S02 - Attachment 04 - BOE Template - IV Buffer Support - 19AUG2026.pdf
PDF 236 KB Posted
- Solicitation number
- 36C24C26Q0027
About this file
This is a Basis of Estimate (BOE) template for Insurance Entry and Verification Buffer Support Services. The template is designed for quoters to submit pricing proposals alongside Volume IV — Price documentation and must accompany the completed Section B pricing schedule, which controls the quoter's proposed prices. The BOE does not modify the Performance Work Statement (PWS), Section B requirements, Performance Requirements Summary Matrix (PRSM), Quality Assurance Surveillance Plan (QASP), or other solicitation requirements.
The pricing structure consists of six Contract Line Item Numbers (CLINs) covering reverification actions and new-policy actions, including Medicare policy actions. The evaluated quantities total 3,243,800 actions across the CLINs, with CLIN 0001 containing 643,200 reverification actions, CLIN 0002 containing 160,800 new-policy actions, CLINs 1001 and 2001 containing zero reverification actions, and CLINs 1002 and 2002 each containing 820,000 new-policy actions. The quoter must provide unit prices and extended prices for each CLIN and confirm that prices exactly match the Section B pricing schedule. Section 3 requires quoters to document material pricing assumptions regarding workload mix, non-chargeable exceptions, contractor-caused rejected actions, staffing and productivity, and transition/ramp-up activities. Section 4 mandates required confirmations on price reconciliation, included costs (labor, supervision, management, quality control, facilities, equipment, and indirect costs), and payment treatment clarifying that only accepted completed actions are billable and contractor-caused rejections are corrected at no additional cost. An authorized representative must certify the BOE's consistency with the Section B pricing schedule in Section 5.
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Text version
ATTACHMENT 04 — BASIS OF ESTIMATE [BOE] TEMPLATE
Insurance Entry and Verification Buffer Support Services
Instructions Submit this completed form with Volume IV — Price. Keep responses concise. The completed Section B pricing schedule controls the Quoter’s proposed prices.
This BOE does not change the PWS, Section B, the Performance Requirements Summary Matrix [PRSM], the Quality Assurance Surveillance Plan [QASP], or any other solicitation requirement. Bracketed text is a Quoter instruction and should be removed before submission.
1. Quoter Information
Required Item Quoter Response
Quoter legal name [INSERT]
UEI / CAGE Code [INSERT]
Solicitation number [INSERT]
Proposal date [INSERT]
Pricing point of contact — name, title, telephone, email [INSERT]
2. Price Summary
Enter the proposed prices exactly as shown in the completed Section B pricing schedule. Use the CLIN numbers and evaluated quantities in Section B. Do not add a line item that is not included in Section B.
Section
B CLIN
Action Type Unit Evaluated Quantity
Proposed Unit Price
Proposed Extended Price
0001 Reverification actions Each 643,200 $[INSERT] $[INSERT]
0002 New-policy actions, including Medicare policy actions
Each 160,800 $[INSERT] $[INSERT]
1001 Reverification actions Each 0 $[INSERT] $[INSERT]
1002 New-policy actions, including Medicare policy actions
Each 820,000 $[INSERT] $[INSERT]
2001 Reverification actions Each 0 $[INSERT] $[INSERT]
2002 New-policy actions, including Medicare policy actions
Each 820,000 $[INSERT] $[INSERT]
Total Evaluated Actions
$[INSERT]
3. Material Pricing Assumptions Historical workload and planning information is provided only for quotation preparation, pricing support, and price evaluation. It does not guarantee future workload, work mix, delivery periods, staffing, payment, or Task Order award.
Topic Quoter assumption and pricing impact
Workload mix, backlog, and volume distribution
[INSERT]
Non-chargeable exceptions
[INSERT]
Contractor-caused rejected actions and correction/rework
[INSERT]
Staffing and productivity assumptions
[INSERT]
Transition, access, credentialing, training, ramp-up, and surge assumptions
[INSERT]
Other material assumption
[INSERT or “None”]
4. Required Confirmations
Required confirmation
Quoter response
Price reconciliation
[Confirm that the prices above exactly match the completed Section B pricing schedule and that the Total Evaluated Price is calculated from the evaluated quantities in Section B.]
Included costs
[Confirm that, except for Government-furnished resources expressly identified in the contract or applicable Task Order, the proposed unit prices include all resources required to perform the PWS, including labor, supervision, management, quality control, reporting, Contractor-provided training, access administration, security/privacy compliance, facilities, equipment, connectivity, indirect costs, and profit.]
Payment treatment
[Confirm that only accepted completed actions are billable; Contractor-caused rejected actions will be corrected at no additional cost and are not separately billable; and non-chargeable exceptions are not billable.]
5. Certification
I certify that this BOE is consistent with the Quoter’s completed Section B pricing schedule and reflects the assumptions used to develop the proposed prices.
Authorized representative — name and title Signature Date
[INSERT] [INSERT] [INSERT]
File details come from the government source that posted it. Updated .