MPN-MBP_PWS DRAFT.docx

Section C Performance Work Statement (PWS)

OWCP Medical Provider Network – Medical Bill Processing Services (OWCP MPN-MBP Services) version December 23, 2025

Part 1 - General Information

Description of Services/Introduction:

The contractor shall provide all personnel, equipment, tools, materials, supervision, and other items and non-personal services necessary to perform OWCP Medical Provider Network – Medical Bill Processing Services (OWCP MPN-MBP Services) as defined in this Performance Work Statement, except as Specified in section 3 as government furnished property and services. The contractor shall perform to the standards in this contract action.

Background:

The Office of Workers’ Compensation Programs (OWCP) under the Department of Labor (DOL) administers disability compensation programs which mitigate, through the provision of wage replacement and cash benefits, medical treatment, vocational rehabilitation, and other benefits, the financial burden on certain workers, or their dependents or survivors, resulting from work-related injury, disease, or death.

• The Federal Employees’ Compensation Act (FECA) program, administered by the Division of Federal Employees Compensation (DFEC) provides wage replacement and medical benefits to civilian employees of the federal government who were injured at work and to certain other designated groups.

DFEC maintains a National Office responsible for policy setting, performance metrics, and other program-wide functions that support the FECA Program. Staff throughout the United States process compensation claims and authorize wage replacement and medical benefits.

• The Black Lung Benefits Act (BLBA) program administered by the Division of Coal Mine Workers’ Compensation (DCMWC) provides compensation benefits to eligible coal miners and their families and medical benefits to eligible coal miners in the event of total disability or death due to pneumoconiosis. These benefits are financed through direct federal appropriations, earmarked tax revenues, and legislatively mandated private sector liability insurance arrangements.

The DCMWC National Office develops strategic plans, establishes policies, and performs certain program-wide functions. District Offices process and adjudicate compensation claims, determine whether a claimant is totally disabled from pneumoconiosis (Black Lung Disease), adjudicate and input prior authorizations for certain medical procedures, and service program customers.

• The Energy Employees Occupational Illness Compensation Program Act (EEOICPA) administered by the Division of Energy Employees Occupational Illness Compensation (DEEOIC) provides lump sum compensation and medical benefits to employees or survivors of eligible Department of Energy (DOE) nuclear weapons workers including employees, former employees, contractors, and subcontractors, as well as lump sum compensation to certain survivors of deceased workers. The EEOICPA also covers individuals who received an award from the Department of Justice (DOJ) under the Radiation Exposure Compensation Act (RECA) and individuals that worked in a mine, mill, or as an ore transporter at a facility covered by the RECA.

The DEEOIC National Office develops strategic plans, establishes policies, and performs certain program functions. Four DEEOIC district Offices process and adjudicate compensation claims and service program customers.

• The Longshore and Harbor Workers' Compensation Act and its extensions (including the Defense Base Act) is administered by the Division of Longshore and Harbor Workers’ Compensation (DLHWC). The mission of DLHWC is to minimize the impact of employment injuries and deaths of eligible employees and their families by ensuring that workers' compensation benefits are paid promptly and properly, and providing information, technical and compliance assistance, support, and informal dispute resolution services to workers, employers, and insurers.

The National Office develops and monitors public and financial policy issues and oversees authorized self-insured employers and Carriers. The Longshore program also manages district office staff and run-off District of Columbia cases which occurred prior to 1982.

In cases where the authorized carrier or self-insured employer is insolvent, or the employer is uninsured and unable to pay appropriate medical related expenses, the Special Fund steps in to pay bills at the discretion of the Secretary of Labor.

Each OWCP program provides medical benefits only when the medical care is related to a valid injury/illness claim (case), the medical condition(s) treated are accepted for payment by DOL Staff, and the treatment occurs within time period(s) of eligibility covered by legislative mandates. OWCP requirements differ from other bill processing operations by applying the concept of accepted conditions. Specifically, workers are entitled to coverage only for medical conditions accepted by the government as related to an injury/illness claim.

The designated DOL staff for each program determine the accepted condition(s) and authorize certain medical treatments. Data from the MPN-MBP contractor keeps DOL staff informed of the nature and quantity of treatment for a given accepted condition, and of requests for treatment requiring prior authorization by designated DOL staff.

1.2.1 Mission

To deliver an accessible and comprehensive provider network that provides coverage for claimants of the OWCP FECA, BLBA and EEOICPA programs, along with efficient and cost-effective medical bill processing services.

1.2.2 Vision

Nationwide timely access to quality medical treatment for OWCP claimants of the FECA, BLBA and EEOICPA programs, with comprehensive medical bill processing and related services.

Objectives:

1. Establish, support the growth of, and maintain a comprehensive nationwide provider network that maximizes claimants’ access to quality providers to effectively administer compensation programs.

2. Obtain comprehensive state-of-the-art services to process medical bills timely and accurately to serve our OWCP claimants and retain providers.

3. Obtain centralized mailroom operations with scanning and data entry capabilities to process paper bills and non-bill-related documents ensuring timely and accurate claims adjudication and provision of benefits.

4. Provide prompt, effective, and compassionate communication with providers, claimants and other stakeholders to successfully share information and resolve issues.

5. Provide accessible information to stakeholders through a cutting edge, user friendly, secure, and regulatorily compliant online portal.

6. Achieve a seamless transition from the existing bill processing contractor and a comprehensive approach for implementing and maintaining full operational capability without disruption or degradation of performance.

7. Establish and maintain timely and accurate reporting of data and analysis to oversee implementation and operations, identify potential fraud, waste and abuse, and to ensure effective performance that meets fiduciary obligations.

Scope:

Services include provision to the OWCP FECA, BLBA and EEOICPA programs of a qualified network of medical specialists, consolidated processing of bills, prior authorization of services, and responding to inquiries related to medical services from claimants and providers. Tasks include:

· Managing a robust network of contracted, qualified, and appropriate medical specialists nationwide within the US, its Possessions, Territories and Trust Territories and within a reasonable commuting distance of each claimant’s residence.

· Timely scheduling and communication of appointments for examinations and referrals for medical file reviews.

· Delivery of timely, complete, and well-reasoned medical reports from examinations and medical file reviews.

· Compliance with applicable provisions of the Privacy Act of 1974 and the security and confidentiality of claimant medical records (and related materials) entrusted to the custody of the contractor and its employees or subcontractors.

· Receipt and processing of electronic and hardcopy medical bills, attachments, other documents, including scanning and data entry of hardcopy documents.

· Processing bills to payment or denial.

· Processing of requests for adjustment, authorization of services, suspense resolution, and appeals.

· Processing and response to applicable correspondence from medical providers and claimants.

· Provision and maintenance of a secure imaging system for the Government to view images of bills, correspondence, and other documents.

· Enrollment and management of providers.

· Call Center services for provider and claimant inquiries.

· An automated, interactive self-help system for providers and claimants.

· Secure electronic access for Government staff, providers, and claimants to ascertain the history of adjudication and final determination on payment of submitted bills.

· Weekly payment files for OWCP certification and transmission to The Treasury Department for issuance of payments.

Period of Performance:

The period of performance shall be for one (1) Base Period of 15 months and four 12-month option periods. The Period of Performance may include up to two Award Terms based on contractor performance, one term of 12 months and one term of 9 months. The entire period covers:

The government reserves the right to extend the term of this contract action at the prices set forth in Section B in accordance with the terms and conditions contained in clause 52.217-9 entitled, “Option to Extend the Term of the Contract”.

General Information

1.6.1 Quality Control:

. The Contractor’s QCP is the means by which the Contractor ensures compliance with the requirements of the contract.

1.6.1.1 The contractor shall develop and submit QC Plan to ensure services are performed in accordance with this PWS.

· An effective plan includes procedures to identify, prevent, and ensure non-recurrence of defective services.

· As a minimum, the contractor shall develop quality control procedures that address the areas identified in Technical Exhibit 1, “Performance Requirements Summary”.

· After acceptance of the quality control plan, the contractor shall receive the Contracting Officer’s acceptance in writing of any proposed change to his QC system.

· The Quality Control Plan is to be delivered with the Contractor’s proposal with updates provided when changes occur and/or upon government request.

1.6.1.2 The contractor shall implement and maintain an effective quality control program based on the approved plan.

1.6.2 Quality Assurance:

The government shall evaluate the contractor’s performance under this contract action in accordance with the Quality Assurance Surveillance Plan. This plan is primarily focused on what the government must do to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s). [Reference Quality Assurance Plan and surveillance methodology to be used to ensure quality assurance.]

1.6.3 Government Remedies:

The Contracting Officer shall follow FAR 52.212-4, “Contract Terms and Conditions-Commercial Items” or 52.246-4, “Inspection of Services-Fixed Price” for contractor’s failure to perform satisfactory services or failure to correct non-conforming services.

1.6.4 Recognized Holidays:

The contractor is not required to work on the following recognized Federal holidays.

Independence Day However, medical providers may choose to perform medical examinations and file reviews at any time. The contractor may request, for approval at the government’s discretion, to work on a holiday in lieu of another date. For example, the contractor may request to work on Columbus Day in lieu of the day after Thanksgiving.

1.6.5 Hours of Operation:

The contractor is responsible for conducting performance between the hours of 8am and 8pm Eastern Time for the call center and bill processing services, and 8am – 5pm Eastern Time for all other services. Monday through Friday, except federal holidays or when the government facility is closed due to local or national emergencies, administrative closings, or similar government directed facility closings. The contractor must at all times maintain an adequate workforce for the uninterrupted performance of all tasks defined within this statement of work when the government facility is not closed for the above reasons. When hiring personnel, the contractor shall keep in mind that stability and continuity of the work force are essential. Telecommuting or “work at home” is not authorized under this contract action unless under emergency situations as determined by the Contracting Officer’s Representative (COR).

1.6.6 Place of Performance:

The work under this contract action will be performed at contractor facilities in the continental United States. The contractor shall communicate any change to the government of facilities used to support the PWS requirements.

1.6.7 Type of Contract:

The government anticipates the award of a fixed price contract.

1.6.8 Security Requirements:

The contractor's solution must comply with various federal security guidelines as noted in the requirements below.

Physical Security The contractor shall be responsible for safeguarding all government property provided for contractor use.

Employee Security

1.6.8.2.1 The contractor must ensure that every employee completes all mandated federal security and training requirements prior to the employee’s first day of work under the contract.

· The contractor must provide a signed Security Documentation Review Certification for each employee.

· All contractor staff using the DOL LAN/WAN and computer systems to perform duties under this PWS must sign the DOL Rules of Behavior for Computer Use and a Non- Disclosure Agreement.

· A copy of each signed and witnessed Non-Disclosure Agreement (NDA) must be submitted to the COR prior to the employee performing any work under this PWS.

· Additional copies of signed NDAs for any contractor employee or subcontractor are due upon government request.

1.6.8.2.2 The contractor shall perform background investigations on employees with access to OWCP data.

· The background investigation must be thorough enough to establish the trustworthiness of the individual to handle federally owned, unclassified information.

1.6.8.2.3 The contractor shall ensure that all staff assigned to OWCP services meet ongoing training and security requirements.

· The contractor is responsible for ensuring its employees comply with the security regulations of DOL and other government installations or contractor facilities where work is performed under this PWS.

Information and System Security

1.6.8.3.1 The contractor shall ensure that the system, data, transmission processes, and associated processes conform to the current DOL implementation of federal information security guidelines.

1.6.8.3.2 The contractor must comply with DOL and federal security standards as they apply for “moderate” systems.

· At a minimum, the contractor must ensure compliance with the following or the most current version of the following federal guidance documents:

· NIST SP 800-18 Rev. 2 Developing Security, Privacy, and Cybersecurity Supply Chain Risk Management Plans for Systems

· NIST SP 800-30, Rev. 1 Guide for Conducting Risk Assessments

· NIST SP 800-37 Rev. 2, Risk Management Framework for Information Systems and Organizations: A System Life Cycle Approach for Security and Privacy

· DLMS 7 – Chapter 400, IT Security

· NIST SP 800-63-3, Digital Identity Guidelines

· Binding Operational Directive 18-01 “Enhance Email and Web Security”

· OMB M-15-13 “The HTTPS-Only Standard”

· The Freedom of Information Act, as amended (5 USC §522)

· The Privacy Act of 1974, as amended (5 USC §522a), including the Computer Matching and Privacy Act of 1988 (Public Law 100-503)

· The federal Information Security Modernization Act of 2014 (FISMA), 44 USC §3551 et seq.

· OMB Circular A-130, Management of federal Information Resources,

· OMB Memorandum M-17-12, Preparing for and Responding to a Breach of Personally Identifiable Information,

· FIPS PUB 199, Standards for Security Categorization of federal Information and Information Systems

· FIPS PUB 200, Minimum Security Requirements for federal Information Systems

· NIST Special Publication (SP) 800-171, Rev. 3, Protecting Controlled Unclassified Information in Nonfederal Systems and Organizations

· US DOL Cybersecurity Policy Portfolio (CPP) (DOL’s implementation of NIST SP 800-53). (Reference Attachment 25 - Cybersecurity Policy Portfolio)

· Department of Labor Manual Series (DLMS) – 7, Chapter 1100, DOL Safeguarding Sensitive Data Including Personally Identifiable Information (Reference Attachment 26 – DLMS 7, Chapter 1100)

1.6.8.3.3 The contractor shall submit a complete System Security Plan in accordance with the DOL and federal security standards outlined in Section 1.6.8.3.2 above.

· A complete plan includes an Incident Response Plan that reflects processes that comply with identification, assessment, notification, correction, and prevention requirements detailed in Section 1.6.8.3.4 below.

1.6.8.3.4 The contractor shall ensure that any Cloud hosting of components is FedRamp authorized and maintain the controls required by FedRamp for authorization.

1.6.8.3.5 The contractor shall establish a secure VPN connection with DOL that conforms to current NIST standards to transmit data that includes PII.

· The connection will require a certificate to authenticate the secure connection so it can be added to the government's trusted server list.

· The types of information for transmission include at minimum, eligibility, compensation, user authentication, and bill processing detail transactional files (e.g., payment files, bill history files, etc.) in government specified formats and timeframes.

· The landing zone may also be used to transmit provider files for access by the pharmacy benefits (PB) services contractor. This is the current process but is subject to change.

· Currently, a secure Simple Object Access Protocol (SOAP) connection is being used.

· Interface files are currently transmitted to and from a ‘Landing Zone’ made up of secure FTP servers on both the contractor’s private network and the government's network. The contractor's technical staff will work with the government to identify potential solutions and customizations.

1.6.8.3.6 The contractor shall allow authorized federal client-agency users already authenticated in the government’s web-based application session to be forwarded with credentials to the contractor’s portal without requiring an additional login.

· The contractor must use a federal Identity, Credential, and Access Management (FICAM) compliant authentication method for authenticating external users.

· The contractor may leverage the active DOL FICAM solution - currently ECOMP via OWCP Connect (subject to change) - to meet this requirement.

· The government must approve the solution as compliant with NIST, DOL security, and the PWS requirements prior to Assumption of Operations.

1.6.8.3.7 The contractor shall allow authorized users already authenticated by the contractor to be forwarded with credentials to the government’s web-based application without requiring an additional login.

· The government must approve the solution as compliant with NIST, DOL security, and the PWS requirements prior to Assumption of Operations.

1.6.8.3.8 The contractor shall regularly assess the systems used for MPN-MBP services to identify security vulnerabilities and recommend appropriate actions for remediation and improvement.

· The government must approve the contractor’s recommended actions and proposed timeline.

1.6.8.3.9 The contractor shall comply with DOL third-party monitoring requirements for maintaining up-to-date information system security documentation and identifying vulnerabilities.

· Currently third-party monitoring includes monthly audit log review submissions, quarterly vulnerability assessments, and annual documentation updates as part of the third-party monitoring checklist

· The contractor shall complete the DOL Third-Party Security Monitoring Checklist on an annual basis. The initial DOL Third-Party Security Monitoring Checklist shall be submitted along with the final system security plan prior to deployment. On a quarterly basis, the contractor shall also provide proof of monthly audit log reviews, user account reviews, vulnerability scans, plan of actions & milestones (POA&Ms), and additional security documentation as required. This is part of DOL’s third-party security monitoring program.

1.6.8.3.10 The contractor shall complete approved remediation actions for security vulnerabilities by the government-approved milestone date.

Security Incidents and Breaches

1.6.8.4.1 The contractor shall notify the government of any PII or security incidents using the government-approved incident reporting form within one hour of becoming aware of a suspected or verified breach.

· Notify the government via zzowcpsecurity@dol.gov and OWCP-DAO-BAS-CORS@dol.gov of all security incidents, disclosures, breaches, and disasters involving PII, whether suspected or confirmed.

· The notification must describe the security incident, disclosure, breach, or disaster in detail and state the measures taken to protect the confidentiality, integrity, and availability of OWCP information.

1.6.8.4.2 The contractor shall investigate the suspected or confirmed incident to discover the facts surrounding the incident and submit a completed Incident Report form as additional information becomes available.

· Submit the Incident Report to zzowcpsecurity@dol.gov.

1.6.8.4.3 The contractor shall provide resolution of PII security incidents, disclosures, breaches, and disasters, including one year of comprehensive credit monitoring services for affected claimants at the MPN-MBP contractor’s own expense.

· The government must approve the contractor’s resolution approach.

· Comprehensive monitoring services include identity theft insurance for affected claimants.

· The contractor is responsible for any liability resulting from its security incident, disclosure, or breach involving a claimant’s PII, including financial harm to the government.

· The contractor may only contact affected claimants or their authorized representatives after receiving government authorization. The government makes first notifications to the claimants.

1.6.8.4.4 If more than three breaches occur in a calendar month, the contractor must perform a root cause analysis and provide a corrective action plan for preventing future breaches.

· The government must approve the contractor’s corrective action plan.

1.6.9 Special Qualifications:

TBD

1.6.10 Post Award Conference/Periodic Progress Meetings:

The contractor agrees to attend any post award conference convened by the contracting activity or contract administration office in accordance with Federal Acquisition Regulation Subpart 42.5. The Contracting Officer, Contracting Officer’s Representative (COR), and other government personnel, as appropriate, may meet periodically with the contractor to review the contractor's performance. At these meetings, the Contracting Officer will inform the contractor of how the government views the contractor's performance and the contractor shall inform the government of problems, if any, being experienced. Appropriate action shall be taken to resolve outstanding issues. These meetings shall be at no additional cost to the government.

1.6.11 Contracting Officer’s Representative:

A COR will be delegated separately.

1.6.12 Key Personnel:

The following personnel are considered key personnel by the government: Program Manager, Operations Manager, Technical Manager, Training Manager, Lead Software Engineer, Authorization / Triage Nurse (2 positions), Program Liaison Manager (2 positions), Provider Outreach Supervisor (overseen by Operations Manager), and Call Center Manager. The contractor shall provide a contract manager who shall be responsible for the performance of the work. The name of this person and an alternate who shall act for the contractor when the manager is absent shall be designated in writing to the Contracting Officer. The contract manager or alternate shall have full authority to act for the contractor on all contract matters relating to the daily operation of this contract action. The contract manager or alternate shall be available between 8 a.m. to 8 p.m. Eastern Time, Monday through Friday except for federal holidays or when the government facility is closed for administrative reasons. Qualifications for all key personnel are listed below:

1.6.12.1 The Contractor shall provide one (1) full time Program Manager with these qualifications:

· Project Management Professional (PMP) Certification within one (1) year after contract award, and

· Equivalent of Federal Minimum Background Investigation (MBI), and

· Either a BS/BA degree, with recent experience of at least twelve (12) years as a Program Manager (or equivalent) and/or Deputy Program Manager (or equivalent) in planning, scheduling and monitoring the personnel and activities supporting overall system design, development, and implementation in a transaction processing environment for a large IT system related to medical bill processing or similar environment

· Or a High School or GED equivalent diploma, with recent experience of at least sixteen (16) years as a Program Manager (or equivalent) and/or Deputy Program Manager (or equivalent) in planning, scheduling and monitoring the personnel and activities supporting overall system design, development, and implementation in a transaction processing environment for a large IT system related to medical bill processing or similar environment

1.6.12.2 The Contractor shall provide one (1) full time Operations Manager with these qualifications:

· Equivalent to a National Agency Check Investigation (NACI).

· A High School or GED equivalent diploma.

· Three (3) to five (5) years’ experience as an Operations Manager (or equivalent) performing services of similar scope and size.

· A BS/BA degree is preferred.

· Project Management Professional (PMP) Certification or other nationally recognized technical or PM certification is preferred

1.6.12.3 The Contractor shall provide one (1) full time Technical Manager with these qualifications:

· Project Management Professional (PMP) Certification within one (1) year after contract award or other nationally recognized technical certification, and

· Equivalent of a Federal Minimum Background Investigation (MBI), and

· Either a BS/BA degree in Computer Science, Information Systems, Engineering, Business, or other related scientific or technical discipline, with recent experience of at least eight (8) years analyzing user needs to determine functional and cross-functional requirements; performing functional allocation to identify required tasks and their interrelationships; ensuring technical solutions and schedules are implemented in a timely manner; and performing horizontal integration planning for interfaces to other functional systems; and three (3) years of that experience in a leadership role involving design, development, and implementation in a transaction processing environment for a large IT system related to medical bill processing or similar environment , demonstrated ability to provide guidance and direction in tasks of similar size and complexity, proven expertise in the management and control of resources, demonstrated capability in managing multi-task operations of this type and complexity (may overlap with other experience)

· Or a High School or GED equivalent diploma, with recent experience of at least twelve (12) years analyzing user needs to determine functional and cross-functional requirements; performing functional allocation to identify required tasks and their interrelationships; ensuring technical solutions and schedules are implemented in a timely manner; and performing horizontal integration planning for interfaces to other functional systems; and five (5) years of that experience in a leadership role involving design, development, and implementation in a transaction processing environment for a large IT system related to medical bill processing or similar environment , demonstrated ability to provide guidance and direction in tasks of similar size and complexity, proven expertise in the management and control of funds and resources, demonstrated capability in managing multi-task operations of this type and complexity (may overlap with other experience)

1.6.12.4 The Contractor shall provide one (1) full time Training Manager with these qualifications:

· Equivalent of a National Agency Check Investigation (NACI), and

· Either a BS/BA degree, with recent experience of at least five (5) years assessing training needs and planning, implementing, and evaluating education and training programs in the field of health care, medical bill processing or healthcare call center operations; and three (3) years of that experience in a management role developing and providing technical and end-user training in the fields of healthcare, medical bill processing or healthcare call center operations (may overlap with other experience)

· Or a High School or GED equivalent diploma, with recent experience of at least eight (8) years assessing training needs and planning, implementing, and evaluating education and training programs in the field of health care, medical bill processing or healthcare call center operations; and five (5) years of that experience in a management role developing and providing technical and end-user training in the fields of healthcare, medical bill processing or healthcare call center operations (may overlap with other experience)

1.6.12.5 The Contractor shall provide one (1) full time Lead Software Engineer with these qualifications:

· Project Management Professional (PMP) Certification within one (1) year after contract award or other nationally recognized technical certification, and

· Equivalent of a Federal Minimum Background Investigation (MBI), and

· Either a BS/BA degree in Computer Science, Information Systems, Engineering, or other related scientific or technical discipline, with recent experience of at least eight (8) years hands-on experience in software development of COTS based and custom developed applications in a transaction processing environment for a large IT system, including a broad range of expertise in programming languages, tools and methodologies, and designing and developing software applications using a modern programming language (e.g. Java, .NET, C#, Dart, etc.); and three (3) years of that hands-on experience leading a team of developers (may overlap with other experience)

· Or a High School or GED equivalent diploma, with recent experience of at least twelve (12) years hands-on experience in software development of COTS based and custom developed applications in a transaction processing environment for a large IT system, including a broad range of expertise in programming languages, tools and methodologies, and designing and developing software applications using a modern programming language (e.g. Java, .NET, C#, Dart, etc.); and five (5) years of that hands-on experience leading a team of developers (may overlap with other experience)

1.6.12.6 The Contractor shall provide two (2) full time Authorization/Triage Nurses, with these qualifications:

· Registered Nurse License, with recent experience of at least five (5) years in Prior Authorization and/or Pre-Certification in the field of healthcare, and

· Equivalent of a National Agency Check Investigation (NACI)

1.6.12.7 The Contractor shall provide two (2) full time Program Liaison Managers (one for DFEC and one for both DCMWC and DEEOIC), with these qualifications:

· Equivalent of a Federal Minimum Background Investigation (MBI), and

· Either a BS/BA degree, with recent experience of at least five (5) years in project/program management, enterprise account level management, or other similar customer facing role consulting on or delivering technical products or services related to medical bill processing or similar environment; and three (3) years of that experience in a project/program management leadership role, consulting on or delivering technical products or services related to medical bill processing or similar environment (may overlap with other experience

· Or a High School or GED equivalent diploma, with recent experience of at least eight (8) years in project/program management, enterprise account level management, or other similar customer facing role consulting on or delivering technical products or services related to medical bill processing or similar environment; and five (5) years of that experience in a project/program management leadership role, consulting on or delivering technical products or services related to medical bill processing or similar environment (may overlap with other experience)

· Project Management Professional (PMP) Certification is desired

1.6.12.8 The Contractor shall provide one (1) full time Provider Outreach Supervisor with these qualifications, to be overseen by the Operations Manager:

· Equivalent of a National Agency Check Investigation (NACI), and

· Either a BS/BA degree in a field such as Marketing or Communications, with recent experience of at least five (5) years general experience in communications with community outreach in the field of health care; and three (3) years of that experience in a leadership role conducting outreach by communicating with medical providers to identify and assess the need for provider education related to medical bill processing programs/policies or similar environment (may overlap with other experience)

· Or a High School or GED equivalent diploma, with recent experience of at least eight (8) years general experience in communications with community outreach in the field of health care; and five (5) years of that experience in a leadership role conducting outreach by communicating with medical providers to identify and assess the need for provider education related to medical bill processing programs or policies or similar environment (may overlap with other experience)

1.6.12.9 The Contractor shall provide full time Call Center Managers (the number to be determined by the Contractor) with these qualifications:

· Equivalent of a National Agency Check Investigation (NACI), and

· Either a BS/BA degree in Computer Science, Information Systems, Engineering, Business, or other related scientific or technical discipline, with recent experience of at least eight (8) years in a customer contact service/call center related to healthcare or medical bill processing or similar environment; and three (3) years of that experience in a Call Center supervisory role, demonstrated ability to provide guidance and direction in tasks of similar size and complexity (may overlap with other experience)

· Or a High School or GED equivalent diploma, with recent experience of at least twelve (12) years in a customer contact service/call center related to healthcare or medical bill processing or similar environment; and five (5) years of that experience in a Call Center supervisory role, demonstrated ability to provide guidance and direction in tasks of similar size and complexity (may overlap with other experience)

1.6.13 Identification of Contractor Employees:

All contract personnel attending meetings, answering government telephones, and working in other situations where their contractor status is not obvious to third parties are required to identify themselves as such to avoid creating an impression in the minds of members of the public that they are government officials. They must also ensure that all documents or reports produced by contractors are suitably marked as contractor products or that contractor participation is appropriately disclosed.

1.6.14 Organizational Conflict of Interest:

Contractor and subcontractor personnel performing work under this contract action may receive, have access to or participate in the development of proprietary or source selection information (e.g., cost or pricing information, budget information or analyses, specifications or work statements, etc.) or perform evaluation services which may create a current or subsequent Organizational Conflict of Interests (OCI), as defined in FAR Subpart 9.5. The contractor shall notify the Contracting Officer immediately whenever it becomes aware that such access or participation may result in any actual or potential OCI and shall promptly submit a plan to the Contracting Officer to avoid or mitigate any such OCI. The contractor’s mitigation plan will be determined to be acceptable solely at the discretion of the Contracting Officer and in the event the Contracting Officer unilaterally determines that any such OCI cannot be satisfactorily avoided or mitigated, the Contracting Officer may affect other remedies as he or she deems necessary, including prohibiting the contractor from participation in subsequent contracted requirements which may be affected by the OCI.

1.6.15 Liquidated Damages – Directed Medical Services

The following liquidated damages are provided for this contract. See FAR Subpart 11.5.

The Contractor is required to deliver services under this Contract, as demonstrated by submitting the associated Billable Work Products, no later than the Due Dates set out throughout the PWS and Technical Exhibits which are referenced in the table below. If the Contractor fails to submit the Billable Work Products by the Due Date, the Contractor shall, in place of actual damages, pay to the Government liquidated damages, calculated as set out below. The Government presents to the Contractor, and the Contractor understands that the liquidated damage amounts below reflect the Government’s reasonable conservative estimates, at the time of award, of the probable costs to the Government for delayed performance.

If the Government terminates this Contract in whole or in part for cause, the Contractor is liable for liquidated damages accruing until the Government reasonably obtains delivery or performance of similar supplies or services. These liquidated damages are in addition to excess costs of repurchase under the termination provision of this Contract.

The Contractor will not be charged with liquidated damages when the delay in delivery or performance is beyond the control and without the fault or negligence of the Contractor as defined in the termination for cause provisions of this Contract.

Supplemental Report Section 5.1.2.6.3 No more than 21 calendar days from the date of the request for the supplemental report.

A conforming report submitted after 21 calendar days, or after 35 calendar days when diagnostic testing or consultations are necessary, is considered late and subject to liquidated damages.

$50.70 per every 10-calendar day period after the report is due, charged only at the end of the 10-day period, until a conforming report is submitted.

MAX: $152.10 after 30 calendar days.

SECOP Medical Report Section 5.1.2.6.5 No more than 7 calendar days from the date of examination, or no more than 14 additional calendar days (21 total) when diagnostic testing or consultations are necessary.

A conforming report submitted after 7 calendar days, or after 21 calendar days when diagnostic testing or consultations are necessary, is considered late and subject to liquidated damages.

$50.70 per every 10-calendar day period after the report is due, charged only at the end of the 10-day period, until a conforming report is submitted.

IME Medical Report Section 5.1.2.6.6 No more than 14 calendar days from the date of examination, or no more than 14 additional calendar days (28 total) when diagnostic testing or consultations are necessary.

A conforming report submitted after 14 calendar days, or after 28 calendar days when diagnostic testing or consultations are necessary, is considered late and subject to liquidated damages.

$50.70 per every 10-calendar day period after the report is due, charged only at the end of the 10-day period, until a conforming report is submitted.

Case File Review - Surgical Review Report Section 5.1.2.6.7.2(1) No more than 7 calendar days from the date of referral.

A conforming report submitted after 7 calendar days is considered late and subject to liquidated damages.

$50.70 per every 10-calendar day period after the report is due, charged only at the end of the 10-day period, until a conforming report is submitted.

Case File Review - Impairment Rating Report or IME File Review Section 5.1.2.6.7.2(2) No more than 30 calendar days from the date of referral.

A conforming report submitted after 30 calendar days is considered late and subject to liquidated damages $50.70 per every 10-calendar day period after the report is due, charged only at the end of the 10-day period, until a conforming report is submitted.

Wage Lose Case File Review Section 5.1.2.6.7.2(3) No more than 21 calendar days from the date of referral.

A conforming report submitted after 21 calendar days is considered late and subject to liquidated damages $50.70 per every 10-calendar day period after the report is due, charged only at the end of the 10-day period, until a conforming report is submitted.

Diagnosis Clarification File Review

5.1.2.6.7.2(4) No more than 14 calendar days from the date of referral.

A conforming report submitted after 14 calendar days is considered late and subject to liquidated damages $50.70 per every 10-calendar day period after the report is due, charged only at the end of the 10-day period, until a conforming report is submitted.

Causation File Review

5.1.2.6.7.2(5) No more than 30 calendar days from the date of referral.

A conforming report submitted after 30 calendar days is considered late and subject to liquidated damages $50.70 per every 10-calendar day period after the report is due, charged only at the end of the 10-day period, until a conforming report is submitted.

Case File Review – Other Report Section 5.1.2.6.7.2(6) No more than 21 calendar days from the date of referral.

A conforming report submitted after 21 calendar days is considered late and subject to liquidated damages $50.70 per every 10-calendar day period after the report is due, charged only at the end of the 10-day period, until a conforming report is submitted.

The Liquidated Damages listed above are determined based on Government Staff Costs, those costs include only the effort of DOL personnel which will be needed to monitor, identify, address, and correct the Contractor’s delays in performance. Additional costs beyond these are possible but have not been included in the calculation. There may be instances of delays where the Government may need to spend extraordinary efforts to correct the Contractor delays (incurring costs not reflected in the liquidated damages amounts below) in which case the Government may pursue actual damages in lieu of or in addition to liquidated damages.

· Liquidated Damages Calculation: ([X# of calendar days after due date a conforming billable work product is submitted] / 10 calendar days, rounded down to a whole number), multiplied by $50.70 Assessed Liquidated Damages

· Below are some examples for calculating the Liquidated Damages for delayed billable work products:

· Billable Work Product is delivered 9 calendar days after due date (16 calendar days after the examination) 9 calendar days / 10 calendar days = 0.9 = 0 after rounding down * $50.70 = $0.00 in assessed damages.

· Billable Work Product is delivered 11 calendar days after the due date (or 18 calendar days after examination). 11 calendar days / 10 calendar days = 1.1 = 1 after rounding down * $50.70 = $50.70 in assessed damages

· Billable Work Product is delivered 21 calendar days after due date (28 calendar days after the examination) 21 calendar days / 10 calendar days = 2.1 = 2 after rounding down * $50.70 = $101.40 in assessed damages The due date does not shift if the first/last day is on a holiday, weekend. Further, DOL may seek actual damages from the contractor for its failure to perform the billable work product (including the impacts to the Government from the delay in return to work by the OWCP claimant).

Reference Technical Exhibit 2 “Deliverables Schedule” for a list of billable work products, service periods and due dates.

1.6.16 Pricing and Payment for Services – Directed Medical Services Pricing for the required services is fixed unit rate based on the specified work products detailed in the Billable Work Products table in this section. All costs for contract management services, contractor personnel training, outreach, oversight, task and performance reports, and additional support services must be incorporated into the fixed pricing for the listed billable work products. This includes any and all labor, direct and indirect costs, general and administrative costs, materials, pick-up and delivery, ancillary costs, applicable fees and profit associated with providing the required services. The only items other than billable work products which may be billed, with prior authorization, are direct expenses for:

1) Interpreter services, diagnostic testing, and other unforeseen necessities in rendering a complete medical report

2) Transportation for arranged transport and travel.

These direct expenses must be submitted using the approved OWCP direct expense invoice template via the WCMBP portal for approval and payment.

The price is inclusive of any/all labor, indirect costs, materials, pick-up and delivery, ancillary costs and applicable fees. Notwithstanding the above, Service Contract Labor Standard price adjustments may modify contract prices as permitted by FAR 52.222-43 to comply with prevailing Wage Determination.

Payment for services under this contract is made through the FECA and Energy fund, as outlined in Section 5.1.2.7, based on the approval of billable work products accompanied by associated billing/invoice. The billable work products and associated invoices must be accurate, complete, timely and fully address all questions posed by the Federal claims examiner. The Contractor must note and apply the applicable Tier Pricing and any applicable liquidated damages for each billing/invoice submitted. The billing/invoice and associated work product are both considered late if not submitted in appropriate format together within required timeframes through approved mechanism(s) of transmission. The Contractor shall correct any deficiencies/issues identified by the Government and resubmit within seven (7) calendar days of notice from the Government.

Pricing for this contract is based on the delivery date for confirming billable work products. The Government will apply tier pricing to the billable work products listed in the table below, based on the submission date. The tier pricing unit rates for the respective billable work products will be approved at contract award. Tier 1 represents the base billable price applicable for a respective work product and the highest billable price for resubmitted work products. Tier 2 represents the incentive pricing (10% increase of the Tier 1 price) and highest billable price for initial (i.e. not resubmitted) work products. Tier 2 pricing does not apply to resubmissions.

The rest of the billable work products where tier pricing does not apply will have fixed price per unit also determined at contract award.

Supplemental Report Section 5.1.2.6.3 No more than 21 calendar days from the date of supplemental request.

A report submitted after 21 calendar days, or after 35 calendar days when diagnostic testing or consultations are necessary, is considered late and subject to liquidated damages.

SECOP Medical Report Section 5.1.2.6.5 No more than 7 calendar days from the date of examination, or no more than 14 additional calendar days (21 total) when diagnostic testing or consultations are necessary.

A report submitted after 7 calendar days, or after 21 calendar days when diagnostic testing or consultations are necessary, is considered late and subject to liquidated damages.

IME Medical Report Section 5.1.2.6.6 No more than 14 calendar days from the date of examination, or no more than 14 additional calendar days (28 total) when diagnostic testing or consultations are necessary.

A report submitted after 14 calendar days, or after 28 calendar days when diagnostic testing or consultations are necessary, is considered…