Amendment 0003 - Remote Coding Services.pdf

W40M REGIONAL HEALTH CONTRACTING OF

US MEDCOM HCAA JBLM HCC

POC: JOHN E. MCGUIRE

673 WOODLAND SQUARE LOOP SE, SUITE 101

LACY WA 98503

0011704936

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER (Type or print)

30-105-04EXCEPTION TO SF 30

APPROVED BY OIRM 11-84

STANDARD FORM 30 (Rev. 10-83) Prescribed by GSA

FAR (48 CFR) 53.243

The purpose of this amendment is to update the extended description w ithin CLINs 0003, 1003, 2003, 3003 and 4003; see summary of changes for further detail. All other terms and conditions remain unchanged.

1. CONTRACT ID CODE PAGE OF PAGES

J 1 3

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)

16C. DATE SIGNED

BY 23-Feb-2022

16B. UNITED STATES OF AMERICA15C. DATE SIGNED15B. CONTRACTOR/OFFEROR

(Signature of Contracting Officer)(Signature of person authorized to sign)

8. NAME AND ADDRESS OF CONTRACTOR (No., Street, County, State and Zip Code) X W81K0222Q0025

X 9B. DATED (SEE ITEM 11)

07-Feb-2022

10B. DATED (SEE ITEM 13)

9A. AMENDMENT OF SOLICITATION NO.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

X The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offer is extended, X is not extended.

Offer must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended by one of the following methods:

(a) By completing Items 8 and 15, and returning 1 copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted;

or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN

REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

12. ACCOUNTING AND APPROPRIATION DATA (If required)

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS.

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE

CONTRACT ORDER NO. IN ITEM 10A.

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(B).

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority)

E. IMPORTANT: Contractor is not, is required to sign this document and return copies to the issuing office.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

10A. MOD. OF CONTRACT/ORDER NO.

2. AMENDMENT/MODIFICATION NO. 5. PROJECT NO.(If applicable)

6. ISSUED BY

3. EFFECTIVE DATE

23-Feb-2022

CODE

W40M REGIONAL HEALTH CONTRACTING OF

REGIONAL HEALTH CONTR OFC PACIFIC

BLDG 339 CLARK ROAD

FT SHAFTER HI 96858-5098

W81K02 7. ADMINISTERED BY (If other than item 6)

4. REQUISITION/PURCHASE REQ. NO.

CODE W81K02

FACILITY CODECODE

EMAIL:TEL:

W81K0222Q0025

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

SECTION SF 1449 - CONTINUATION SHEET

SUPPLIES OR SERVICES AND PRICES

CLIN 0003

The CLIN extended description has changed from:

The contractor shall provide 4 (Quarterly) On-site physician coding/documentation Training Visits for medical providers at Bassett Army Community Hospital, Fort Wainwright, Alaska. Services shall be provided in accordance with PWS Section 5.1.4.

To:

The contractor shall perform DHA Audit, Appeal and Mediation services for Bassett Army Community Hospital, Fort Wainwright, Alaska. Performance will be provided in accordance with PWS Section 5.1.4.

CLIN 1003

The contractor shall provide 4 (Quarterly) On-site physician coding/documentation Training Visits for medical providers at Bassett Army Community Hospital, Fort Wainwright, Alaska. Services shall be provided in accordance

The contractor shall perform DHA Audit, Appeal and Mediation services for Bassett Army Community Hospital, CLIN 2003

The contractor shall provide 4 (Quarterly) On-site physician coding/documentation Training Visits for medical providers at Bassett Army Community Hospital, Fort Wainwright, Alaska. Services shall be provided in accordance

The contractor shall perform DHA Audit, Appeal and Mediation services for Bassett Army Community Hospital, W81K0222Q0025

CLIN 3003

The contractor shall provide 4 (Quarterly) On-site physician coding/documentation Training Visits for medical providers at Bassett Army Community Hospital, Fort Wainwright, Alaska. Services shall be provided in accordance

The contractor shall perform DHA Audit, Appeal and Mediation services for Bassett Army Community Hospital, CLIN 4003

The contractor shall provide 4 (Quarterly) On-site physician coding/documentation Training Visits for medical providers at Bassett Army Community Hospital, Fort Wainwright, Alaska. Services shall be provided in accordance

The contractor shall perform DHA Audit, Appeal and Mediation services for Bassett Army Community Hospital, Fort Wainwright, Alaska. Performance will be provided in accordance with PWS Section 5.1.4.

(End of Summary of Changes)