STATE OF MAINE

Department of Administrative & Financial Services Office of Employee Health, Wellness, & Workers’ Compensation

RFP# 202607125

Worker’s Compensation Medical Bill Review Program

RFP Coordinator

Submitted Questions Due Date

August 17, 2026, no later than 4:00 p.m., local time

TABLE OF CONTENTS

Page

A. PURPOSE AND BACKGROUND

B. GENERAL PROVISIONS

C. CONTRACT TERM

D. NUMBER OF AWARDS

A. VENDOR SELF SERVICE SYSTEM (VSS)

B. QUESTIONS

C. DEMONSTRATION

D. AMENDMENTS

E. PROPOSAL SUBMISSION

A. EVALUATION PROCESS – GENERAL INFORMATION

B. SCORING WEIGHTS AND PROCESS

C. NEGOTIATIONS

D. SELECTION AND AWARD

E. APPEAL OF CONTRACT AWARDS

A. CONTRACT DOCUMENT

B. STANDARD STATE CONTRACT PROVISIONS

APPENDIX A – PROPOSAL COVER PAGE

APPENDIX B – RESPONSIBLE BIDDER CERTIFICATION

APPENDIX C – QUALIFICATIONS AND EXPERIENCE FORM

APPENDIX D – SUBCONTRACTORS FORM

APPENDIX E – TECHNICAL ASSESSMENT FORM

APPENDIX F – PROPOSED SERVICES FORM

APPENDIX G – COST PROPOSAL FORM

PUBLIC NOTICE

State of Maine Department of Administrative and Financial Services

RFP# 202607125

Worker’s Compensation Medical Bill Review Program

The State of Maine is seeking proposals for review and negotiation of medical bills received as part of workers’ compensation claims. Bidders will also propose a software solution for managing the medical bill review process.

A copy of the RFP and all related documents can be obtained through Vendor Self Service (VSS): https://mevss.hostams.com/PRDVSS1X1/AltSelfService

Proposals must be submitted to the Office of State Procurement Services, via Vendor Self Service (VSS). Proposal submissions must be received no later than 4:00 p.m., local time, on September 2, 2026. Proposals will be opened on the following business day.

RFP TERMS/ACRONYMS with DEFINITIONS

The following terms and acronyms, as referenced in the RFP, have the meanings indicated below:

State of Maine Department of Administrative & Financial Services Office of Employee Health, Wellness, & Workers’ Compensation

RFP# 202607125

Worker’s Compensation Medical Bill Review Program

PART I INTRODUCTION

A. Purpose and Background

The Department of Administrative and Financial Services, Bureau of Human Resources, Office of Employee Health, Wellness, and Workers’ Compensation (Department) is seeking services to ensure appropriate payment and recovery for our self-insured Workers’ Compensation Program for Maine State Government employees as defined in this Request for Proposals (RFP) document. This document provides instructions for submitting proposals, the procedure and criteria by which the Awarded Bidder will be selected, and the contractual terms which will govern the relationship between the State of Maine (State) and the Awarded Bidder.

The Department is responsible for the overall management of the State of Maine’s self-insured workers’ compensation program. The Department averages approximately 1,200 to 1,400 workers’ compensation claims per year. The Workers’ Compensation Board mandates that all medical bills are processed for payment within thirty (30) days of receipt of bill pursuant to the Workers’ Compensation Act, Section 205. It is the mission of the Department to make sure that payments are made appropriately, timely and in accordance with Section 205 (4) of the Workers’ Compensation Act. http://legislature.maine.gov/statutes/39-A/title39-Asec205.pdf

B. General Provisions

1. From the time the RFP is issued until award notification is made, all contact with the State regarding the RFP must be made through the RFP Coordinator. No other person/State employee is empowered to make binding statements regarding the RFP. Violation of this provision may lead to disqualification from the bidding process, at the State’s discretion.

2. Issuance of the RFP does not commit the Department to issue an award or to pay expenses incurred by a Bidder in the preparation of a response to the RFP. This includes attendance at personal interviews or other meetings and software or system demonstrations, where applicable.

3. All proposals must adhere to the instructions and format requirements outlined in the RFP and all written supplements and amendments (such as the Summary of Questions and Answers), issued by the Department. Proposals must follow the format and respond to all questions and instructions specified below in the “Proposal Submission Requirements” section of the RFP.

4. Bidders will take careful note that in evaluating a proposal submitted in response to the RFP, the Department will consider materials provided in the proposal, information obtained through interviews/presentations (if any), and internal Departmental information of previous contract history with the Bidder (if any). The Department also reserves the right to consider other reliable references and publicly available information in evaluating a Bidder’s experience and capabilities.

5. The proposal must be signed by a person authorized to legally bind the Bidder and must contain a statement that the proposal and the pricing contained therein will remain valid and binding for a period of 180 days from the date and time of the bid opening.

6. The RFP and the Awarded Bidder’s proposal, including all appendices or attachments, will be the basis for the final contract, as determined by the Department.

7. Following announcement of an award decision, all records and documents regarding this RFP, including bid submissions, will be public records, available for public inspection pursuant to 5 M.R.S. §1825 B (6 &15) and the State of Maine Freedom of Access Act (FOAA) (1 M.R.S. § 401 et seq.). State contracts and information related to contracts, including all records, documents, supporting documents, and bid submissions, are public records unless otherwise excepted by statute (Id).

8. Subject to the above and pursuant to applicable law, in the event that a Bidder believes any information that it submits in response to this RFP is confidential, it must mark that information accordingly, and include citation to legal authority in support of the Bidder’s claim of confidentiality. In the event that the Department receives a FOAA request that includes submissions marked as confidential, the Department shall evaluate the information and any legal authority from the Bidder to determine whether the information is an exception to FOAA’s definition of public record. If the Department determines to release information that a Bidder has marked confidential, it shall provide advance notice to the Bidder to allow for them to seek legal relief.

9. The Department, at its sole discretion, reserves the right to recognize and waive minor informalities and irregularities found in proposals received in response to the RFP.

10. ACCESSIBILITY: All IT applications are required to comply with the Digital Accessibility Policy. In addition, all IT applications and content delivered through web browsers are required to comply with the State Web Standards.

11. STATE IT POLICIES: All IT products and services delivered as part of this Agreement shall conform to the State IT policies, standards, and procedures effective at the time this RFP is published.

12. If awarded a contract resulting from this RFP, vendors shall be required to disclose, in writing and in accordance with applicable Maine law, any actual or potential conflicts of interest. Such disclosure must include any financial, professional, or personal relationships that could give rise to a conflict of interest or the appearance of a conflict of interest. Failure to disclose a known conflict or appearance of conflict may result in disqualification, contract termination, or other remedies as provided by law.

13. All applicable laws, whether or not herein contained, are included by this reference. It is the Bidder’s responsibility to determine the applicability and requirements of any such laws and to abide by them.

C. Contract Term

The Department is seeking cost-efficient proposals to provide services, as defined in this RFP, for the anticipated contract period defined in the table below. The dates below are estimated and may be adjusted, as necessary, in order to comply with all procedural requirements associated with the RFP and the contracting process. The actual contract start date will be established by a completed and approved contract.

Contract Renewal: Following the initial term of the contract, the Department may opt to renew the contract for two renewal periods, as shown in the table below, and subject to continued availability of funding and satisfactory performance.

The term of the anticipated contract, resulting from the RFP, is defined as follows:

D. Number of Awards

The Department anticipates making one (1) award as a result of this RFP process.

PART II SCOPE OF SERVICES TO BE PROVIDED

A. Business Requirements

1. The Department will securely send facility bills, including but not limited to hospitals, inpatient or outpatient clinics, and surgery centers, as well as professional fees associated with these services, to the Awarded Bidder to down-code in accordance with the current Maine Medical Fee Schedule: https://www.maine.gov/wcb/Departments/omrs/medfeesched.html. The Awarded Bidder may also utilize a clearinghouse to obtain the facility bills, including, but not limited to, those from hospitals, inpatient or outpatient clinics, and surgery centers, as well as professional fees associated with these services.

a. The Awarded Bidder must propose solutions for receiving and importing scanned images of bills from the Department using a secure method (See also Part II, Section B. Software Requirements).

b. Awarded Bidder must propose solutions for medical providers to submit bills electronically via a medical bill clearing house using a secure method (See also Part II, Section B. Software Requirements). The Awarded Bidder must:

Review the bill and return it to the Department with the down-coded amount due, along with the savings due to the audit and the invoice for payment.

c. Awarded Bidder must propose electronic solutions for making data on reviewed bills available to the Department (See also Part II, Section B. Software Requirements), and

d. Awarded Bidder must also propose solutions for integrating data from reviewed bills with the Department’s Risk Management Information System (See also Part II, Section B. Software Requirements).

2. The warded Bidder must:

a. Apply the Medical Fee Schedule mandated by the Workers’ Compensation Board, with review/audit of the bills and an evaluation of the appropriateness of codes, modifiers, and charges, along with the recommendations for payment.

b. Provide directions to the Department regarding billing, coding, and modifiers.

c. Provide quarterly training to Department staff relative to billing issues and new billing information provided by the Workers’ Compensation Board - utilizing either an in-person or virtual delivery method as selected by the Department.

d. Negotiate fees for specific medical services as requested by the Department, including but not limited to the following:

i. Surgical procedures,

ii. Assisted living arrangements,

iii. Durable equipment supplies,

iv. Home health care services,

v. And out-of-state providers who are not willing to accept payment in accordance with the Maine Medical Fee Schedule.

e. Provide recommendations on bills that should have been negotiated to reduce costs before services were completed.

f. Ensure that all reviews/audits are completed within seven (7) calendar days from receipt of the bill from the Department unless special arrangements have been made in writing with the Department.

g. Provide a quarterly report outlining the number of bills audited, savings due to the audit, and issues found. This report will be used as the basis for quarterly training.

h. Provide a billing method on their auditing process.

i. Provide training on their software system to employees authorized by the Department to approve medical bills.

j. Educate medical providers about their ability to submit medical bills electronically via a medical clearinghouse to the Department.

k. At their own cost and via separate agreement, have access to the services of a medical bill clearinghouse.

B. Software Requirements

1. The Awarded Bidder will provide a medical bill review software solution enabling the Department to:

a. create, view, and edit data on claimants and associated medical claims;

b. create, view, and edit data on vendors used by the State of Maine for medical bill information;

c. track status of medical bill reviews conducted by Awarded Bidder;

d. view the results of the Awarded Bidder’s medical bill review, including any fee schedule reductions;

e. look up and review medical fee schedules;

f. look up and review medical codes;

g. search, sort, and filter data by claimant, claim #, review status, and date of services, and

h. Approve for payment by the Department of the medical bills negotiated by the Awarded Bidder.

2. The Awarded Bidder’s medical bill review software will provide the following software integrations capable of:

a. receiving and importing medical bill information from a medical clearing house;

b. receiving and importing current and historical data from scanned images of any medical bills received by the Department;

c. receiving and importing claimant and claims data from the Department’s Risk Management Information System;

d. receiving and importing vendor data from the Department’s Risk Management Information System;

e. receiving and importing payment information from the Department’s Risk Management Information System;

f. exporting data for reviewed and downcoded medical bills, along with a supplemental index file of the images associated with the reviewed medical bills, to the Department’s Risk Management Information System, and

g. exporting data for approved medical payments to the Department’s Risk Management Information System.

3. The Awarded Bidder’s medical bill review software will provide the following reports:

a. Monthly Summary: a monthly report outlining the number of bills audited, savings resulting from the audit, and issues found.

b. Bill Review and Activity Reports: number of bills received, processed, pending, turnaround times, and other operational metrics.

c. Savings Analysis Reports: gross billed charges, allowed amounts, total savings, and savings by category.

d. Exception Reports: bills requiring manual intervention, provider disputes and appeals, incomplete submissions, and other processing exceptions.

e. Medical Cost Trend Reports: high-cost and high-volume providers, most frequently billed CPT codes, utilization trends, and open versus closed claim analyses.

f. Compliance and Quality Reports: coding errors identified, fee schedule compliance issues, duplicate billing findings, and providers with recurring billing concerns.

g. Provider Outlier Reports: providers billing significantly above peer averages, unusual utilization patterns, and other noteworthy trends.

C. COMPLIANCE

The Awarded Bidder must:

1. Complete all reviews according to the latest published version of the Maine Workers’ Compensation Board Medical Fee Schedule 90-351 Chapter 5, Board Rules, with All Appendices as applicable;

2. Monitor for, and comply with, any Rule changes made by the Workers’ Compensation Board;

3. Have access to MS-DRG Grouper and use this resource to properly code inpatient bills;

4. Keep current with the Maine Hospital Association resources and guidelines, as applicable to support accurate inpatient hospital billing and coding; and

5. Keep current on and comply with the Center for Medicare and Medicaid Services guidelines.

D. Technical Requirements

1. All IT products must be accessible to persons with disabilities and must comply with State Accessibility Policy and Standards and the Americans with Disabilities Act. All IT applications must comply with the Digital Accessibility Policy (https://www.maine.gov/oit/sites/maine.gov.oit/files/inline-files/DigitalAccessibilityPolicy.pdf). In addition, all IT applications and content delivered through web browsers must comply with the State Web Standards (https://www.maine.gov/oit/policies/webstandards.html).

2. All IT products and services delivered as part of this RFP must conform to the State IT Policies, Standards, and Procedures (https://www.maine.gov/oit/policies-standards) effective at the time a Contract is executed. Special attention must be paid to the following policy/procedures:

a. Access Control Policy (AC-1);

b. Access Control Procedures for Users (AC-2);

c. Application Deployment Certification Guidelines;

d. Application Deployment Certification Policy;

e. Change Management Policy;

f. Data Exchange Policy;

g. Information Security Policy;

h. Risk Assessment Policy and Procedures (RA);

i. Security Awareness and Training Policy and Procedures (AT);

j. System and Services Acquisition Policy and Procedures (SA); and

k. Vulnerability Scanning Procedure (RA-5).

3. The Awarded Bidder must comply with the provisions of Health Insurance Portability Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and 22 M.R.S.A § 1711-C https://legislature.maine.gov/statutes/22/title22sec1711-C.html in all respects. Nothing in this contract may be construed to maintain, use, disclose, or share the Data in a manner not allowed by HIPAA or 22 M.R.S.A § 1711-C.

4. The Awarded Bidder must require all employees and contractors to comply with this contract, and all applicable provisions of HIPAA, and other Federal and State Laws, with respect to the Data. Additionally, the Awarded Bidder must require of, and maintain, an appropriate confidentiality agreement with each employee, contractor, and agent with access to the State’s data. The Awarded Bidder may only disclose, or otherwise use the State’s data, for the purpose of fulfilling the work described in this contract.

5. The Awarded Bidder must provide the full results of a vulnerability scan of the application prior to deployment and annually thereafter.

a. Alternatively, Awarded Bidder must allow the State of Maine to conduct, at the Department’s expense, a third-party, independent security assessment, including but not limited to vulnerability and compliance assessment, and penetration testing of the application provided on an annual basis and when necessary, at the direction of the State CISO.

6. The Awarded Bidder must provide a third-party SOC 2 Type 2 audit (including all five Trust Services Principles) against the environment using the standards set by the American Institute of Certified Public Accountants (CISPA).

a. The third-party auditor will be appropriately certified to conduct such audits;

b. The full report, and all future reports, will be made available to the State of Maine Information Security Office for their review;

c. Audit findings rated Critical or High must have an accompanying plan of action for remediation to the satisfaction of the Chief Information Security Officer, State of Maine, and;

d. The Awarded Bidder must provide a third-party audit using the most current version of CISPA SOC 2 Type 2 guidelines annually thereafter.

7. The Awarded Bidder must use data obtained from the Department only for the explicit purposes of fulfilling this Agreement.

8. At the request of the Department, the Awarded Bidder must provide a copy of all data obtained from the Department as part of this Agreement within ten (10) days of the request.

9. The Awarded Bidder must provide a copy of all data obtained from the State to the Department in a manner specified by OIT, and;

10. When the data collected for the purposes of the proposed services is no longer needed for the stated purposes of this Agreement, the Awarded Bidder must destroy it completely, including any archival/backup copies, per NIST SP 800-88.

PART III KEY RFP EVENTS

A. Vendor Self Service System (VSS)

The Office of State Procurement Services Vendor Self Service System website is found at the link below: https://www.maine.gov/dafs/bbm/procurementservices/vendors/vendor-self-service-system A copy of the RFP and all associated documents will be published in VSS.

Only documents published in VSS will be considered binding.

Any interested party may view open solicitations in VSS using the Public Access feature.

Vendors must have an active User ID and password in VSS to submit questions and respond to solicitations, including this RFP.

Vendor registration instructions and User Guide may be found at the link above, which include steps for searching for an existing account/User ID, or registering for a new account/User ID.

Vendors interested in responding to a solicitation are encouraged to obtain a User ID and password for VSS as soon as possible.

Vendors must have an active Vendor Code (VC or VS) to contract with the department.

B. Questions

1. General Instructions: It is the responsibility of all Bidders and other interested parties to examine the entire RFP and to seek clarification, in writing, if they do not understand any information or instructions.

a. Questions must be submitted in VSS as soon as possible but no later than the date and time published in VSS.

b. Questions should be clearly stated and reference the applicable section and/or page number of the RFP.

c. The Department assumes no liability for assuring accurate/complete/on time transmission and receipt.

2. Question & Answer Summary: Responses to all questions will be compiled in writing and published in VSS no later than seven (7) calendar days prior to the Proposal Submission Deadline. It is the responsibility of all interested parties to go to VSS to obtain a copy of the Question & Answer Summary. Only those answers issued in writing in VSS will be considered binding.

C. Demonstration

Software Demonstration: Bidders may be required to discuss and demonstrate the proposed software and explain how its components would be applied to the requirements described in this RFP. The Department will contact Bidders during the selection process to schedule a virtual meeting for these demonstrations.

D. Amendments

All amendments released in regard to the RFP will be published in VSS. It is the responsibility of all interested parties to go to VSS to obtain amendments. Only those amendments published in VSS are considered binding.

E. Proposal Submission

1. Proposals Due

a. Proposal submissions must be received no later than the Proposal Submission Deadline (closing date) published in VSS.

b. Any proposal submissions or any additional or revised proposal files received after the Proposal Submission Deadline will be rejected without exception.

2. Delivery Instructions

a. Proposal submissions must be submitted to the Office of State Procurement Services via VSS.

b. Only proposal submissions received via VSS will be considered. The Department assumes no liability for assuring accurate/complete receipt.

c. Submissions containing links to file sharing sites or online file repositories will not be accepted as submissions. Only proposal submissions that have the actual requested files attached will be accepted.

d. Encrypted submissions received which require opening attachments and logging into a proprietary system will not be accepted. Bidders should work with their Information Technology team to ensure that the proposal submission will not be encrypted due to any security settings.

e. File size limits are 15MB per file. Bidders may separate their submissions into multiple files, as necessary, due to file size concerns.

3. Submission Format:

a. Bidders must submit multiple files, with each file named and containing the required information as defined below.

File 1 [Bidder’s Name] – Preliminary Information PDF format preferred, and must include:

· Appendix A (Proposal Cover Page)

· Appendix B (Responsible Bidder Certification)

File 2 [Bidder’s Name] – Organization Qualifications and Experience PDF format preferred, and must include:

· Appendix C (Organization Qualifications and Experience Form)

· Appendix D (Subcontractors Form)

· And all required information and attachments stated in PART IV, Section II.

File 3 [Bidder’s Name] – Proposed Services PDF format preferred, and must include:

· Appendix E (Technical Assessment Form)

· Appendix F (Proposed Services Form)

· And all required information and attachments stated in PART IV, Section III.

File 4 [Bidder’s Name] – Cost Proposal Excel format preferred, and must include:

· Appendix G (Cost Proposal Form)

PART IV PROPOSAL SUBMISSION REQUIREMENTS

This section contains instructions for Bidders to use in preparing their proposals. The Department seeks detailed yet succinct responses that demonstrate the Bidder’s qualifications, experience, and ability to perform the requirements specified throughout the RFP.

Bidders’ proposals must follow the outline used below, including the numbering, section, and sub-section headings. Failure to use the outline specified in PART IV, or failure to respond to all questions and instructions throughout the RFP, may result in the proposal being disqualified as non-responsive or receiving a reduced score. The Department, and its evaluation team, has sole discretion to determine whether a variance from the RFP specifications will result either in disqualification or reduction in scoring of a proposal. Rephrasing of the content provided in the RFP will, at best, be considered minimally responsive.

Bidders are not to provide additional attachments beyond those specified in the RFP for the purpose of extending their response. Additional materials not requested will not be considered part of the proposal and will not be evaluated. Bidders must include any forms provided in the submission package or reproduce those forms as closely as possible. All information must be presented in the same order and format as described in the RFP.

Proposal Format and Contents

Section I Preliminary Information (File #1)

1. Proposal Cover Page Bidders must complete Appendix A (Proposal Cover Page). It is critical that the cover page show the specific information requested, including Bidder address(es) and other details listed. The Proposal Cover Page must be dated and signed by a person authorized to enter into contracts on behalf of the Bidder.

2. Responsible Bidder Certification Bidders must complete Appendix B (Responsible Bidder Certification). The Responsible Bidder Certification must be dated and signed by a person authorized to enter into contracts on behalf of the Bidder.

Section II Organization Qualifications and Experience (File #2)

1. Overview of the Organization Bidders must complete Appendix C (Qualifications and Experience Form) describing their qualifications and skills to provide the requested services in the RFP. Bidders must include three (3) examples of projects which demonstrate their experience and expertise in performing these services, as well as highlighting the Bidder’s stated qualifications and skills.

2. Subcontractors Bidders must complete Appendix D (Subcontractors Form) to provide a list that specifies the name, address, phone number, contact person, and a brief description of organizational capacity and qualifications for any subcontractors to be used. If no subcontractors will be used, indicate as such on the form.

3. Organizational Chart Bidders must provide an organizational chart. The organizational chart must include the project being proposed. Each position must be identified by position title and corresponding to the personnel job descriptions.

4. Litigation Bidders must attach a list of all current litigation in which the Bidder is named and a list of all closed cases that have closed within the past five (5) years in which the Bidder paid the claimant either as part of a settlement or by decree. For each, list the entity bringing suit, the complaint, the accusation, amount, and outcome.

5. Financial Viability Bidders must provide the following information for each of the past three (3) tax years:

a. Balance Sheets

b. Income (Profit/Loss) Statements

6. Licensure/Certification Bidders may provide documentation of any applicable licensure/certification or specific credentials that are related to providing the proposed services of the RFP. This documentation may include:

7. Certificate of Insurance Bidders must provide a certificate of insurance on a standard ACORD form (or the equivalent) evidencing the Bidder’s general liability, professional liability and any other relevant liability insurance policies that might be associated with the proposed services.

Section III Proposed Services (File #3)

1. Technical Assessment Bidders must complete Appendix E (Technical Assessment Form) to describe the Bidder’s capability to meet the stated requirements and policies identified in this RFP.

2. Services to be Provided Bidders must complete Appendix F (Proposed Services Form) to discuss the Scope of Services referenced above in Part II of the RFP and what the Bidder will offer, including a description of the methods and resources the Bidder will use and how each task involved will be accomplished. Bidders must also describe how the expectations and/or desired outcomes as a result of these services will be achieved. If subcontractors are involved, Bidders must clearly identify the work each will perform.

3. Implementation - Work Plan Bidders must provide a realistic work plan for the implementation of the program through the first contract period. The work plan must be displayed in a timeline chart, and concisely describe each program development and implementation task, the month it will be carried out, and the person or position responsible for each task. If applicable, Bidders must identify all tasks to be delegated to subcontractors.

Section IV Cost Proposal (File #4)

1. Cost Proposal Form Bidders must complete Appendix G (Cost Proposal Form).

2. General Instructions

a. The cost proposal must include the costs necessary for the Bidder to fully comply with the contract terms, conditions, and RFP requirements.

b. No costs related to the preparation of the proposal for the RFP, or to the negotiation of the contract with the Department, may be included in the proposal. Only costs to be incurred after the contract effective date that are specifically related to the implementation or operation of contracted services may be included.

PART V PROPOSAL EVALUATION AND SELECTION

Evaluation of the submitted proposals will be accomplished as follows:

A. Evaluation Process – General Information

1. An evaluation team, composed of qualified reviewers, will judge the merits of the proposals received in accordance with the criteria defined in the RFP.

2. Officials responsible for making decisions on the award selection will ensure that the selection process accords equal opportunity and appropriate consideration to all who are capable of meeting the specifications. The goals of the evaluation process are to ensure fairness and objectivity in review of the proposals and to ensure that the contract is awarded to the Bidder whose proposal provides the best value to the State of Maine.

3. The Department reserves the right to communicate and/or schedule interviews/presentations with Bidders, if needed, to obtain clarification of information contained in the proposals received. The Department may revise the scores assigned in the initial evaluation to reflect those communications and/or interviews/presentations.

4. Changes to proposals, including updating or adding information, will not be permitted during any portion of the evaluation process. Therefore, Bidders must submit proposals that present their rates and other requested information as clearly and completely as possible.

B. Scoring Weights and Process

1. Scoring Weights: Proposal scores will be based on a 100-point scale and will measure the degree to which each proposal meets the following criteria. The proposal materials that will be evaluated under each section below are identified in Part IV of the RFP.

2. Scoring Process: For proposals that demonstrate meeting the requirements in Section I, if applicable, the evaluation team will use a consensus approach to evaluate and score Sections II & III above. Members of the evaluation team will not score those sections individually but, instead, will arrive at a consensus as to assignment of points for each of those sections. Section IV, the Cost Proposal, will be scored as described below.

3. Scoring the Cost Proposal: The total cost proposed for conducting all the functions specified in the RFP will be assigned a score according to a mathematical formula. The lowest bid will be awarded 30 points. Proposals with higher bid values will be awarded proportionately fewer points calculated in comparison with the lowest bid.

The scoring formula is:

(Lowest submitted cost proposal / Cost of proposal being scored) x 30 = pro-rated score

No Best and Final Offers: The State of Maine will not seek or accept a best and final offer (BAFO) from any Bidder in this procurement process. All Bidders are expected to provide their best value pricing with the submission of their proposal.

C. Negotiations

1. The Department reserves the right to negotiate with the awarded Bidder(s) to finalize a contract. Such negotiations may not significantly vary the content, nature, or requirements of the proposal or the Department’s Request for Proposal to an extent that may affect the price of goods or services requested.

2. The Department reserves the right to terminate contract negotiations with an awarded Bidder who submits a proposed contract significantly different from the proposal they submitted in response to the advertised RFP.

3. In the event that an acceptable contract cannot be negotiated with the highest ranked Bidder, the Department may withdraw its award and negotiate with the next-highest ranked Bidder, and so on, until an acceptable contract has been finalized. Alternatively, the Department may cancel the RFP, at its sole discretion.

D. Selection and Award

1. The final decision regarding the award of the contract will be made by representatives of the Department subject to approval by the State Procurement Review Committee.

2. Notification of conditional award selection or non-selection will be made in writing by the Department.

3. Issuance of the RFP in no way constitutes a commitment by the State of Maine to award a contract, to pay costs incurred in the preparation of a response to the RFP, or to pay costs incurred in procuring or contracting for services, supplies, physical space, personnel or any other costs incurred by the Bidder.

4. The Department reserves the right to reject any and all proposals or to make multiple awards.

E. Appeal of Contract Awards

Any person aggrieved by the award decision that results from the RFP may appeal the decision to the Director of the Bureau of General Services in the manner prescribed in 5 M.R.S.A. § 1825-E and 18-554 Code of Maine Rules Chapter 120. The appeal must be in writing and filed with the Director of the Bureau of General Services, 9 State House Station, Augusta, Maine, 04333-0009 within fifteen (15) calendar days of receipt of notification of conditional contract award.

PART VI CONTRACT ADMINISTRATION AND CONDITIONS

A. Contract Document

1. The awarded Bidder will be required to execute an IT Service Contract (IT-SC) with Confidentiality and Non-Disclosure Agreement (NDA) including appropriate riders as determined by the issuing department. Bidders will carefully review the IT-SC.

All exceptions will be negotiated between the awarded Bidder(s) and the State. The State will not accept any proposed exceptions as part of this RFP process. The State is not obligated to accept, negotiate, or compromise of any proposed exceptions.

The complete set of standard State of Maine Service Contract documents, along with other forms and contract documents commonly used by the State, may be found on the Office of State Procurement Services’ website at the following link: Office of .

2. Allocation of funds is final upon successful negotiation and execution of the contract, subject to the review and approval of the State Procurement Review Committee. Contracts are not considered fully executed and valid until approved by the State Procurement Review Committee and funds are encumbered. No contract will be approved based on an RFP which has an effective date less than fourteen (14) calendar days after award notification to Bidders. (Referenced in the regulations of the Department of Administrative and Financial Services, Chapter 110, § 3(B)(i).)

This provision means that a contract cannot be effective until at least fourteen (14) calendar days after award notification.

3. The State recognizes that the actual contract effective date depends upon completion of the RFP process, date of formal award notification, length of contract negotiation, and preparation and approval by the State Procurement Review Committee. Any appeals to the Department’s award decision(s) may further postpone the actual contract effective date, depending upon the outcome. The contract effective date listed in the RFP may need to be adjusted, if necessary, to comply with mandated requirements.

4. In providing services and performing under the contract, the awarded Bidder must act as an independent contractor and not as an agent of the State of Maine.

B. Standard State Contract Provisions

1. Contract Administration Following the award, a Contract Administrator from the Department will be appointed to assist with the development and administration of the contract and to act as administrator during the entire contract period. Department staff will be available after the award to consult with the awarded Bidder in the finalization of the contract.

2. Payments and Other Provisions The State anticipates paying the awarded Bidder on the basis of net 30 payment terms, upon the receipt of an accurate and acceptable invoice. An invoice will be considered accurate and acceptable if it contains a reference to the State of Maine contract number, contains correct pricing information relative to the contract, and provides any required supporting documents, as applicable, and any other specific and agreed-upon requirements listed within the contract that results from the RFP.

PART VII LIST OF RFP APPENDICES AND RELATED DOCUMENTS

Appendix A – Proposal Cover Page

Appendix B – Responsible Bidder Certification

Appendix C – Qualifications and Experience Form

Appendix D – Subcontractors Form

Appendix E – Technical Assessment Form

Appendix F – Proposed Services Form

Appendix G – Cost Proposal Form

APPENDIX A

Department of Administrative & Financial Services Office of Employee Health, Wellness, & Workers’ Compensation

PROPOSAL COVER PAGE

RFP# 202607125

Bidder Name:

Chief Executive - Name/Title:

Tel:

E-mail:

Headquarters Street Address:

Headquarters City/State/Zip:

(Provide information requested below if different from above)

Lead Point of Contact for Proposal - Name/Title:

Tel:

E-mail:

Headquarters Street Address:

Headquarters City/State/Zip:

· This proposal and the pricing structure contained herein will remain firm for a period of 180 days from the date and time of the bid opening.

· No personnel currently employed by the Department participated, either directly or indirectly, in any activities relating to the preparation of the Bidder’s proposal.

· No attempt has been made, or will be made, by the Bidder to induce any other person or firm to submit or not to submit a proposal.

· The above-named organization is the legal entity entering into the resulting contract with the Department if they are awarded the contract.

· The undersigned is authorized to enter contractual obligations on behalf of the above-named organization.

To the best of my knowledge, all information provided in the enclosed proposal, both programmatic and financial, is complete and accurate at the time of submission.

Name (Print):

Title:

Authorized Signature:

Date:

APPENDIX B

Department of Administrative & Financial Services Office of Employee Health, Wellness, & Workers’ Compensation

RESPONSIBLE BIDDER CERTIFICATION

RFP# 202607125

Bidder Name:

By signing this document, I certify to the best of my knowledge and belief that the aforementioned organization, its principals and any subcontractors named in this proposal:

a. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from bidding or working on contracts issued by any governmental agency.

b. Have not within three years of submitting the proposal for this contract been convicted of or had a civil judgment rendered against them for:

i. Fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a federal, state, or local government transaction or contract.

ii. Violating Federal or State antitrust statutes or committing embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property.

c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or Local) with commission of any of the offenses enumerated in paragraph (b) of this certification.

d. Have not within a three (3) year period preceding this proposal had one or more federal, state, or local government transactions terminated for cause or default.

e. Have not entered into a prior understanding, agreement, or connection with any corporation, firm, or person submitting a response for the same materials, supplies, equipment, or services and this proposal is in all respects fair and without collusion or fraud. The above-mentioned entities understand and agree that collusive bidding is a violation of state and federal law and can result in fines, prison sentences, and civil damage awards.

f. Is not a foreign adversary business entity (https://www.maine.gov/oit/prohibited-technologies).

g. Is not on the list of prohibited companies (https://www.maine.gov/oit/prohibited-technologies) or does not obtain or purchase any information or communications technology or services included on the list of prohibited information and communications technology and services https://www.maine.gov/oit/prohibited-technologies (Title 5 §2030-B).

Name (Print):

Title:

Authorized Signature:

Date:

APPENDIX C

Department of Administrative & Financial Services Office of Employee Health, Wellness, & Workers’ Compensation QUALIFICATIONS and EXPERIENCE FORM

RFP# 202607125

Bidder Name:

Present a brief statement of qualifications. Describe the history of the Bidder’s organization, especially regarding skills pertinent to the specific work required by the RFP and any special or unique characteristics of the organization which would make it especially qualified to perform the required work activities. The Bidder may expand this form and use additional pages to provide this information.

Provide a description of projects the Bidder performed which occurred within the past five (5) years and reflect experience and expertise needed in performing the functions described in Part II – Scope of Services to be Provided of the RFP. The Bidder may expand this form and use additional pages to provide this information.

Project One

Client Name:

Client Contact Person:

Telephone:

E-Mail:

Project Start/End Dates:

Brief Description of Project

Project Two

Client Name:

Client Contact Person:

Telephone:

E-Mail:

Project Start/End Dates:

Brief Description of Project

Project Three

Client Name:

Client Contact Person:

Telephone:

E-Mail:

Project Start/End Dates:

Brief Description of Project

APPENDIX D

Department of Administrative & Financial Services Office of Employee Health, Wellness, & Workers’ Compensation

SUBCONTRACTORS FORM

RFP# 202607125

Bidder Name:

Subcontractors If subcontractors are to be used, Bidders must use the tables below to describe the name, address, phone number, contact person, and a brief description of the subcontractors’ organizational capacity and qualifications.

Subcontractor 1

Subcontractor Name:

Contact Person:

Telephone:

E-Mail:

Brief Description of Anticipated Role and Qualifications

Subcontractor 2

Subcontractor Name:

Contact Person:

Telephone:

E-Mail:

Brief Description of Anticipated Role and Qualifications

Subcontractor 3

Subcontractor Name:

Contact Person:

Telephone:

E-Mail:

Brief Description of Anticipated Role and Qualifications

APPENDIX E

Department of Administrative & Financial Services Office of Employee Health, Wellness, & Workers’ Compensation

TECHNICAL ASSESSMENT FORM

RFP# 202607125

Worker’s Compensation Medical Bill Review Program

Bidders must complete the Technical Assessment Form embedded below.

The Technical Assessment Form may be obtained by double-clicking the Excel (.xlsx) icon below.

APPENDIX F

Department of Administrative & Financial Services Office of Employee Health, Wellness, & Workers’ Compensation

PROPOSED SERVICES FORM

RFP# 202607125

Bidder Name:

Services to be Provided Bidders must discuss the Scope of Services referenced in Part II of the RFP and what the Bidder will offer, including a description of the methods and resources the Bidder will use and how each task involved will be accomplished. Bidders must also describe how the expectations and/or desired outcomes as a result of these services will be achieved. If subcontractors are involved, Bidders must clearly identify the work each will perform.

APPENDIX G

Department of Administrative & Financial Services Office of Employee Health, Wellness, & Workers’ Compensation

COST PROPOSAL FORM

RFP# 202607125

Bidder Name:

Special Instructions

1. Proposed fees must include all costs necessary to provide the requested services. No additional administration, implementation, transaction, access, licensing, or other fees will be permitted unless specifically identified in the Cost Proposal.

Bidders must submit a Cost Proposal that covers the Initial Period of Performance as defined in Part I of the RFP.

2. The Total Evaluated Cost identified in the table below will constitute the Proposed Cost and will be used to score the cost proposal as defined in Part V, B, 3 of this RFP.

3. Bidders must provide a fixed fee or rate for each pricing element listed below. Pricing must remain firm throughout the Initial Period of Performance unless otherwise provided in the resulting contract.

Proposed Cost Schedule:

Bidders must complete the table below…