S000000390 Official Bid Price Sheet REVISED.xlsx
XLSX spreadsheet 18 KB Posted
- Attached to
- Managed Care for Workers' Compensation
- Solicitation number
- S000000390
- Issued by
- Arkansas
About this file
This is a revised official bid price sheet (Form S000000390) issued by the Arkansas Insurance Division Public Employee Claims Division for Managed Care for Workers' Compensation services. The document provides detailed instructions and tables for prospective contractors to submit pricing for various managed care services, including PPO access fees, bill review, peer review, pre-certification, and medical case management services.
The price sheet contains six tables, with Tables 1-4 used for cost point determination and Tables 5-6 for supplementary pricing information. The pricing structure includes a PPO access fee calculated as a percentage of savings (capped at $15,000 per medical bill) based on estimated annual savings of $4.3 million, flat rates for services such as bill review (14,000 estimated annual quantity), peer review (50 reviews), and pre-certification (250 instances), and hourly rates for field medical case management (4,400 hours), telephonic medical case management (1,100 hours), utilization review (600 hours), and negotiation (200 hours). Table 5 covers excess mileage rates, while Table 6 addresses optional pass-through payments for various payment methods, including EOBs, ACH, mail, and virtual card payments, with estimated annual quantities ranging from 1,000 to 14,000 transactions.
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Text version
Price Instructions
REVISED
Official Solicitation Price Sheet* S000000390 Managed Care for Workers' Compensation Arkansas Insurance Division Public Employee Claims Division
CHANGES TO THIS PRICE SHEET ARE DISPLAYED IN RED FONT
Prospective Contractor Name:
| Instructions |
| 1. The Prospective Contractor should enter their name in the green-highlighted cell on this tab. |
| Table 1 |
| 1. Table 1 will automatically calculate the total estimated seven (7) year cost based on the pricing entered into Table 2, Table 3, and Table 4. |
| 2. This cost must include all costs associated with the activities and tasks that meet the Requirements of the RFP, including travel costs, fees, billable expenses, etc. and all additional activities and tasks identified in the Prospective Contractor's proposal. |
| 3. The total estimated costs from Table 2, Table 3, and Table 4 must add up to match the total estimated cost in Table 1. |
| 4. In the event of a discrepancy between Table 1, and Table 2, Table 3, and Table 4, Table 1 shall govern. |
| 5. Cost Points will be awarded based on the total estimated cost in Table 1. |
| Table 2 |
| 1. The Prospective Contractor shall enter the PPO access fee charge as percentage (whole #) of savings in the green-shaded cell in Table 2. |
| 2. The Prospective Contractor shall not charge the Division more than $15,000 in PPO access fee charges per individual medical bill. |
| Table 3 |
| 1. The Prospective Contractor shall enter the rates for each green-shaded cell in Table 3. |
| 2. The Contractor may identify additional tasks not specified by the State in the blank lines on Table 3 and may add lines to Table 3 as needed. |
| Table 4 |
| 1. The Prospective Contractor shall enter the hourly rates for each green-shaded cell in Table 4. |
| 2. The Contractor may identify additional tasks not specified by the State in the blank lines on Table 4 and may add lines to Table 4 as needed. |
| Table 5 - Not used in determining Cost Points |
| 1. The Prospective Contractor shall enter the excess mileage rate in the green-shaded cell in Table 5. |
| Table 6 - Not used in determining Cost Points |
| 1. The Prospective Contractor should enter the rates for each green-shaded cell in Table 6. |
Price Sheet
REVISED
Official Solicitation Price Sheet S000000390 Managed Care for Workers' Compensation Arkansas Insurance Department Public Employee Claims Division
CHANGES TO THIS PRICE SHEET ARE DISPLAYED IN RED FONT
Prospective Contractor Name: 0
| Table 1: Used in determining Cost Points | |
| Description | All-Inclusive Estimated Seven (7) Year Grand Total |
| Managed Care for Workers' Compensation | $ - 0 |
| Table 2: Used in determining Cost Points | |||
| Description | PPO Access fee charge as Percentage (whole #) of Savings | Estimated Total Amount of Savings | Estimated Annual PPO Access Fee Cost to the State |
| PPO Savings | $ 4,300,000.00 | $ - 0 |
| Table 3: Used in determining Cost Points | |||
| Description | Rate | Estimated Annual Quantity | Estimated Annual Total |
| Bill Review - Flat Rate Per Bill | 14,000 | $ - 0 | |
| Peer Review - Flat Rate | 50 | $ - 0 | |
| Peer Review - Each additional page | 200 | $ - 0 | |
| Pre-Certification - Flat Rate per each | 250 | $ - 0 |
Estimated Total $ - 0
| Table 4: Used in determining Cost Points | |||
| Description | Hourly Rate | Estimated Annual Hours | Estimated Annual Total |
| Field Medical Case Management | 4,400 | $ - 0 | |
| Telephonic Medical Case Management | 1,100 | $ - 0 | |
| Utilization Review (Beyond Normal Bill Review) | 600 | $ - 0 | |
| Negotiation | 200 | $ - 0 |
Estimated Total $ - 0
| Table 5: Not used in determining Cost Points | |
| Description | Rate per Mile |
| Excess Mileage Rate |
| Table 6: Optional Pass-Through Payments | Not used in determining Cost Points | ||
| Description | Rate | Estimated Annual Quantity | Estimated Annual Total |
| Payments with EOB's - Flat Rate Per Bill & EOB | 14,000 | $ - 0 | |
| Payments by ACH (includes sending EOB) | 8,000 | $ - 0 | |
| Payments by Mail (includes sending EOB) | 5,000 | $ - 0 | |
| Payments by Virtual Card (includes sending EOB) | 1,000 | $ - 0 | |
| Estimated Total | $ - 0 |
File details come from the government source that posted it. Updated .