PricingSchedule.rtf

PRICING SCHEDULE

MEDICAL CLAIMS ADJUDICATION SERVICE

All offerors shall fill out this form completely and may submit other methods of pricing along with this form. Offerors shall also submit one-time start-up costs and training costs. The proposal accepted will be the one that’s most advantageous to the Government.

(A) TWO YEAR BASE PERIOD:

Effective Date of Award (DOA) thru 24 Months

MEDICAL CLAIMS:

Guaranteed Minimum 80,000

Price Per claim: $ X 80,000 = $

Estimated Maximum 300,000

Price Per claim: $ X 300,000 = $

(B) OPTION YEAR 1

25 thru 36 months

MEDICAL CLAIMS:

Guaranteed Minimum 40,000

Price Per claim: $ X 40,000 = $

Estimated Maximum 150,000

Price Per claim: $ X 150,000 = $

(C) OPTION YEAR 2

37 thru 48 months

MEDICAL CLAIMS:

Guaranteed Minimum 40,000

Price Per claim: $ X 40,000 = $

Estimated Maximum 150,000

Price Per claim: $ X 150,000 = $

(D) OPTION YEAR 3

49 thru 60 months

MEDICAL CLAIMS:

Guaranteed Minimum 40,000

Price Per claim: $ X 40,000 = $

Estimated Maximum 150,000

Price Per claim: $ X 150,000 = $

Guaranteed Minimum Price for 200,000 Medical Claims for 5 Years

*Estimated Maximum Price for 750,000 Medical Claims for 5 Years*

CONTRACT PRICE FOR 5 YEARS:

TOTAL GUARANTEED MINIMUM PRICE $

ONE-TIME START-UP COSTS $

TRAINING COSTS $

ACTUAL TOTAL CONTRACT PRICE:$

*The estimated maximum were not included in the actual total price.*