct Labor $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Travel$0$0$0$0$0$0$0$0$0$0$0$0$0.00
SUBCONTRACTORS
Subcontractor Name0$00$00$00$00$00$00$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$00$00$00$00$00$00$0.00
Total Subcontractor0$00$00$00$00$00$00$00$00$00$00$00$00$0.00

Other Direct Costs $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

SUBTOTAL ALL DIRECT COSTS $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Indirect Costs (at ______ %) $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

TOTAL OTHER BEFORE FEE $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Base Fee (at ____%)$0$0$0$0$0$0$0$0$0$0$0$0$0.00
Award Fee (at ______%)$0$0.00
Fixed Fee (at ______%)$0$0$0$0$0$0$0$0$0$0$0$0$0.00

TOTAL OTHER AFTER FEE $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Complementary Credits$0$0.00
Note: Comp. credit information will be provided by CMS prior to final proposal revision. Offerors should not propose amounts at this time.
GRAND TOTAL0.00$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0.00
V1.3 04092012

75FCMC20R0008

PART A & PART B (A/B) MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)

Confidential Procurement Sensitive

SLIN-0004 MIP B

COST TEMPLATE - Attachment J.37
(Provide a cost spreadsheet for each CLIN proposed)
SLIN 0004 MIP BC.5.6C.5.7C.5.12C.5.13C.5.14C.5.15C.6C.7Z
A/B SERVICESTotal FTEsLCDsProvider Customer Service ProgramMedical ReviewCoordination with PSCs/ZPICsMSPProvider OversightInterface RequirementsJurisdiction Specific RequirementsAWARD FEEGRAND TOTAL
Medicare Integrity ProgramHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursTotal
COST ELEMENTS
Direct Labor
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
Add Other Appropriate Labor Categories (note: labor categories should match WBS)0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
Subtotal Direct Labor0$00$00$00$00$00$00$00$00$0.00

Fringe Benefits (at ____%) $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Total Direct Labor $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Travel$0$0$0$0$0$0$0$0$0.00
SUBCONTRACTORS
Subcontractor Name0$00$00$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$00$00$0.00
Total Subcontractor0$00$00$00$00$00$00$00$00$0.00

Other Direct Costs $0 $0 $0 $0 $0 $0 $0 $0 $0.00

SUBTOTAL ALL DIRECT COSTS $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Indirect Costs (at ______ %) $0 $0 $0 $0 $0 $0 $0 $0 $0.00

TOTAL OTHER BEFORE FEE $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Base Fee (at ____%)$0$0$0$0$0$0$0$0$0.00
Award Fee (at ______%)$0$0.00
Fixed Fee (at ______%)$0$0$0$0$0$0$0$0$0.00

TOTAL OTHER AFTER FEE $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Complementary Credits
Note: Comp. credit information will be provided by CMS prior to final proposal revision. Offerors should not propose amounts at this time.
GRAND TOTAL0.00$0$0$0$0$0$0$0$0$0$0.00

75FCMC20R0008

PART A & PART B (A/B) MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)

Confidential Procurement Sensitive

SLIN-0004 RAC A

COST TEMPLATE - Attachment J.37
(Provide a cost spreadsheet for each CLIN proposed)
SLIN 0004 RAC AC.5.26.1C.5.26.2C.5.26.3C.5.26.4C.5.26.5ReservedReservedZ
A/B SERVICESTotal FTEsAdjustment of Recovery Auditor Selected ClaimsHandling Underpayments and Overpayments Identified by the Recovery AuditorAppeals of Recovery Auditor Adjusted ClaimsReporting for Recovery Audit Program Support OperationsOther Recovery Audit Program Support ActivitiesFuture UseFuture UseAWARD FEEGRAND TOTAL
HoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursTotal
COST ELEMENTS
Direct Labor
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
Add Other Appropriate Labor Categories (note: labor categories should match WBS)0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
Subtotal Direct Labor0$00$00$00$00$00$0.00

Fringe Benefits (at ____%) $0 $0 $0 $0 $0 $0.00

Total Direct Labor $0 $0 $0 $0 $0 $0.00

Travel$0$0$0$0$0$0.00
SUBCONTRACTORS
Subcontractor Name0$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$0.00
Total Subcontractor0$00$00$00$00$00$0.00

Other Direct Costs $0 $0 $0 $0 $0 $0.00

SUBTOTAL ALL DIRECT COSTS $0 $0 $0 $0 $0 $0.00

Indirect Costs (at ______ %) $0 $0 $0 $0 $0 $0.00

TOTAL OTHER BEFORE FEE $0 $0 $0 $0 $0 $0.00

Base Fee (at ____%)$0$0$0$0$0$0.00
Award Fee (at ______%)$0$0.00
Fixed Fee (at ______%)$0$0$0$0$0$0.00

TOTAL OTHER AFTER FEE $0 $0 $0 $0 $0 $0 $0.00

Complementary Credits
Note: Comp. credit information will be provided by CMS prior to final proposal revision. Offerors should not propose amounts at this time.
GRAND TOTAL$0$0$0$0$0$0$0$0$0.00

75FCMC20R0008

PART A & PART B (A/B) MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)

Confidential Procurement Sensitive

SLIN-0004 RAC B

COST TEMPLATE - Attachment J.37
(Provide a cost spreadsheet for each CLIN proposed)
SLIN 0004 RAC BC.5.26.1C.5.26.2C.5.26.3C.5.26.4C.5.26.5ReservedZ
A/B SERVICESTotal FTEsAdjustment of Recovery Auditor Selected ClaimsHandling Underpayments and Overpayments Identified by the Recovery AuditorAppeals of Recovery Auditor Adjusted ClaimsReporting for Recovery Audit Program Support OperationsOther Recovery Audit Program Support ActivitiesFuture UseAWARD FEEGRAND TOTAL
HoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursTotal
COST ELEMENTS
Direct Labor
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
Add Other Appropriate Labor Categories (note: labor categories should match WBS)0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
0$0.00$00$0.00$00$0.00$00$0.00$00$0.00$00$0.00
Subtotal Direct Labor0$00$00$00$00$00$0.00

Fringe Benefits (at ____%) $0 $0 $0 $0 $0 $0.00

Total Direct Labor $0 $0 $0 $0 $0 $0.00

Travel$0$0$0$0$0$0.00
SUBCONTRACTORS
Subcontractor Name0$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$0.00
Total Subcontractor0$00$00$00$00$00$0.00

Other Direct Costs $0 $0 $0 $0 $0 $0.00

SUBTOTAL ALL DIRECT COSTS $0 $0 $0 $0 $0 $0.00

Indirect Costs (at ______ %) $0 $0 $0 $0 $0 $0.00

TOTAL OTHER BEFORE FEE $0 $0 $0 $0 $0 $0.00

Base Fee (at ____%)$0$0$0$0$0$0.00
Award Fee (at ______%)$0$0.00
Fixed Fee (at ______%)$0$0$0$0$0$0.00

TOTAL OTHER AFTER FEE $0 $0 $0 $0 $0 $0 $0.00

Complementary Credits
Note: Comp. credit information will be provided by CMS prior to final proposal revision. Offerors should not propose amounts at this time.
GRAND TOTAL$0$0$0$0$0$0$0$0.00

75FCMC20R0008

PART A & PART B (A/B) MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)

Confidential Procurement Sensitive

SLIN-0004

COST TEMPLATE - Attachment J.37
(Provide a cost spreadsheet for each CLIN proposed)
SLIN 0004Resesrved
A/B SERVICESTotal FTEsFuture Use
HoursRatesTotal
COST ELEMENTS
Direct Labor
0$0.00$0
0$0.00$0
Add Other Appropriate Labor Categories (note: labor categories should match WBS)0$0.00$0
0$0.00$0
0$0.00$0
0$0.00$0
0$0.00$0
0$0.00$0
0$0.00$0
0$0.00$0
Subtotal Direct Labor0$0

Fringe Benefits (at ____%) $0

Total Direct Labor $0

Travel$0
SUBCONTRACTORS
Subcontractor Name0$0
Subcontractor Name0$0
Subcontractor Name0$0
Subcontractor Name0$0
Subcontractor Name0$0
Subcontractor Name0$0
Total Subcontractor0$0

Other Direct Costs $0

TOTAL ALL DIRECT COSTS $0

Indirect Costs (at ______ %) $0

TOTAL OTHER BEFORE FEE $0

Base Fee (at ____%)$0
Award Fee (at ______%)$0
Fixed Fee (at ______%)$0

TOTAL OTHER AFTER FEE $0

Complementary Credits
Note: Comp. credit information will be provided by CMS prior to final proposal revision. Offerors should not propose amounts at this time.
GRAND TOTAL$0

75FCMC20R0008

PART A & PART B (A/B) MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)

Confidential Procurement Sensitive

SLIN-0004AL

COST TEMPLATE - Attachment J.37
(Provide a cost spreadsheet for each CLIN proposed)
SLIN 0004AL - C.7.34C.7.34
A/B SERVICESTotal FTEsRecords Storage and Retrieval Costs for non-J5 Legacy A Records (J1, J4, J12) (Jurisdiction 5 only)
HoursRatesTotal
COST ELEMENTS
Direct Labor
0$0.00$0
0$0.00$0
Add Other Appropriate Labor Categories (note: labor categories should match WBS)0$0.00$0
0$0.00$0
0$0.00$0
0$0.00$0
0$0.00$0
0$0.00$0
0$0.00$0
0$0.00$0
Subtotal Direct Labor0$0

Fringe Benefits (at ____%) $0

Total Direct Labor $0

Travel$0
SUBCONTRACTORS
Subcontractor Name0$0
Subcontractor Name0$0
Subcontractor Name0$0
Subcontractor Name0$0
Subcontractor Name0$0
Subcontractor Name0$0
Total Subcontractor0$0

Other Direct Costs $0

TOTAL ALL DIRECT COSTS $0

Indirect Costs (at ______ %) $0

TOTAL OTHER BEFORE FEE $0

Base Fee (at ____%)$0
Award Fee (at ______%)$0
Fixed Fee (at ______%)$0

TOTAL OTHER AFTER FEE $0

Complementary Credits
Note: Comp. credit information will be provided by CMS prior to final proposal revision. Offerors should not propose amounts at this time.
GRAND TOTAL$0

75FCMC20R0008

PART A & PART B (A/B) MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)

Confidential Procurement Sensitive

Reserved

RFX-CMS-20XX-000X

PART A & PART B (A/B) MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)

SLIN = Sub Line Item Number

Attachment J-XX &P v.1 consol 07/05/2016

File details come from the government source that posted it. Updated .