J.39 CLIN 0006 Cost Proposal Template - Option Year 4 (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

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Written by GovTribe AI ·

This solicitation requests proposals for a Part A and Part B Medicare Administrative Contractor to provide specified health insurance benefit administration services for Jurisdiction L. The contractor will be responsible for Medicare claims processing and payment services in support of the Medicare Fee-For-Service Program for Delaware, Maryland, New Jersey, Pennsylvania, Washington D.C., and parts of Virginia. The Centers for Medicare and Medicaid Services intends to award a single contract to provide these services, which includes processing Part A and Part B claims. The solicitation number is 75FCMC20R0008.

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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.37 CLIN 0004 Cost Proposal Template - Option Year 2 (PM, MIP, RAC).xlsx XLSX spreadsheet
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
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CLIN-0006 Consolidated SLIN

COST TEMPLATE - Attachment J.39
(Provide a cost spreadsheet for each CLIN proposed)
CLIN 0006 ConsolidatedSLIN 0006AA (PM)SLIN 0006AB (MIP)SLIN 0006AC (RAC)ReservedReservedSLIN 0006AL
A/B SERVICESTotal FTEsProgram Management (PM)Medicare Integrity Program (MIP)Support of Recovery Audit Program OperationsFuture UseFuture 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-0006

COST TEMPLATE - Attachment J.39
(Provide a cost spreadsheet for each CLIN proposed)
CLIN 0006SLIN 0006 PM ASLIN 0006 MIP ASLIN 0006 PM BSLIN 0006 MIP BSLIN 0006 RAC ASLIN 0006 RAC BSLIN 0006SLIN 0006SLIN 0006SLIN 0006AL
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 OperationsVA Remittance Advice Project Part A (JH only)VA Remittance Advice Project Part B (JH only)ReservedRecords 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.39
TRAVEL SUMMARY
CLIN 0006
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.39
(Provide an ODC Spreadsheet for each CLIN Proposed)
CLIN 0006 A/B SERVICESSLIN 0006 PM ASLIN 0006 MIP ASLIN 0006 PM BSLIN 0006 MIP BSLIN 0006 RAC ASLIN 0006 RAC BSLIN 0006 VA ASLIN 0006 VA BSLIN 0006 ReservedSLIN 0006AL 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-0006 PM A

COST TEMPLATE - Attachment J.39
(Provide a cost spreadsheet for each CLIN proposed)
SLIN 0006 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-0006 MIP A

COST TEMPLATE - Attachment J.39
(Provide a cost spreadsheet for each CLIN proposed)
SLIN 0006 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-0006 PM B

COST TEMPLATE - Attachment J.39
(Provide a cost spreadsheet for each CLIN proposed)
SLIN 0006 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-0006 MIP B

COST TEMPLATE - Attachment J.39
(Provide a cost spreadsheet for each CLIN proposed)
SLIN 0006 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-0006 RAC A

COST TEMPLATE - Attachment J.39
(Provide a cost spreadsheet for each CLIN proposed)
SLIN 0006 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-0006 RAC B

COST TEMPLATE - Attachment J.39
(Provide a cost spreadsheet for each CLIN proposed)
SLIN 0006 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-0006

COST TEMPLATE - Attachment J.39
(Provide a cost spreadsheet for each CLIN proposed)
SLIN 0006Resesrved
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-0006AL

COST TEMPLATE - Attachment J.39
(Provide a cost spreadsheet for each CLIN proposed)
SLIN 0006AL - 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 .