i

REQUEST FOR PROPOSALS FOR

Preferred Provider Organizations (PPO)

AND

Comprehensive Medical Bill Review Services (MBR)

ISSUING OFFICE

DEPARTMENT OF GENERAL SERVICES

BUREAU OF PROCUREMENT

FOR

DEPARTMENT OF LABOR AND INDUSTRY

STATE WORKERS’ INSURANCE FUND

RFP NUMBER DGS-CN-00020848

DATE OF ISSUANCE

July 21, 2006

ii

REQUEST FOR PROPOSALS FOR

PREFERRED PROVIDER ORGANIZATIONS (PPO)

AND

COMPREHENSIVE MEDICAL BILL REVIEW SERVICES (MBR)

TABLE OF CONTENTS

CALENDAR OF EVENTS Page iii

Part I—GENERAL INFORMATION Page 1

Part II—PROPOSAL REQUIREMENTS Page 9

Part III—CRITERIA FOR SELECTION Page 17

Part IV—WORK STATEMENT Page 20

APPENDIX A, STANDARD CONTRACT TERMS AND CONDITIONS

APPENDIX B, DOMESTIC WORKFORCE UTILIZATION CERTIFICATION

APPENDIX C, COST PROPOSAL

APPENDIX D, LOCATIONS AND NUMBER OF POLICY HOLDERS

APPENDIX E, PAYROLL CLASS CODES

APPENDIX F, PART A AND PART B BILL DATA

APPENDIX G, CONFIDENTIALITY CERTIFICATION

APPENDIX H, INTERFACE – SWIF TO OFFEROR

APPENDIX I, INTERFACE – OFFEROR TO SWIF

APPENDIX J, IMAGE INTERFACE

APPENDIX, K, PREMIUM BANDS

APPENDIX L, MEDICAL BILL WORKFLOW

iii

CALENDAR OF EVENTS

The Commonwealth will make every effort to adhere to the following schedule:

Activity Responsibility Date

Deadline to submit Questions via email to

jblocker@state.pa.us

Potential

Offerors 08/04/06

Preproposal Conference— Forum Place, 555 Walnut Street,

6th

Floor, Conference Rm #9, Harrisburg, PA 17101.

Issuing

Office/Potential

Offerors

08/09/06

Answers to Potential Offeror questions posted to the DGS

website (http://www.dgsweb.state.pa.us/comod/main.asp)

no later than this date.

Issuing Office 08/15/06

Please monitor website for all communications regarding

the RFP.

Potential

Offerors Ongoing

Sealed proposal must be received by the Issuing Office at

Dept. of General Services, Forum Place, 6th

Floor, 555

Walnut Street, Harrisburg, PA 17101.

Offerors 09/06/06

by 1:30 p.m.

Page 1 of 39

PART I

GENERAL INFORMATION

I-1. Purpose. This request for proposals (―RFP‖) provides to those interested in submitting

proposals for the subject procurement (―Offerors‖) sufficient information to enable them to

prepare and submit proposals for the State Workers’ Insurance Fund’s (―SWIF‖) consideration

on behalf of the Commonwealth of Pennsylvania (―Commonwealth‖) to satisfy a need for

Provider Panels, Preferred Provider Organizations (―PPOs‖) and Discounts extended by

providers which render medical services to injured employees of SWIF policyholders and for

Medical Bill Review Services.

I-2. Issuing Office. The Department of General Services (―Issuing Office‖) has issued this

RFP on behalf of the Commonwealth and SWIF. The sole point of contact in the

Commonwealth for this RFP shall be Jan Blocker, 6th

Floor, 555 Walnut Street, Harrisburg, PA

17101, jblocker@state.pa.us, the Issuing Officer for this RFP. Please refer all inquiries to the

Issuing Officer.

I-3. Scope. This RFP contains instructions governing the requested proposals, including the

requirements for the information and materials to be included; a description of the services to be

provided; requirements which Offerors must meet to be eligible for consideration; general

evaluation criteria; and other requirements specific to this RFP.

I-4. Problem Statement. To contain the cost of health care services provided to its claimants

SWIF is seeking to increase the use of provider panels, as permitted by 77 P.S. 531 to utilize

PPOs and to obtain discounted prices for health care services rendered to SWIF claimants by

health care providers which are not currently part of a panel or PPO. SWIF is also seeking to

procure comprehensive Medical Bill Review Services to assist in reviewing and paying bills

submitted for medical services provided to its claimants. Additional detail is provided in Part

IV of this RFP.

I-5. Type of Contract. It is proposed that if the Issuing Office enters into a contract as a

result of this RFP, it will be a fee for service and an incentive contract containing the Standard

Contract Terms and Conditions as shown in Appendix A and available at

http:/www.dgs.state.pa.us/dgs/lib/dgs/forms/comod/procurementforms/std274doc. The Issuing

Office, in its sole discretion, may undertake negotiations with Offerors whose proposals, in the

judgment of the Issuing Office, show them to be qualified, responsible and capable of

performing the Project. Further, in its sole discretion the Issuing Office reserves its right to

award all of the services sought by this RFP or part of the services sought by this RFP.

I-6. Rejection of Proposals. The Issuing Office reserves the right, in its sole and complete

discretion, to reject any and all proposal received in response to this RFP.

I-7. Incurring Costs. The Issuing Office is not liable for any costs the Offeror incurs in

preparation and submission of its proposal, in participating in the RFP process or in anticipation

of award of the contract.

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I-8. Preproposal Conference. A pre-proposal conference will be held as specified in the

Calendar of Events. The purpose of this conference is to provide opportunity for clarification of

the RFP. It is intended to be an informative dialog regarding the statement of work. Offerors

should forward all questions to the Issuing Office in accordance with Part I, Section I-9 to

ensure adequate time for analysis before the Issuing Office provides an answer. Offerors may

also ask questions at the conference. In view of the limited facilities available for the

conference, Offerors should limit their representation to two (2) individuals per Offeror. The

conference is for information only. Any answers furnished during the conference will not be

official until they have been verified, in writing, by the Issuing Office. All questions and written

answers will be posted on the Department of General Services’ (DGS) website as an addendum

to, and shall become part of, this RFP. Attendance is strongly encouraged.

I-9. Questions & Answers. If an Offeror has any questions regarding this RFP, the Offeror

must submit the questions by email (with the subject line ―RFP DGS-CN-00020848

Question‖) to the Issuing Officer named in Part I, Section I-2 of the RFP. If the Offeror has

questions, they must be submitted via email no later than the date indicated on the Calendar of

Events. The Offeror shall not attempt to contact the Issuing Officer by any other means. The

Issuing Officer shall post the answers to the questions on the DGS website by the date stated on

the Calendar of Events.

All questions and responses as posted on the DGS website are considered an addendum to, and

part of, this RFP in accordance with RFP Part I, Section I-10. Each Offeror shall be responsible

to monitor the DGS website for new or revised RFP information. The Issuing Office shall not be

bound by any verbal information nor shall it be bound by any written information that is not

either contained within the RFP or formally issued as an addendum by the Issuing Office. The

Issuing Office does not consider questions to be a protest of the specifications or of the

solicitation. The required protest process for Commonwealth procurements is described on the

DGS website.

I-10. Addenda to the RFP. If the Issuing Office deems it necessary to revise any part of this

RFP before the proposal response date, the Issuing Office will post an addendum to the DGS

website at www.dgsweb.state.pa.us/comod/main.asp. It is the Offeror’s responsibility to check

the website periodically for any new information or addenda to the RFP. Answers to the

questions asked during the Questions & Answers period also will be posted to the website as an

addendum to the RFP.

I-11. Response Date. To be considered for selection, hard copies of proposals must arrive at

the Issuing Office on or before the time and date specified in the RFP Calendar of Events. The

Issuing Office will not accept proposals via email or facsimile transmission. Offerors who send

proposals by mail or other delivery service should allow sufficient delivery time to ensure timely

receipt of their proposals. If, due to inclement weather, natural disaster, or any other cause, the

Commonwealth office location to which proposals are to be returned is closed on the proposal

response date, the deadline for submission will be automatically extended until the next

Commonwealth business day on which the office is open, unless the Issuing Office otherwise

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notifies Offerors. The hour for submission of proposals shall remain the same. The Issuing

Office will reject, unopened, any late proposals.

I-12. Proposals. To be considered, Offerors should submit a complete response to this RFP,

using the format provided in Part II, providing 10 paper copies of the proposal to the Issuing

Office. In addition to the paper copies of the proposal, Offerors shall submit two complete and

exact copies of the technical proposal on CD-ROM in Microsoft Office or Microsoft Office-

compatible format. The Offeror shall make no other distribution of its proposal to any other

Offeror or Commonwealth official or Commonwealth consultant. Each proposal page should be

numbered for ease of reference. An official authorized to bind the Offeror to its provisions must

sign the proposal. For this RFP, the proposal must remain valid for 120 days or until a contract

is fully executed. If the Issuing Office selects the Offeror’s proposal for award, the contents of

the selected Offeror’s proposal will become, except to the extent the contents are changed

through Best and Final Offers or negotiations, contractual obligations. The information in the

proposal will become a public record upon contract execution, except as limited by Section 106

(b)(1) of the Commonwealth Procurement Code, 62 Pa. C.S. § 106 (b)(1).

Each Offeror submitting a proposal specifically waives any right to withdraw or modify it,

except that the Offeror may withdraw its proposal by written notice received at the Issuing

Office’s address for proposal delivery prior to the exact hour and date specified for proposal

receipt. An Offeror or its authorized representative may withdraw its proposal in person prior to

the exact hour and date set for proposal receipt, provided the withdrawing person provides

appropriate identification and signs a receipt for the proposal. An Offeror may modify its

submitted proposal prior to the exact hour and date set for proposal receipt only by submitting a

new sealed proposal or sealed modification that complies with the RFP requirements.

I-13. Disadvantaged Business Information. The Issuing Office encourages participation by

small disadvantaged businesses as prime contractors, joint ventures and subcontractors/suppliers

and by socially disadvantaged businesses as prime contractors.

Small Disadvantaged Businesses are small businesses that are owned or controlled by a majority

of persons, not limited to members of minority groups, who have been deprived of the

opportunity to develop and maintain a competitive position in the economy because of social

disadvantages. The term includes:

a. Department of General Services Bureau of Minority and Women Business

Opportunities (BMWBO)-certified minority business enterprises (MBEs) and

women business enterprises (WBEs) that qualify as small businesses; and

b. United States Small Business Administration-certified small disadvantaged

businesses or 8(a) small disadvantaged business concerns.

Small businesses are businesses in the United States that are independently owned, are not

dominant in their field of operation, employ no more than 100 persons and earn less than $20

million in gross annual revenues ($25 million in gross annual revenues for those businesses in

the information technology sales or service business).

Page 4 of 39

Socially disadvantaged businesses are businesses in the United States that BMWBO determines

are owned or controlled by a majority of persons, not limited to members of minority groups,

who are subject to racial or ethnic prejudice or cultural bias, but which do not qualify as small

businesses. In order for a business to qualify as ―socially disadvantaged,‖ the Offeror must

include in its proposal clear and convincing evidence to establish that the business has personally

suffered racial or ethnic prejudice or cultural bias stemming from the business person’s color,

ethnic origin or gender.

Questions regarding this Program can be directed to:

Department of General Services

Bureau of Minority and Women Business Opportunities

Room 611, North Office Building

Harrisburg, PA 17125

Phone: (717) 787-6708

Fax: (717) 772-0021

Email: gs-bmwbo@state.pa.us

Program information and a database of BMWBO-certified minority- and women-owned

businesses can be accessed at www.dgs.state.pa.us, DGS Keyword: BMWBO. The federal

vendor database can be accessed at http://www.ccr.gov by clicking on Dynamic Small Business

Search (certified companies are so indicated).

I-14. Information Concerning Small Businesses in Enterprise Zones. The Issuing Office

encourages participation by small businesses, whose primary or headquarters facility is

physically located in areas the Commonwealth has identified as Designated Enterprise Zones, as

prime contractors, joint ventures and subcontractors/suppliers.

The definition of headquarters includes, but is not limited to, an office or location that is the

administrative center of a business or enterprise where most of the important functions of the

business are conducted or concentrated and location where employees are conducting the

business of the company on a regular and routine basis so as to contribute to the economic

development of the geographical area in which the office or business is geographically located.

Small businesses are businesses in the United States that are independently owned, are not

dominant in their field of operation, employ no more than 100 persons and earn less than $20

million in gross annual revenues ($25 million in gross annual revenues for those businesses in

the information technology sales or service business).

There is no database or directory of small businesses located in Designated Enterprise Zones.

Information on the location of Designated Enterprise Zones can be obtained by contacting:

Aldona M. Kartorie

Center for Community Building

PA Department of Community and Economic Development

Page 5 of 39

4th

Floor, Commonwealth Keystone Building

400 North Street

Harrisburg, PA 17120-0225

Phone: (717) 720-7409

Fax: (717) 787-4088

Email: akartorie@state.pa.us

I-15. Economy of Preparation. Offerors should prepare proposals simply and economically,

providing a straightforward, concise description of the Offeror’s ability to meet the requirements

of the RFP that is no longer than 75 pages, excluding exhibits and/or appendices.

I-16. Alternate Proposals. The Issuing Office has identified the basic approach to meeting its

requirements, allowing Offerors to be creative and propose their best solution to meeting these

requirements. The Issuing Office will not accept alternate proposals.

I-17. Discussions for Clarification. Offerors may be required to make an oral or written

clarification of their proposals to the Issuing Office to ensure thorough mutual understanding and

Offeror responsiveness to the solicitation requirements. The Issuing Office will initiate requests

for clarification.

I-18. Prime Contractor Responsibilities. The contract will require the selected Offeror to

assume responsibility for all services offered in its proposal whether it produces them itself or by

subcontract. The Issuing Office will consider the selected Offeror to be the sole point of contact

with regard to contractual matters.

I-19. Proposal Contents. Offerors should not label proposal submissions as confidential or

proprietary. The Issuing Office will hold all proposals in confidence and will not reveal or

discuss any proposal with competitors for the contract, unless disclosure is required:

a. Under the provisions of any Commonwealth or United States statute or

regulation; or

b. By rule or order of any court of competent jurisdiction.

After a contract is executed, however, the successful proposal is considered a public record under

the Right-to Know Law, 65 P.S. § 66.1—66.9, and therefore subject to disclosure. The financial

capability information submitted under Part II, Section II-6 shall not be disclosed in the final

contract. All material submitted with the proposal becomes the property of the Commonwealth

of Pennsylvania and may be returned only at the Issuing Office’s option. The Issuing Office, in

its sole discretion, may include any person other than competing Offerors on its proposal

evaluation committee. The Issuing Office has the right to use any or all ideas presented in any

proposal regardless of whether the proposal becomes part of a contract.

I-20. Best and Final Offers. The Issuing Office reserves the right to conduct discussions with

Offerors for the purpose of obtaining ―best and final offers.‖ To obtain best and final offers from

Offerors, the Issuing Office may do one or more of the following:

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a. Enter into pre-selection negotiations, including the use of an online auction;

b. Schedule oral presentations; and

c. Request revised proposals.

The Issuing Office will limit any discussions to responsible Offerors (those that have submitted

responsive proposals and possess the capability to fully perform the contract requirements in all

respects and the integrity and reliability to assure good faith performance) whose proposals the

Issuing Office has determined to be reasonably susceptible of being selected for award. The

Criteria for Selection found in Part III, Section III-4, will also be used to evaluate the best and

final offers. Price reductions offered through any reverse online auction shall have no effect

upon the Offeror’s Technical Submittal. Dollar commitments to Disadvantaged Businesses and

Enterprise Zone Small Businesses can be reduced only in the same percentage as the percent

reduction in the total price offered through negotiations, including the online auction.

I-21. News Releases. Offerors shall not issue news releases, Internet postings, advertisements

or any other public communications pertaining to this Project without prior written approval of

the Issuing Office, and then only in coordination with the Issuing Office.

I-22. Restriction of Contact. From the issue date of this RFP until the Issuing Office selects

a proposal for award, the Issuing Officer is the sole point of contact concerning this RFP. Any

violation of this condition may be cause for the Issuing Office to reject the offending Offeror’s

proposal. If the Issuing Office later discovers that the Offeror has engaged in any violations of

this condition, the Issuing Office may reject the offending Offeror’s proposal or rescind its

contract award. Offerors must agree not to distribute any part of their proposals beyond the

Issuing Office. An Offeror who shares information contained in its proposal with other

Commonwealth personnel and/or competing Offeror personnel may be disqualified.

I-23. Debriefing Conferences. Offerors whose proposals are not selected will be notified of

the name of the selected Offeror and given the opportunity to be debriefed. The Issuing Office

will schedule the time and location of the debriefing. The debriefing will not compare the

Offeror with other Offerors, other than the position of the Offeror’s proposal in relation to all

other Offeror proposals. An Offeror’s exercise of the opportunity to be debriefed does not

constitute the filing of a protest.

I-24. Issuing Office Participation. Offerors shall provide all services, supplies, facilities, and

other support necessary to complete the identified work, except as otherwise provided in this

Part I, Section I-24. SWIF will make available certain personnel to assist Offerors in

implementing the contract. No space or other type of physical facilities will be made available.

I-25. Term of Contract. The term of the contract will commence on the Effective Date and

will end after a three (3) year period. The contract will have two (2) additional one year renewal

options. Any renewal options will be at the same costs in effect during the third year of the

contract, unless the Offeror decreases the prices due to efficiency of operations. The Issuing

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Office will fix the Effective Date after the contract has been fully executed by the selected

Offeror and by the Commonwealth and all approvals required by Commonwealth contracting

procedures have been obtained. The selected Offeror shall not start the performance of any work

prior to the Effective Date of the contract and the Commonwealth shall not be liable to pay the

selected Offeror for any service or work performed or expenses incurred before the Effective

Date of the contract.

I-26. Offeror’s Representations and Authorizations. By submitting its proposal, each

Offeror understands, represents, and acknowledges that:

a. All of the Offeror’s information and representations in the proposal are material

and important, and the Issuing Office may rely upon the contents of the proposal

in awarding the contract. The Commonwealth shall treat any misstatement,

omission or misrepresentation as fraudulent concealment of the true facts relating

to the Proposal submission, punishable pursuant to 18 Pa. C.S. § 4904.

b. The Offeror has arrived at the prices and amounts in its proposal independently

and without consultation, communication, or agreement with any other Offeror or

potential Offeror.

c. The Offeror has not disclosed the price(s), the amount of the proposal, nor the

approximate price(s) or amount(s) of its proposal to any other firm or person who

is an Offeror or potential Offeror for this RFP, and the Offeror shall not disclose

any of these items on or before the proposal submission deadline specified in the

Calendar of Events of this RFP.

d. The Offeror has not attempted, nor will it attempt, to induce any firm or person to

refrain from submitting a proposal on this contract, or to submit a proposal higher

than this proposal, or to submit any intentionally high or noncompetitive proposal

or other form of complementary proposal.

e. The Offeror makes its proposal in good faith and not pursuant to any agreement or

discussion with, or inducement from, any firm or person to submit a

complementary or other noncompetitive proposal.

f. To the best knowledge of the person signing the proposal for the Offeror, the

Offeror, its affiliates, subsidiaries, officers, directors, and employees are not

currently under investigation by any governmental agency and have not in the last

four years been convicted or found liable for any act prohibited by State or

Federal law in any jurisdiction, involving conspiracy or collusion with respect to

bidding or proposing on any public contract, except as the Offeror has disclosed

in its proposal.

g. To the best of the knowledge of the person signing the proposal for the Offeror

and except as the Offeror has otherwise disclosed in its proposal, the Offeror has

no outstanding, delinquent obligations to the Commonwealth including, but not

Page 8 of 39

limited to, any state tax liability not being contested on appeal or other obligation

of the Offeror that is owed to the Commonwealth.

h. The Offeror is not currently under suspension or debarment by the

Commonwealth, any other state or the federal government, and if the Offeror

cannot so certify, then it shall submit along with its proposal a written explanation

of why it cannot make such certification.

i. The Offeror has not made, under separate contract with the Issuing Office, any

recommendations to the Issuing Office concerning the need for the services

described in its proposal or the specifications for the services described in the

proposal.

j. Each Offeror, by submitting its proposal, authorizes Commonwealth agencies to

release to the Commonwealth information concerning the Offeror's Pennsylvania

taxes, unemployment compensation and workers’ compensation liabilities.

k. Until the selected Offeror receives a fully executed and approved written contract

from the Issuing Office, there is no legal and valid contract, in law or in equity,

and the Offeror shall not begin to perform.

I-27. Notification of Selection. The Issuing Office will notify the selected Offeror in writing

of its selection for negotiation after the Issuing Office has determined, taking into consideration

all of the evaluation factors, the proposal that is the most advantageous to the Issuing Office.

I-28. RFP Protest Procedure. The RFP Protest Procedure is on the DGS website at

http://www.dgs.state.pa.us A protest by a party not submitting a proposal must be filed within

seven days after the protesting party knew or should have known of the facts giving rise to the

protest, but no later than the proposal submission deadline specified in the Calendar of Events of

the RFP. Offerors may file a protest within seven days after the protesting Offeror knew or

should have known of the facts giving rise to the protest, but in no event may an Offeror file a

protest later than seven days after the date the notice of award of the contract is posted on the

DGS website. The date of filing is the date of receipt of the protest. A protest must be filed in

writing with the Issuing Office.

I-29. Use of Electronic Versions of this RFP. This RFP is being made available by electronic

means. If an Offeror electronically accepts the RFP, the Offeror acknowledges and accepts full

responsibility to insure that no changes are made to the RFP. In the event of a conflict between a

version of the RFP in the Offeror’s possession and the Issuing Office’s version of the RFP, the

Issuing Office’s version shall govern.

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PART II

PROPOSAL REQUIREMENTS

Offerors must submit their proposals in the format, including heading descriptions, outlined

below. To be considered, the proposal must respond to all requirements in this part of the RFP.

Offerors should provide any other information thought to be relevant, but not applicable to the

enumerated categories, as an appendix to the Proposal. All cost data relating to this proposal and

all Disadvantaged Business cost data should be kept separate from and not included in the

Technical Submittal. Each Proposal shall consist of the following three separately sealed

submittals:

1. Technical Submittal, which shall be a response to RFP Part II, Sections II-1

through II-7;

2. Disadvantaged Business Submittal, in response to RFP Part II, Section

II-8; and

3. Cost Submittal, in response to RFP Part II, Section II-9.

The Issuing Office reserves the right to request additional information, which, in the Issuing

Office’s opinion, is necessary to assure that the Offeror’s competence, number of qualified

employees, business organization, and financial resources are adequate to perform according to

the RFP.

The Issuing Office may make investigations as deemed necessary to determine the ability of the

Offeror to perform the Project, and the Offeror shall furnish to the Issuing Office all requested

information and data. The Issuing Office reserves the right to reject any proposal if the evidence

submitted by, or investigation of, such Offeror fails to satisfy the Issuing Office that such Offeror

is properly qualified to carry out the obligations of the RFP and to complete the Project as

specified.

II-1. Statement of the Problem. State in succinct terms your understanding of the services

required by this RFP.

II-2. Management Summary. Summarize, in narrative form, the proposed effort and a list of

the services you will provide to meet the requirements of this RFP.

II-3. Implementation and Execution Plan. Describe in narrative form your technical plan for

accomplishing the work. Use the task descriptions in Part IV of this RFP as your reference

point. Modifications of the task descriptions are permitted; however, reasons for changes should

be fully explained. Indicate the number of person hours allocated to each task. Include a

Program Evaluation and Review Technique (PERT) or similar type display, time related,

showing each event. If more than one approach is apparent, comment on why you chose this

approach.

Page 10 of 39

II-4. IT Requirements. State in succinct terms your understanding of the IT requirements of

this RFP and your plan to meet the requirements. Use the task descriptions in Part IV-5 of this

RFP as your reference point.

II-5. Offeror and Personnel Qualifications. Describe your experience in providing the

services required by this RFP. Include experience in (1) establishing provider panels as

permitted under the Pennsylvania Workers’ Compensation Act, 77 P.S. 531, or similar

legislation in other states, and your success in encouraging employers to use such panels; (2)

establishing and managing preferred provider organizations (PPO’s), or utilizing PPO’s

established by a different entity, and your success in marketing these to employers, and their

employees, for use in the treatment of services for work-related injuries; (3) in negotiating

discounts with health care providers with respect to their charges for services rendered in

connection with work-related injuries; (4) providing and maintaining a web-based system to

support the services requested in this RFP; and (5) experience in providing comprehensive

review and pre-payment services related to medical bills for injured workers submitted to

workers’ compensation insurance carriers which are subject to the Pennsylvania Workers’

Compensation Act. Experience shown should be work done by individuals who will be assigned

to this project as well as that of your company. Similar experience referred to must be identified

by the name of the customer, including the name, address, and telephone number of the

responsible official of the customer, company, or agency who may be contacted.

Include the number of executive and professional personnel, analysts, auditors, researchers,

programmers, consultants, etc., who will be engaged in the work. Show where these personnel

will be physically located during the time they are engaged in the Project. For key personnel,

which include at least the executive staff, the project administrator, the technical (IT) and

marketing staff, include the employee’s name and, through a resume or similar document, the

Project personnel’s education and experience with: establishing provider panels, establishing or

utilizing PPOs, negotiating discounts with providers, providing IT support for such services

and/or providing comprehensive bill review and pre-payment services. Indicate the

responsibilities each individual will have in this Project and how long each has been with your

company. Identify by name any subcontractors you intend to use and the services they will

perform.

II-6. Financial Capability. Describe your company’s financial stability and economic

capability to perform the contract requirements. Financial documents such as audited financial

statements or recent tax returns will be acceptable to the Commonwealth.

II-7. Objections and Additions to Standard Contract Terms and Conditions. The Offeror

will identify which, if any, of the terms and conditions (contained in Appendix A) it would like

to renegotiate and what additional terms and conditions the Offeror would like to add to the

standard contract terms and conditions. The Offeror’s failure to make a submission under this

paragraph will result in its waiving its right to do so later, but the Issuing Office may consider

late objections and requests for additions if to do so, in the Issuing Office’s sole discretion,

would be in the best interest of the Commonwealth. The Issuing Office may, in its sole

discretion, accept or reject any requested changes to the standard contract terms and conditions.

The Offeror shall not request changes to the other provisions of the RFP, nor shall the Offeror

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request to completely substitute its own terms and conditions for Appendix A. All terms and

conditions must appear in one integrated contract. The Issuing Office will not accept references

to the Offeror’s, or any other, online guides or online terms and conditions contained in any

proposal.

Regardless of any objections set out in its proposal, the Offeror must submit its proposal,

including the cost proposal, based on the terms and conditions set out in Appendix A. The

Issuing Office will reject any proposal that is conditioned on the negotiation of terms and

conditions other than those set out in Appendix A.

II–8. Disadvantaged Business Submittal.

II-8.1. Disadvantaged Business Information. To receive credit for being a Small

Disadvantaged Business or a Socially Disadvantaged Business or for entering into a joint

venture agreement with a Small Disadvantaged Business or for subcontracting with a Small

Disadvantaged Business (including purchasing supplies and/or services through a purchase

agreement), an Offeror must include proof of Disadvantaged Business qualification in the

Disadvantaged Business Submittal of the proposal, as indicated below:

a. A Small Disadvantaged Businesses certified by BMWBO as an MBE/WBE must

provide a photocopy of their BMWBO certificate.

b. Small Disadvantaged Businesses certified by the U.S. Small Business

Administration pursuant to Section 8(a) of the Small Business Act (15 U.S.C. §

636(a)) as an 8(a) or small disadvantaged business must submit proof of U.S.

Small Business Administration certification. The owners of such businesses must

also submit proof of United States citizenship.

c. All businesses claiming Small Disadvantaged Business status, whether as a result

of BMWBO certification or U.S. Small Business Administration certification as

an 8(a) or small disadvantaged business, must attest to the fact that the business

has 100 or fewer employees.

d. All businesses claiming Small Disadvantaged Business status, whether as a result

of BMWBO certification or U.S. Small Business Administration certification as

an 8(a) or small disadvantaged business, must submit proof that their gross annual

revenues are less than $20,000,000 ($25,000,000 for those businesses in the

information technology sales or service business). This can be accomplished by

including a recent tax return or audited financial statement.

e. All businesses claiming status as a Socially Disadvantaged Business must include

in the Disadvantaged Business Submittal of the proposal clear and convincing

evidence to establish that the business has personally suffered racial or ethnic

prejudice or cultural bias stemming from the business person’s color, ethnic origin

or gender. The submitted evidence of prejudice or bias must:

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1) Be rooted in treatment that the business person has experienced in

American society, not in other countries.

2) Show prejudice or bias that is chronic and substantial, not fleeting

or insignificant.

3) Indicate that the business person’s experience with the racial or

ethnic prejudice or cultural bias has negatively affected his or her

entry into and/or advancement in the business world.

4) BMWBO shall determine whether the Offeror has established that

a business is socially disadvantaged by clear and convincing

evidence.

f. In addition to the above verifications, the Offeror must include in the

Disadvantaged Business Submittal of the proposal the following information:

1) The name and telephone number of the Offeror’s project (contact)

person for the Small Disadvantaged Business.

2) The business name, address, name and telephone number of the

primary contact person for each Small Disadvantaged Business

included in the proposal. The Offeror must specify each Small

Disadvantaged Business to which it is making commitments. The

Offeror will not receive credit for stating that it will find a Small

Disadvantaged Business after the contract is awarded or for listing

several businesses and stating that one will be selected later.

3) The specific work, goods or services each Small Disadvantaged

Business will perform or provide.

4) The estimated dollar value of the contract to each Small

Disadvantaged Business.

5) Of the estimated dollar value of the contract to each Small

Disadvantaged Business, the percent of the total value of services

or products purchased or subcontracted that will be provided by the

Small Disadvantaged Business directly.

6) The location where each Small Disadvantaged Business will

perform these services.

7) The timeframe for each Small Disadvantaged Business to provide

or deliver the goods or services.

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8) The amount of capital, if any, each Small Disadvantaged Business

will be expected to provide.

9) The form and amount of compensation each Small Disadvantaged

Business will receive.

10) For a joint venture agreement, a copy of the agreement, signed by

all parties.

11) For a subcontract, a signed subcontract or letter of intent.

g. The Offeror is required to submit only one copy of its Disadvantaged Business

Submittal. The submittal shall be clearly identified as Disadvantaged Business

information and sealed in its own envelope, separate from the remainder of the

proposal.

h. The Offeror must include the dollar value of the commitment to each Small

Disadvantaged Business in the same sealed envelope with its Disadvantaged

Business Submittal. The following will become a contractual obligation once the

contract is fully executed:

1) The amount of the selected Offeror’s Disadvantaged Business

commitment;

2) The name of each Small Disadvantaged Business; and

3) The services each Small Disadvantaged Business will provide,

including the timeframe for performing the services.

i. A Small Disadvantaged Business can be included as a subcontractor with as many

prime contractors as it chooses in separate proposals.

1) An Offeror that qualifies as a Small Disadvantaged Business and

submits a proposal as a prime contractor is not prohibited from

being included as a subcontractor in separate proposals submitted

by other Offerors.

II-8.2. Enterprise Zone Small Business Participation.

a. To receive credit for being an enterprise zone small business or entering into a

joint venture agreement with an enterprise zone small business or subcontracting

with an enterprise zone small business, an Offeror must include the following

information in the Disadvantaged Business Submittal of the proposal:

1) Proof of the location of the business’ headquarters (such as a lease

or deed or Department of State corporate registration), including a

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description of those activities that occur at the site to support the

other businesses in the enterprise zone.

2) Confirmation of the enterprise zone in which it is located (obtained

from the local enterprise zone office).

3) Proof of United States citizenship of the owners of the business.

4) Certification that the business employs 100 or fewer employees.

5) Proof that the business’ gross annual revenues are less than

$20,000,000 ($25,000,000 for those businesses in the information

technology sales or service business). This can be accomplished

by including a recent tax return or audited financial statement.

6) Documentation of business organization, if applicable, such as

articles of incorporation, partnership agreement or other documents

of organization.

b. In addition to the above verifications, the Offeror must include in the

Disadvantaged Business Submittal of the proposal the following information:

1) The name and telephone number of the Offeror’s project (contact)

person for the Enterprise Zone Small Business.

2) The business name, address, name and telephone number of the

primary contact person for each Enterprise Zone Small Business

included in the proposal. The Offeror must specify each Enterprise

Zone Small Business to which it is making commitments. The

Offeror will not receive credit for stating that it will find an

Enterprise Zone Small Business after the contract is awarded or for

listing several businesses and stating that one will be selected later.

3) The specific work, goods or services each Enterprise Zone Small

Business will perform or provide.

4) The estimated dollar value of the contract to each Enterprise Zone

Small Business.

5) Of the estimated dollar value of the contract to each Enterprise

Zone Small Business, the percent of the total value of services or

products purchased or subcontracted that each Enterprise Zone

Small Business will provide.

6) The location where each Enterprise Zone Small Business will

perform these services.

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7) The timeframe for each Enterprise Zone Small Business to provide

or deliver the goods or services.

8) The amount of capital, if any, each Enterprise Zone Small Business

will be expected to provide.

9) The form and amount of compensation each Enterprise Zone Small

Business will receive.

10) For a joint venture agreement, a copy of the agreement, signed by

all parties.

11) For a subcontract, a signed subcontract or letter of intent.

c. The dollar value of the commitment to each Enterprise Zone Small Business must

be included in the same sealed envelope with the Disadvantaged Business

Submittal of the proposal. The following will become a contractual obligation

once the contract is fully executed:

1) The amount of the selected Offeror’s Enterprise Zone Small

Business commitment;

2) The name of each Enterprise Zone Small Business; and

3) The services each Enterprise Zone Small Business will provide,

including the timeframe for performing the services.

II-9. Cost Submittal. The information requested in this Part II, Section II-9 shall constitute

the Cost Submittal. The Cost Submittal shall be placed in a separate sealed envelope within the

sealed proposal, separated from the technical submittal. The total proposed cost shall be broken

down into the components specified on the Cost Submittal sheet, which is attached to the RFP at

Appendix C. Detailed instructions for completing the Cost Submittal sheet are set forth on the

sheet. Offerors should not include any assumptions in their cost submittals. If the Offeror

includes assumptions in its cost submittal, the Issuing Office may reject the proposal. Offerors

should direct in writing to the Issuing Office pursuant to Part I, Section I-9, of this RFP any

questions about whether a cost or other component is included or applies. All Offerors will then

have the benefit of the Issuing Office’s written answer so that all proposals are submitted on the

same basis. Costs must be quoted on the following bases:

1. A cost proposal for medical bill review services. This proposal must include:

a. A charge for reviewing and processing Part A medical bills. This charge must be

quoted on a per bill basis.

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b. A charge for reviewing and processing Part B medical bills. This charge must be

quoted on a per line basis.

These amounts shall be invoiced to SWIF on a monthly basis. These amounts shall be subject to

audit.

2. A cost proposal for services related to provider panels, PPO’s and provider discounts.

a. This proposal must set forth the percentage of savings that the Offeror guarantees

SWIF will realize as a result of its activities in this regard. The percentage of

savings will be measured as the difference between what SWIF would have paid

under the Pennsylvania Workers’ Compensation Fee Schedule and the amount

that SWIF pays as a result of the Offeror’s services.

b. SWIF will pay for these services on a monthly basis. These services shall be

invoiced to SWIF each month. The invoice will set forth the savings, which have

been achieved because of the use of panel providers, PPO providers, and health

care providers who have extended discounts to SWIF claimants. No invoice shall

be sent to SWIF until the Offeror exceeds the guaranteed savings level set forth

on the Cost Submittal sheet. SWIF will pay nothing for these services if SWIF

does not realize the guaranteed savings level. This amount will be subject to

audit.

3. A cost proposal for building an interface with SWIF.

c. This proposal must be a one-time, flat fee. After this interface has been

successfully implemented, the Offeror will invoice this amount to SWIF.

The Issuing Office will reimburse the selected Offeror for work satisfactorily performed after

execution of a written contract and the start of the contract term, in accordance with contract

requirements, and only after the Issuing Office has issued a notice to proceed.

II-10. Domestic Workforce Utilization Certification. Complete and sign the Domestic

Workforce Utilization Certification contained in Appendix B of this RFP. Offerors who seek

consideration for this criterion must submit in hardcopy the signed Domestic Workforce

Utilization Certification Form in the same sealed envelope with the Cost Submittal.

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PART III

CRITERIA FOR SELECTION

III-1. Mandatory Responsiveness Requirements. To be eligible for selection, a proposal

must be:

1. Timely received from an Offeror; and,

2. Properly signed by the Offeror.

III-2. Technical Nonconforming Proposals. The Issuing Office reserves the right, in its sole

discretion, to waive technical or immaterial nonconformities in an Offeror’s proposal.

III-3. Evaluation. The Issuing Office has selected a committee of qualified personnel to

review and evaluate timely submitted proposals. Independent of the committee, BMWBO will

evaluate the Disadvantaged Business Submittal and provide the Issuing Office with a rating for

this component of each proposal. The Issuing Office will notify in writing of its selection for

negotiation the responsible Offeror whose proposal is determined to be the most advantageous to

the Commonwealth as determined by the Issuing Office after taking into consideration all of the

evaluation factors. The Issuing Office will award a contract only to an Offeror determined to be

responsible in accordance with the most current version of Commonwealth Management

Directive 215.9, Contractor Responsibility Program.

III-4. Criteria for Selection. The following criteria will be used, in order of relative

importance from the highest to the lowest weighted factors, in evaluating each proposal:

III-4.1. Technical: Evaluation will be based upon the following in order of importance:

Implementation and Execution Plan

Offeror and Personnel Qualifications

IT Technical Requirements

III-4.2. Cost.

III-4.3 Disadvantaged Business Participation Evaluation will be based upon the

following in order of priority:

Priority Rank 1 Proposals submitted by Small

Disadvantaged Businesses.

Priority Rank 2 Proposals submitted from a joint

venture with a Small Disadvantaged

Business as a joint venture partner.

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Priority Rank 3 Proposals submitted with

subcontracting commitments to

Small Disadvantaged Businesses.

Priority Rank 4 Proposals submitted by Socially

Disadvantaged Businesses.

Each proposal will be rated for its approach to enhancing the utilization of Small

Disadvantaged Businesses and/or Socially Disadvantaged Businesses. Each

approach will be evaluated, with Priority Rank 1 receiving the highest score and

the succeeding options receiving scores in accordance with the above-listed

priority ranking

To the extent that an Offeror qualifies as a Small Disadvantaged Business or a

Socially Disadvantaged Business, the Small Disadvantaged Business or Socially

Disadvantaged Business cannot enter into subcontract arrangements for more than

40% of the total estimated dollar amount of the contract. If a Small

Disadvantaged Business or a Socially Disadvantaged Business subcontracts more

than 40% of the total estimated dollar amount of the contract to other contractors,

the Disadvantaged Business Participation scoring shall be proportionally lower

for that proposal.

III-4.4 Enterprise Zone Small Business Participation: The following options will be

considered as part of the final criteria for selection:

Priority Rank 1 Proposals submitted by an Enterprise

Zone Small Business will receive the

highest score.

Priority Rank 2 Proposals submitted by a joint

venture with an Enterprise Zone

Small Business as a joint venture

partner will receive the next highest

score for this criterion.

Priority Rank 3 Proposals submitted with a

subcontracting commitment to an

Enterprise Zone Small Business will

receive the lowest score for this

criterion.

Priority Rank 4 Proposals with no Enterprise Zone

Small Business Utilization shall

receive no points under this criterion.

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To the extent that an Offeror is an Enterprise Zone Small Business, the Offeror

cannot enter into contract or subcontract arrangements for more than 40% of the

total estimated dollar amount of the contract in order to qualify as an Enterprise

Zone Small Business for purposes of this RFP.

III-4.5. Domestic Workforce Utilization: Each proposal will be scored for its commitment

to use domestic workforce in the fulfillment of the contract. Maximum consideration will be

given to those Offerors who will perform the contracted direct labor exclusively within the

geographical boundaries of the United States. Those who propose to perform a portion of the

direct labor outside of the United States will receive a correspondingly smaller score for this

criterion. Offerors who seek consideration for this criterion must submit in hardcopy the

signed Domestic Workforce Utilization Certification Form in the same sealed envelope with

the Cost Submittal. The certification will be included as a contractual obligation when the

contract is executed.

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PART IV

WORK STATEMENT

IV-1. Objectives.

IV-1.1. General. Section 306 (f.1) of the Pennsylvania Workers’ Compensation Act, 77

P.S. 531, permits employers to require their injured employees to treat with certain

designated providers for 90 days after a work-related injury. 77 P.S. 531 sets forth specific

requirements with respect to the composition of panels of providers and the use of panels.

SWIF wishes to further contain the cost of health care services provided to its claimants by:

increasing the use of provider panels, as permitted by 77 P.S. 531; utilizing preferred

provider organizations (PPO); and obtaining discounted prices for health care services

rendered to SWIF claimants by health care providers which are not part of a panel or part of a

PPO.

SWIF wishes to procure comprehensive medical bill review services to assist it in reviewing

and paying bills submitted for medical services provided to its claimants.

IV-1.2 Specific. Offerors must be able to:

a. Establish panels of health care providers that comply with the requirements of 77

P.S. 531 for SWIF policyholders. SWIF policyholders are located throughout the

Commonwealth and the providers on these panels must be located in areas that

are readily accessible by SWIF claimants and include qualified health care

providers in specialties that are appropriate to render care to SWIF claimants. See

Appendix D for information regarding the location of SWIF policyholders

throughout Pennsylvania. An Offeror must either have a PPO, or have

arrangements with PPO’s throughout the Commonwealth, which can provide care

to SWIF claimants; and the health care providers must practice in specialties that

are appropriate to render care to SWIF claimants. See Appendix E for

information regarding the top 50 industries served by SWIF policyholders. An

Offeror must be able to make arrangements with health care providers that are not

part of its PPO to provide health care services to SWIF claimants on a discounted

basis.

b. Successfully market the concepts of panels of health care providers, PPO’s, and

the use of health care providers that provide services to SWIF claimants on a

discounted basis to SWIF policyholders and claimants.

c. Provide periodic reports as specified in Section IV-7.

d. Offerors must be able to determine whether services reported on bills are related

to the work injury suffered by the claimant; whether the services are properly

coded and appropriate to the injury; determine whether billed amounts are correct;

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and ensure that duplicate bills for the same service and service date are not paid.

Offerors must be able to maintain accurate Pennsylvania-specific medical fee

schedule information to assure that the amount charged does not exceed the fee

schedule established for payments under the Pennsylvania Workers’

Compensation Act and must be able to determine if any discounts or reductions

should be applied. Upon receipt of reviewed medical bills from Offeror, SWIF

will audit a valid statistical sample of reviewed bills and will release medical bills

for payment through the Pennsylvania Treasury.

IV-2. Nature and Scope of the Project.

IV-2.1. Panels, PPOs and Discounts

a. In 2005, SWIF had over 51,000 policyholders throughout Pennsylvania. In 2005,

SWIF paid nearly 250,000 medical bills totaling $104,756,426. Additional

important data regarding SWIF’s business can be found in Appendices D, E, F

and K to this RFP.

b. The Offeror must be able to market the services throughout Pennsylvania. See

Appendix D for information regarding the location of SWIF policyholders

throughout Pennsylvania. SWIF will provide the successful Offeror with

information necessary to perform these services, such as a list of policyholder

names and addresses and the amount of premium paid by the policyholder. To

the extent possible, all information will be provided in electronic format.

c. The Panel/PPO/Discount services must be provided without direct cost to SWIF.

The sole compensation for such services will be a percentage of the savings that

are realized by SWIF as a result of the Offeror’s services. The requirements of

the cost proposal are set forth in Section II-9 of the RFP.

IV-2.2. Medical Bill Review Services

a. SWIF has policyholders throughout Pennsylvania and claims for medical services

provided to the injured workers of these policyholders are submitted to SWIF for

payment. SWIF must assure that these claims are properly reviewed, processed

and paid in correct amounts and in a timely manner. Important data regarding

SWIF’s business can be found in Appendices D, F and L to this RFP.

b. A successful Offeror must be able to determine if the services reported on a bill

are related to the work injury and are otherwise appropriate. Offerors must be

able to re-price the bills to assure that the payment does not exceed the amount

which may be paid under the Pennsylvania Workers’ Compensation Act and that

all appropriate discounts and reductions have been extended to SWIF.

IV-3. Requirements.

IV-3.1 Panels, PPOs and Discounts.

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a. Panels. Offerors must be able to form and market panels of health care providers

for SWIF policyholders in accordance with the requirements of 77 P.S. 531.

b. PPO’s. Offerors must either have their own PPO networks or have established

relationships with other PPO networks, which can be utilized by SWIF claimants.

c. Discounts. Offerors must be able to negotiate discounts from providers which are

not part of the PPO’s which it will utilize, so that SWIF claimants can receive

necessary care at a cost lower than the medical fee caps pursuant to the

Pennsylvania Workers’ Compensation Act.

d. In accordance with the Commonwealth Standard Terms and Conditions

(Appendix A), L&I/SWIF may conduct an audit of a successful Offeror to assure

that services rendered by panel providers, PPO providers and providers which

offer discounted prices to SWIF claimants are being provided in an efficient

manner, with an effort to expedite the injured worker’s return to work, and not to

unnecessarily extend or expand the course of treatment rendered to the injured

worker.

IV-3.2 Marketing.

a. Offerors must encourage SWIF policyholders to establish panels of providers for

their employees as permitted by 77 P.S. 531.

b. Offerors must encourage SWIF policyholders to encourage their employees to use

health care providers in its PPO.

c. Offerors must encourage providers to provide care to SWIF claimants at

discounted prices.

d. With respect to panel providers, PPO providers and discounted providers, the

successful Offeror must provide program literature to policyholders and sponsor

policyholder seminars which encourage the use of a panel as permitted by 77 P.S.

531, PPO providers and discount providers.

IV-3.3 Medical Bill Review

a. Offerors must be able to determine whether services reported on bills are related

to the work injury suffered by the claimant; whether the services are properly

coded and appropriate to the injury; determine whether billed amounts are correct;

and ensure that duplicate bills for the same service and service date are not paid.

Offerors must be able to maintain accurate Pennsylvania-specific medical fee

schedule information to assure that the amount charged does not exceed the fee

schedule established for payments under the Pennsylvania Workers’

Compensation Act and must be able to determine if any discounts or reductions

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should be applied. Upon receipt of reviewed medical bills from Offeror, SWIF

will audit a valid statistical sample of reviewed bills and will release medical bills

for payment through the Pennsylvania Treasury.

IV-4. Confidentiality. An Offeror must agree to keep as strictly confidential all data and

information that it receives, or to which it has access, while performing the requirements of this

Contract, including, but not limited to, all information it receives pertaining to the identity of a

claimant and the type of services that a claimant receives. In addition, all data and information

acquired by an Offeror shall be and will remain the property of SWIF. In its proposal, the

Offeror must:

IV-4.1 Protect Confidential Information. Describe the procedures it has in effect to

protect the confidentiality of the information that it will receive, or have access to, in the

performance of the Contract, with particular focus on the manner in which it protects

information specific to a claimant, particularly any medical or health information specific to

a claimant.

IV-4.2 Ensure Confidentiality. Describe the procedures it has in effect to communicate

the confidentiality requirements to its employees, contractors, agents or any other persons

which it may use to perform the Contract and which may receive, or have access to,

information about SWIF, its claimants, and policyholders. Describe the actions it takes to

monitor and ensure that its employees, contractors, agents and any other persons it may use

to perform the Contract comply with the confidentiality requirements.

IV-4.3 Certify Confidentiality. Agree to sign, and require its employees, contractors,

agents, and any other persons which it may use to perform the Contract, to sign, the

confidentiality statement prescribed by SWIF, attached to this RFP at Appendix G.

IV-4.4 Transfer Data. Agree to provide tapes or otherwise transfer all SWIF data and

information to SWIF or to another Offeror’s system at the conclusion or termination of the

contract. Agree to cooperate with and help facilitate all transition activities to be done for all

aspects of the contract. Describe how such cooperation will be provided and what

procedures for a cooperative, orderly transfer of data and services will be established.

Failure to cooperate or the withholding of any information or records requested by SWIF that

impairs in any way the transition of the provision of the tasks and services to a different

Offeror shall constitute a material breach of the contract, subjecting the Offeror to liability

for all damages incurred by SWIF because of such failure.

IV-5. Tasks.

IV-5.1 Implementation and Execution Plan

a. SWIF is seeking to reduce workers’ compensation costs incurred by it and its

policyholders through the use of panels, a PPO network, discounts and medical

bill review services. Although each service requested in the RFP will be reviewed

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individually, the services are part of comprehensive solution and should be

approached as such in the Implementation and Execution Plan.

b. A successful Offeror must provide an Implementation and Execution Plan that

describes in narrative form how it will implement and execute the tasks defined in

Sections IV-5.2-IV-5.4 below. The Implementation and Execution Plan must also

include the following:

1) Describe how the Offeror will work with designated SWIF

personnel during the implementation of the contract and indicate

capability to make an orderly transition of services to coincide with

the expiration of the current emergency procurements, without any

interruption of services to SWIF customers.

2) Provide a timeline for implementation of all of the work proposed

in this RFP. If a ―phased-in‖ approach is proposed, the start of the

phase-in must be coordinated with SWIF and all interim deadlines

must be specifically identified. The timeline must also include the

Offeror’s approach to testing and implementing any required

interfaces.

3) Describe the two distinct processes for implementation -- one for

the Panels/PPO/Discount services and one for the Medical Bill

Review services – but also indicate where the implementation plan

and services overlap.

4) State how many of your employees or contractors will be used to

market the panel, PPA and discount programs and describe the

steps its employees or contractors will take to market the

programs. State how many of your employees or contractors will

be used to provide medical bill review services.

IV-5.2 Panels, PPOs and Discounts.

a. Panels. Offerors must be able to form and market panels of health care providers

for SWIF policyholders in accordance with the requirements of 77 P.S. 531. The

proposal must:

5) Describe how panels of health care providers for SWIF

policyholders will be formed in accordance with the requirements

of 77 P.S. 531. State whether they will include only health care

providers that are part of your PPO. Describe how a panel will be

customized to meet a policyholder’s specific needs. Describe how

health care providers, in particular those that are not part of the

PPO network you are using, will be recruited to serve on panels.

Page 25 of 39

6) Describe the quality assurance procedures that will be utilized.

Describe how the health care providers that will comprise the

panels will be periodically evaluated.

7) Describe the records that you will maintain to show which SWIF

claimants use panels that you establish. Describe how you will

identify employees covered by panels that do not use the

established panels. Describe how you will identify and ensure that

SWIF does not pay bills where a policyholder has posted a panel

and a claimant of the policyholder did not use a panel provider

when s/he was required to by law.

8) Describe how you will update the panel lists that you establish and

explain how often you will update such list to ensure that the

provider information is current.

9) Describe what you will do to ensure that the providers on the

panels understand the importance of a cooperative effort among

the injured worker, policyholder/employee, SWIF and the treating

provider to expedite the injured worker’s return to work.

10) Attach a copy of a sample contract with the panel providers or

describe the provisions that will be included in the contract.

b. PPO’s. Offerors must either have their own PPO networks or have established

relationships with other PPO networks, which can be utilized by SWIF claimants.

The proposal must:

1) Describe the PPO network. The PPO network must have, at the

inception of the contract, throughout the Commonwealth, an

adequate number of health care providers in appropriate specialties

so that a PPO provider will be readily available to all claimants.

Included within the PPO network must be: Board Certified

physicians, chiropractors and other health care providers as defined

by 34 Pa. Code 127.3; hospitals, rehabilitation centers and trauma

centers; durable medical equipment suppliers; and ancillary

medical service providers usually involved with the provision of

care to workers’ compensation claimants. State whether you

maintain more than one PPO network or have access to more than

one PPO network. If you have arrangements to use a PPO, please

describe the details of that arrangement. State the length of time

that the PPO network you will be using to meet the requirements of

this RFP has been in existence.

Page 26 of 39

2) The successful Offeror must provide a list of all PPO providers

within each Pennsylvania county and a map showing the locations

of its providers in Pennsylvania. For each provider, the list must

show the specialty, address, phone number, and an indication of

whether the provider is board certified.

3) State your penetration rate for each county in Pennsylvania.

4) Describe how you recruit health care providers into your PPO

network. Describe the quality assurance procedures that you use in

recruiting health care providers. Describe the professional

qualifications that each health care provider must meet in order to

become part of your PPO. Describe how you periodically evaluate

the health care providers in your PPO network.

5) Describe how you maintain a list of the health care providers in

your PPO network. This list must be available via a web-based

application that is user-friendly and secure. State how often you

will update this list. Describe the various means by which a

policyholder or claimant will be able to identify a preferred

provider in their geographic area.

6) Describe what you will do to ensure that all the providers within

your PPO and all your staff understand the importance of a

cooperative effort among the injured worker, the

policyholder/employee, SWIF and the treating provider to expedite

the injured worker’s return to work.

7) Provide sample contracts that the PPOs that you will utilize have

with the preferred health care providers.

c. Discounts. Offerors must be able to negotiate discounts from providers which are

not part of the PPO’s which it will utilize, so that SWIF claimants can receive

necessary care at a cost lower than the medical fee caps set under the

Pennsylvania Workers’ Compensation Act. The proposal must:

1) Describe what actions you will take to encourage health care

providers that are not part of your PPO to provide health care to

SWIF claimants on a discounted basis. Describe your success with

encouraging health care providers that are not part of your PPO for

other customers.

2) Describe the quality assurance provisions that you will utilize in

recruiting health care providers to provide discounted services to

SWIF claimants. Describe how you periodically evaluate the

Page 27 of 39

health care providers who agree to provide care to SWIF claimants

at a discounted basis.

3) Describe how you will maintain a list of providers that have agreed

to provide services on a discounted basis. This list must be

available via a web-based application that is user-friendly and

secure. State how often you will update this list. Describe the

various means by which a policyholder or claimant will be able to

identify a provider which provides discounted process in their

geographic area. The successful Offeror must provide SWIF and

SWIF policyholders with a list of all of these providers within each

Pennsylvania county. For each provider, the list must show the

specialty, address, phone number, and an indication of whether the

provider is board certified.

4) Provide sample copies of the contracts with the providers that

agree to provide discounted services to SWIF claimants. If you do

not have contracts prepared, describe the provisions that will be

included in the contracts.

d. Marketing. In its proposal, an Offeror must:

1) Describe the actions it will take to encourage SWIF policyholders

to permit it to establish panels of providers for their employees as

permitted by 77 P.S. 531.

2) Describe the actions it will take to encourage SWIF policyholders

to encourage their employees to use health care providers in its

PPO.

3) Describe the actions it will take to encourage providers to provide

care to SWIF claimants at discounted prices. Describe the actions

it will take to encourage SWIF policyholders to encourage their

employees to use providers that have agreed to discount their

prices for SWIF claimants.

4) With respect to panel providers, PPO providers and discounted

providers, the successful Offeror must provide program literature

to policyholders and sponsor policyholder seminars which

encourage the use of a panel as permitted by 77 P.S. 531, PPO

providers and discount providers. A successful Offeror bears all

costs to provide literature to and sponsor seminars for SWIF

policyholders, including printing and mailing costs. In addition:

a) The Offeror must provide at least three policyholder

seminars a year. These will be conducted throughout the

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Commonwealth – one in eastern Pennsylvania, one in

central Pennsylvania and one in western Pennsylvania. The

specific seminar locations must be approved by SWIF.

b) The Offeror must attach copies of sample marketing

materials that it intends to use to encourage SWIF

policyholders to use provider panels, to participate in the

PPO and to use discount providers.

c) The Offeror must attach copies of sample materials it

intends to distribute to policyholders and employees which

describe the benefits and responsibilities of using panel

providers, PPO providers, and discount providers.

d) The successful Offeror must submit all marketing and

informational materials to SWIF and the Department of

Labor and Industry’s (L&I) Press Office at least 15

calendar days before use and distribution. These materials

may not be used until they are approved in writing by

SWIF and L&I’s Press Office.

e) The Offeror must state how many of its employees or

contractors will be used to market the panel, PPO and

discount programs and a description of what its employees

and contractors will do.

e. IT Requirements for the Provider Panel/PPO/Discount Services.

1) An Offeror’s proposed web-based sites must be user-friendly and

secure. Describe your understanding of this requirement and

provide representative screen shots.

2) Describe the web-based PPO List system availability, i.e. 24x7,

Monday through Friday.

3) Describe how frequently the web-based systems are updated to

maintain a current list of PPO providers and providers that have

agreed to discount their prices for SWIF claimants.

4) Describe the level of ADA compliance for the proposed web-based

systems.

5) Describe how the Offeror’s proposed system uses industry

standard best practices with regard to user sign-on and password

authentication.

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6) The Offeror must describe how its proposed system provides for

confidential and secure access to information including use of SSL

if web-based.

7) Describe the data needed from SWIF. Data must be exchanged

between the Offeror and SWIF daily. The exchange of data must

be completed electronically. SWIF is responsible for building and

implementing an outbound interface to the Offeror and the Offeror

is responsible for accepting and processing the data within the

Offeror’s system, including performing any data transformation or

conversions necessary to import SWIF’s data into the Offeror’s

system.

8) Describe the Offeror’s backup and recovery strategy for all

information maintained as a part of this service.

IV-5.3 Medical Bill Review

a. An Offeror must describe in its proposal how it will review and process medical

bills on behalf of SWIF and in accordance with the Pennsylvania Workers

Compensation Act and related regulations. SWIF expects a successful Offeror to

use its own bill review and processing technology. As discussed in Subsection e

(Technical System Requirements for Medical Bill Review) below, SWIF further

requires a successful Offeror to develop and maintain an interface with the

Powercomp® system used by SWIF so that data can be exchanged between SWIF

and the Offeror on a daily basis. In its proposal, an Offeror must:

1) Describe its proposed processes for receiving medical bills and

provider notes directly from SWIF and/or providers, both

electronically and on paper. Bills misdirected to SWIF will be sent

overnight to the successful Offeror.

2) Describe its processes for imaging paper medical bills and provider

notes. Provider notes are required for payment of all medical bills.

3) Describe its processes for handling medical bills that do not have

the required Provider notes.

4) Describe its processes for indexing images.

5) Describe the business processes that the Offeror follows in its

review of medical bills. Medical review will include, but not be

limited to, applying the Part A and Part B Fee Schedules;

reviewing coding and unbundling of charges; auditing of complex

bills; and negotiating trauma bills.

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6) Describe how the Offeror will track and ensure that all bills are

reviewed, processed and submitted to SWIF for payment within

ten (10) working days of the date that the Offeror receives the bill

directly or from SWIF.

7) Describe its procedures for facilitating requests by SWIF for

―rush‖ processing of medical bills.

8) Describe the processes used to identify duplicate bills and ensure

that SWIF does not pay duplicate bills.

9) Describe proposed processes to handle the medical bill when no

claim number is found in the data feed from the SWIF system.

SWIF claim numbers are automatically assigned within the SWIF

transactional system as the claim is received and processed. The

format is 8 digits.

b. Describe its processes for determining whether medical services rendered to a

workers’ compensation claimant are reasonable and related to the work-related

injury and whether the services are appropriate.

1) Describe the processes the Offeror uses to make an assessment and

adjudication of the reasonableness and relatedness of the bill to the

accepted work injury, or injuries; the appropriateness of the

services provided. (Adjudication is the activity of assuring that

SWIF pays for services in conformance with the Pennsylvania

Workers’ Compensation Act.);

2) State how the Offeror will provide second level review of coding

and liability determinations. What type of personnel – nurses,

coding specialists, utilization review specialists, others – will

provide this level of review and how many of each type of

personnel will be dedicated to handling SWIF work?

3) Describe the Offeror’s source or methodology for ICD-9 and CPT

code relatedness rules and for the National Correct Coding

Initiative and update schedule.

4) Describe how Offeror will notify providers of denied bills and

return denied bills to providers.

c. Describe its processes for determining whether the fee reported for a service is in

accordance with the Pennsylvania Workers’ Compensation Fee Schedule.

Describe the processes it uses to assure that SWIF has taken advantage of all

discounts and reductions available through a successful Offeror’s panel, PPO and

discount programs.

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1) Explain how you maintain current and accurate Pennsylvania-

specific medical fee information, in accordance with the

Pennsylvania Workers’ Compensation Act and the regulations

promulgated thereunder.

2) Describe how you will determine whether reductions or discounts

should be applied to the billed amount.

3) Describe the frequency that the Offeror reviews and updates fee

schedules and usual and customary charges. These reviews and

updates must occur at least monthly.

4) Describe how the Offeror defends or assists clients in defending

the statistical methodology for establishing UCR’s.

d. Describe the quality assurance program the Offeror uses for medical bill review

and processing. Describe any internal systems or audit controls to ensure the

accuracy of billed amounts. These controls should include:

1) Explain the process for prevention of payment of duplicate medical

bills.

2) Describe review of medical fee schedule procedures, including the

extent to which provider bills are audited for coding accuracy and

compliance with reimbursement limitations.

3) Explain the process for ensuring accuracy of remittance to proper

provider (i.e.. Tax ID Number, Proper Location).

4) Describe frequency and extent of supervisory review of medical

bills.

5) Describe any additional audits you will conduct on Pennsylvania

workers’ compensation bills. What percentage of bills processed

will be audited? Who will perform the audits? Are there specific

situations that initiate an audit?

6) Describe any system generated audit flags and medical edits within

the Offeror’s system.

7) Describe how you will communicate the results of your audits to

SWIF.

e. Technical System Requirements for Medical Bill Review.

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1) Based on need, SWIF will install one full T1 or fractional T1 line

direct circuit between SWIF and the Offeror’s main network. The

Offeror must provide a Router with a Layer 2 or 3 switch port for

connection. Describe your understanding of this requirement.

2) The Offeror is responsible for providing all workstations, software,

scanners, printers and any other equipment and supplies that will

be used by their staff. Describe your understanding of this

requirement.

3) SWIF is expecting three (3) interfaces to be developed. The first

will be from SWIF to Offeror and will provide data related to

claims and policies. A representative list of the claims and policy

data to be provided is attached at Appendix H. The second will be

from Offeror to SWIF, transmitting data related to the medical

review. A representative list of the minimum medical review data

that must be transmitted to SWIF is attached at Appendix I. The

third will be from Offeror to SWIF, transmitting indexed images

related to the medical review. A representative list of the

minimum indexed image data that must be transferred to SWIF is

attached at Appendix J. Upon importing the data from Offeror,

SWIF will audit a statistically valid sample of reviewed bills and

will release medical bills for payment through the Pennsylvania

Treasury.

a) Describe the Offeror’s plan to work with SWIF to

document the requirements for the interfaces between the

Offeror and SWIF.

4) Describe the Offeror’s plan to work with SWIF to develop, test and

implement the required interfaces. The Offeror is responsible for

building and implementing outbound interfaces to SWIF. SWIF is

responsible for accepting and processing the data through SWIF’s

system. SWIF is responsible for building and implementing

outbound interfaces to the Offeror and the Offeror is responsible

for accepting and processing the data within the Offeror’s system,

including any data transformations or conversions necessary to

import the data into the Offeror’s system. The Offeror is also

responsible for any data transformations or conversions necessary

in the export of data to SWIF.

5) Describe the Offeror’s information requirements that, at a

minimum, will be needed from the SWIF system in order to review

medical bills.

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6) At a minimum, SWIF will need the information listed in Appendix

I from a successful Offeror’s system in order to review and pay

medical bills. Describe your understanding of this requirement and

list any additional data elements that may be required.

7) Data imports and exports must be in a format mutually agreed to

by the Offeror and SWIF. Describe the proposed possible formats

for data import and export. Data imports and exports must occur

daily. The SWIF image system stores images in TIFF format.

8) Describe the Offeror’s ability to accept medical bills and provider

notes in electronic format. Medical bills submitted in electronic

format must follow ANSI X.12 standards. Describe the Offeror’s

ability to accept Provider notes in electronic format.

9) Describe the Offeror’s back-up and recovery strategy for all

information maintained as part of its services to SWIF, including

its customer service call center.

10) Describe the frequency of regular updates/maintenance to the

Offeror’s proposed system and the frequency of regular

downtime/maintenance .

11) Describe your proposed scanning and image capabilities.

IV-5.4 Customer Service

a. Customer Service Calls.

1) SWIF’s Customer Service Unit (CSU) will be the first point of

contact for all calls related to medical bill discounted amounts.

The CSU unit will handle calls related to the following issues: (1)

bill status in payment cycle; (2) history of bills paid; (3) questions

related to claim (i.e. claim number, claim status); and, (4)

questions specifically related to bill payment window.

2) A successful Offeror must have a process to handle questions

related to the actual review and approval of the bill or those unable

to be addressed by SWIF’s CSU personnel. Currently, SWIF

receives approximately 25 such calls per day. A typical call lasts

less than 10 minutes, although some calls last as long as 45

minutes.

3) Describe the process to handle customer service calls, how many

employees you will devote to SWIF customer service calls and the

days and hours your employee(s) will be available to handle

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customer service calls. A successful Offeror’s call center must

operate at least during SWIF’s CSU hours of operation, which

currently are 8am-4pm Monday through Friday. Describe your

process for handling calls that made outside of your regular hours

of operation.

b. Customer Satisfaction Surveys. Describe Offeror’s use of third party surveys on a

yearly basis to determine providers’ satisfaction with the Offeror’s Medical Bill

Review processes, how it will ensure validity of results, and how the results will

be shared with SWIF.

c. Grievance Process. Describe Offeror’s process for assisting SWIF, as necessary,

in grievance and complaint resolution processes. Grievance and complaint

resolution processes must comply with the provisions of the Pennsylvania

Workers’ Compensation Act and the regulations promulgated thereunder. The

Offeror must assure that its involvement in processing medical claims submitted

to SWIF will not compromise SWIF’s compliance with the law and regulations.

IV- 6. Service Level Agreements and Liquidated Damages. A successful Offeror will be able

to meet the following service level requirements, which have been designed to ensure that the

processes most vital to SWIF’s business are completed on time and without error. In the event

that the following service level requirements are not met, an Offeror may incur liquidated

damages. SWIF either may deduct liquidated damages from amounts due or may bill for the

liquidated damages. Provided, however, if SWIF decides to deduct liquidated damages from

amounts due, SWIF shall notify the Offeror in writing of any claims for liquidated damages

before it deducts such amounts. In its proposal, an Offeror must:

IV-6.1 Image Quality. Describe the measures it will put in place to meet the following

image quality requirements:

a. Scanning density – scanned images must meet the TIFF resolution of 200dpi;

b. Document preparation – staples must be removed, torn edges must be taped,

documents less than 8‖x10‖ (i.e. receipts, sticky notes) must be taped to letter

sized carrier sheets and all documents that are hard to read must be stamped

―Illegible Original‖ and the Offeror must request a legible replacement copy from

the provider; and,

c. Indexing – documents must be indexed with the correct claim number, document

date, medical document flag and document type.

To ensure the image quality requirements are met, SWIF will audit a statistically valid

sample of all scanned documents. SWIF will multiply the percentage of image failures by

the number of pages scanned by the Offeror in the past 30 business days to calculate an

audited failure rate. SWIF will multiply the audited failure rate by $0.15 to calculate the

Page 35 of 39

liquidated damages that the Offeror may be assessed for failing to meet image quality

requirements.

IV-6.2 Data Processing. SWIF’s data processing depends on timely receipt of

information from the Offeror. If the Offeror fails to provide SWIF with data by 5:00 p.m. on

a business day, SWIF may lose up to an entire day’s worth of work at a significant cost and

disruption to services. Describe the measures you will take to ensure that the data file is

provided to SWIF each business day by 5:00 p.m. of the same day. There will be a 30

minute grace period for delivery of the daily data file. Every day that the data file is

provided to SWIF after 5:30 p.m., an Offeror may be assessed liquidated damages in the

amount of $15,000.00.

IV-6.3 Bill Processing Time. Describe the measures you will use to ensure that bills are

processed within ten (10) days of your receiving them. To ensure that the ten (10) day

processing requirement is met, a successful Offeror must provide SWIF with a monthly

report showing the average processing time per month. If the average processing time

exceeds 10 days for any monthly period, an Offeror may be assessed liquidated damages of:

(1) for the first month that exceeds the l0 day average, 10% of the processing fees paid that

month; (2) for the second consecutive month that exceeds the 10 day average, 20 % of the

processing fees paid that month; (3) for the third consecutive month that exceeds the 10 day

average, 20% of the processing fees paid that month. Furthermore, SWIF may terminate the

Offeror’s contract for cause.

IV-6.4 Bill Processing Accuracy. Through its Control Unit, SWIF will audit medical

bills processed by a successful Offeror for accuracy, appropriateness and reasonableness.

SWIF’s Control Unit will audit a statistically valid sample of all reviewed bills using the

following error ratio standards:

a. Greater than 1% for the paid or denied dollars on all bills audited;

b. Greater than 3% for the number of incorrectly paid bills out of all bills audited;

c. Greater than 3% error rate for data entry.

If the error ratio standards for any of the above are exceeded: (1) for the first month, for each

error ratio standard that is exceeded, the Offeror shall provide and implement a written

corrective action plan within 10 business days of SWIF notifying the Offeror of the excessive

error ratio; (2) for the second consecutive month, for each error ratio standard exceeded, an

Offeror may be assessed liquidated damages of 10% of the processing fees paid that month

(i.e., if two standards are exceeded, the Offeror may be assessed 20% of the processing fees

paid that month to SWIF as liquidated damages); (3) for the third consecutive month during

which any error ratio standard is exceeded, an Offeror may be assessed liquidated damages

of 10% of the processing fees paid that month, for each error ratio exceeded (i.e., if two

standards are exceeded, the Offeror may be assessed 20% of the processing fees paid that

month to SWIF as liquidated damages). Furthermore, SWIF may terminate the Offeror’s

contract for cause.

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IV-7. Reports and Project Control. The Offeror must describe the type of status reports it will

provide to SWIF. These reports must be provided on a monthly basis and must include at least:

IV-7.1 Panels: On a monthly basis, the Offeror must provide reports which show: (1) a

list of the policyholders it has contacted about establishing panels pursuant to 77 P.S. 531;

(2) a list of the policyholders for which it has formed a panel of providers; and (3) a list of

SWIF claimants which have used panel providers. After achieving the guaranteed savings

amount, the Offeror must also provide a monthly invoice that sets forth the savings that have

been achieved because of the use of panel providers. This amount will be subject to audit.

The Offeror must describe the records it will maintain which will enable SWIF to verify, by

audit, the amount of monthly savings reported. All such records must be maintained for at

least five (5) years after the termination of the Contract.

IV-7.2 PPO: On a monthly basis, the Offeror must provide reports which show: (1) a list

of the policyholders it has contacted about using its PPO providers; (2) a list of the

policyholders which have agreed to use its PPO providers; and (3) a list of SWIF claimants

which have used PPO providers. After achieving the guaranteed savings amount, the Offeror

must also provide a monthly invoice that sets forth the savings that have been achieved

because of the use of PPO providers. This amount will be subject to audit. The Offeror must

describe the records it will maintain which will enable SWIF to verify, by audit, the amount

of monthly savings reported. All such records must be maintained for at least five (5) years.

IV-7.3 Discounts: On a monthly basis, the Offeror must provide reports which show: (1)

a list of the health care providers which it has contacted about extending discounts to SWIF

claimants; (2) a list of the providers which have agreed to provide health care to SWIF

claimants at a discounted rate and the amount of each discount extended; and (3) a list of

SWIF claimants that have used discount providers. After achieving the guaranteed savings

amount, the Offeror must also provide a monthly invoice that sets forth the savings that have

been achieved because of the use of health care providers that have agreed to extend

discounts to SWIF claimants. This amount will be subject to audit. The Offeror must

describe the records it will maintain which will enable SWIF to verify, by audit, the amount

of monthly savings reported. All such records must be maintained for at least five years.

IV-7.4 Service Level Agreements. On a monthly basis the Offeror must provide: (1) a

report that lists each of the days that data exchange was made after 5 p.m. and the total

liquidated damages amount potentially owed (Number of Times Data Was Exchanged After

5 p.m. x $15,000); (2) a report that provides the monthly average bill processing time and the

total liquidated damages potentially owed (see Section IV-6.c); (3) a report that lists the

number of pages scanned each business day.

IV-7.5 Policyholder and Claimant Satisfaction. Within 90 days of the end of each

contract year, the successful Offeror must successfully complete and provide to SWIF a

survey conducted by a third party that details the satisfaction of policyholders and claimants

with respect to the panel providers, the PPO providers, and the providers that extend

discounts to SWIF claimants. Based on the results of this survey, the successful Offeror will

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develop a plan to improve policyholder and claimant satisfaction with these programs. The

Offeror must describe in its proposal how it will conduct this survey.

IV-7.6 Reports. All reports must be furnished to SWIF on a monthly basis in a mutually

agreeable electronic format. Describe the proposed possible formats for reports.

a. If SWIF requests changes to reports or additional reports, describe how that will

be handled. Describe your ad hoc reporting capabilities, process to request ad hoc

reports and time it takes to create such reports.

IV-8. General Company Information. An Offeror must provide basic information about its

organization and experience. In its proposal, an Offeror must provide the following information

about its organization:

a. Legal name and any fictitious names

b. Legal form of your business

c. State of incorporation. State where it conducts business and where it is registered

to do business.

d. The names of affiliates, franchises and any other strategic relationships

e. An organizational chart, including a detailed chart for your administrative,

production and sales units

f. A list of the names and addresses of your officers and directors, chief executive

officer, chief operating officer, chief financial officer, director of marketing and

medical director.

g. State the number of years it has been performing services similar to those required

under this RFP. Provide specific information, including descriptions of projects

of similar scope that will demonstrate the success it has had in providing these

services.

h. Provide the names of its three largest, current customers, including a contact for

each customer, the phone number and email address for that contact, and the

revenue received from that customer during the last 3 years, or for as long as it

has been its customer, whichever is shorter. State the total number of customers

for the last three years and the number of customers retained for each of those

years.

i. Identify the project manager for this project, including a description of his

education and experience. This person will serve as the primary point of contact

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for this project. Provide a description of the education and experience of persons

filling the positions set forth on the organization chart required above.

j. Identify and describe the features that distinguish you from your competitors.

k. If you are awarded a contract under this RFP, will you have to increase your staff?

If so, by how much? How will you recruit and train your staff?

l. Provide copies of your audited financial statements or tax returns for the last three

(3) years.

m. If available, provide a copy of your current D&B® report or comparable financial

information.

n. Provide the addresses of the offices/locations where medical bills will be

processed.

o. Describe the types of services, other than those requested in this RFP, which it

provides.

p. Provide a copy of the Offeror’s disaster recovery plan. If no plan is available,

describe how you will continue to comply with the requirements of this RFP in

the event of a disaster at one or more of your offices.

q. Provide your current hours of operation. Times must be quoted in EST.

Medical Bill Processing

FROM TO

Mon. – Fri. ______________ _____________

Sat. ______________ _____________

Sun. ______________ _____________

Holidays ______________ _____________

IV-9. Contract Requirements—Disadvantaged Business Participation and Enterprise Zone

Small Business Participation. All contracts containing Disadvantaged Business participation

and/or Enterprise Zone Small Business participation must also include a provision requiring the

selected contractor to meet and maintain those commitments made to Disadvantaged Businesses

and/or Enterprise Zone Small Businesses at the time of proposal submittal or contract

negotiation, unless a change in the commitment is approved by the BMWBO. All contracts

containing Disadvantaged Business participation and/or Enterprise Zone Small Business

participation must include a provision requiring Small Disadvantaged Business subcontractors,

Enterprise Zone Small Business subcontractors and Small Disadvantaged Businesses or

Enterprise Zone Small Businesses in a joint venture to perform at least 50% of the subcontract or

Page 39 of 39

Small Disadvantaged Business/Enterprise Zone Small Business participation portion of the joint

venture.

The selected contractor’s commitments to Disadvantaged Businesses and/or Enterprise Zone

Small Businesses made at the time of proposal submittal or contract negotiation shall be

maintained throughout the term of the contract. Any proposed change must be submitted to

BMWBO, which will make a recommendation to the Contracting Officer regarding a course of

action.

If a contract is assigned to another contractor, the new contractor must maintain the

Disadvantaged Business participation and/or Enterprise Zone Small Business participation of the

original contract.

The selected contractor shall complete the Prime Contractor’s Quarterly Utilization Report (or

similar type document containing the same information) and submit it to the contracting officer

of the Issuing Office and BMWBO within 10 workdays at the end of each quarter the contract is

in force. This information will be used to determine the actual dollar amount paid to Small

Disadvantaged Business and/or Enterprise Zone Small Business subcontractors and suppliers,

and Small Disadvantaged Business and/or Enterprise Zone Small Business participants involved

in joint ventures. Also, this information will serve as a record of fulfillment of the commitment

the selected contractor made and for which it received Disadvantaged Business and Enterprise

Zone Small Business points. If there was no activity during the quarter then the form must be

completed by stating ―No activity in this quarter.‖

NOTE: EQUAL EMPLOYMENT OPPORTUNITY AND CONTRACT COMPLIANCE

STATEMENTS REFERRING TO COMPANY EQUAL EMPLOYMENT OPPORTUNITY

POLICIES OR PAST CONTRACT COMPLIANCE PRACTICES DO NOT CONSTITUTE

PROOF OF DISADVANTAGED BUSINESSES STATUS OR ENTITLE AN OFFEROR TO

RECEIVE CREDIT FOR DISADVANTAGED BUSINESSES UTILIZATION.

Page 1 of 1

APPENDIX B

DOMESTIC WORKFORCE UTILIZATION CERTIFICATION

Each proposal will be scored for its commitment to use the domestic workforce in the fulfillment of the

contract. Maximum consideration will be given to those Offerors who will perform the contracted direct

labor exclusively within the geographical boundaries of the United States. Those who propose to perform

a portion of the direct labor outside of the United States will receive a correspondingly smaller score for

this criterion.

In order to be eligible for any consideration for this criterion, Offerors must complete and sign the

following certification. This certification will be included as a contractual obligation when the contract is

executed. Failure to complete and sign this certification will result in no consideration being given to the

Offeror for this criterion.

I, ______________________[title] of ____________________________________[name of

Contractor] a _______________ [place of incorporation] corporation or other legal entity,

(―Contractor‖) located at ________________________________________________________________

____________________________________________________________________________[address],

having a Social Security or Federal Identification Number of ________________________, do hereby

certify and represent to the Commonwealth of Pennsylvania ("Commonwealth") (Check one of the boxes

below):

All of the direct labor performed within the scope of services under the contract

will be performed exclusively within the geographical boundaries of the United States.

OR

________________ percent (_____%) [Contractor must specify the

percentage] of the direct labor performed within the scope of services under the contract

will be performed within the geographical boundaries of the United States. Please

identify the direct labor performed under the contract that will be performed outside the

United States: ____________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

[Use additional sheets if necessary]

The Department of General Services [or other purchasing agency] shall treat any misstatement as

fraudulent concealment of the true facts punishable under Section 4904 of the Pennsylvania Crimes Code,

Title 18, of Pa. Consolidated Statutes.

Attest or Witness: ______________________________

Corporate or Legal Entity's Name

_____________________________ ______________________________

Signature/Date Signature/Date

_____________________________ ______________________________

Printed Name/Title Printed Name/Title

Commonwealth of Pennsylvania STD-274 Rev. 05/07/04

1

STANDARD CONTRACT

TERMS AND CONDITIONS FOR SERVICES

1. TERM OF CONTRACT

The term of the Contract shall commence on the Effective Date (as defined below) and shall end on the

Expiration Date identified in the Contract, subject to the other provisions of the Contract. The Effective Date

shall be fixed by the Contracting Officer after the Contract has been fully executed by the Contractor and

by the Commonwealth and all approvals required by Commonwealth contracting procedures have been

obtained. The Contract shall not be a legally binding contract until after the Effective Date is affixed and

the fully-executed Contract has been sent to the Contractor. The Contracting Officer shall issue a written

Notice to Proceed to the Contractor directing the Contractor to start performance on a date which is on

or after the Effective Date. The Contractor shall not start the performance of any work prior to the date set

forth in the Notice to Proceed and the Commonwealth shall not be liable to pay the Contractor for any

service or work performed or expenses incurred before the date set forth in the Notice to Proceed. No

agency employee has the authority to verbally direct the commencement of any work under this

Contract. The Commonwealth reserves the right, upon notice to the Contractor, to extend the term of the

Contract for up to three (3) months upon the same terms and conditions. This will be utilized to prevent a

lapse in Contract coverage and only for the time necessary, up to three (3) months, to enter into a new

contract.

2. INDEPENDENT CONTRACTOR

In performing the services required by the Contract, the Contractor will act as an independent contractor

and not as an employee or agent of the Commonwealth.

3. COMPLIANCE WITH LAW

The Contractor shall comply with all applicable federal and state laws and regulations and local

ordinances in the performance of the Contract.

4. ENVIRONMENTAL PROVISIONS

In the performance of the Contract, the Contractor shall minimize pollution and shall strictly comply with all

applicable environmental laws and regulations.

5. POST-CONSUMER RECYCLED CONTENT

Except as specifically waived by the Department of General Services in writing, any products which are

provided to the Commonwealth as a part of the performance of the Contract must meet the minimum

percentage levels for total recycled content as specified in Exhibits A-1 through A-8 to these Standard

Contract Terms and Conditions.

6. COMPENSATION/EXPENSES

The Contractor shall be required to perform the specified services at the price(s) quoted in the Contract. All

services shall be performed within the time period(s) specified in the Contract. The Contractor shall be

compensated only for work performed to the satisfaction of the Commonwealth. The Contractor shall not

be allowed or paid travel or per diem expenses except as specifically set forth in the Contract.

7. INVOICES

Unless the Contractor has been authorized by the Commonwealth for Evaluated Receipt Settlement or

Vendor Self-Invoicing, the Contractor shall send an invoice itemized by line item to the address referenced

on the purchase order promptly after services are satisfactorily completed. The invoice should include only

amounts due under the Contract/purchase order. The purchase order number must be included on all

invoices. In addition, the Commonwealth shall have the right to require the Contractor to prepare and

Commonwealth of Pennsylvania STD-274 Rev. 05/07/04

2

submit a “Work In Progress” sheet that contains, at a minimum, the tasks performed, number of hours,

hourly rate, and the purchase order or task order to which it refers.

8. PAYMENT

a. The Commonwealth shall put forth reasonable efforts to make payment by the required

payment date. The required payment date is: (a) the date on which payment is due

under the terms of the Contract; (b) thirty (30) days after a proper invoice actually is

received at the “Provide Service and Bill To” address if a date on which payment is due is

not specified in the Contract (a “proper” invoice is not received until the Commonwealth

accepts the service as satisfactorily performed); or (c) the payment date specified on the

invoice if later than the dates established by (a) and (b) above. Payment may be delayed

if the payment amount on an invoice is not based upon the price(s) as stated in the

Contract. If any payment is not made within fifteen (15) days after the required payment

date, the Commonwealth may pay interest as determined by the Secretary of Budget in

accordance with Act No. 266 of 1982 and regulations promulgated pursuant thereto.

Payment should not be construed by the Contractor as acceptance of the service

performed by the Contractor. The Commonwealth reserves the right to conduct further

testing and inspection after payment, but within a reasonable time after performance,

and to reject the service if such post payment testing or inspection discloses a defect or a

failure to meet specifications. The Contractor agrees that the Commonwealth may set off

the amount of any state tax liability or other obligation of the Contractor or its subsidiaries

to the Commonwealth against any payments due the Contractor under any contract with

the Commonwealth.

b. The Commonwealth shall have the option of using the Commonwealth purchasing card to

make purchases under the Contract or purchase order. The Commonwealth’s purchasing

card is similar to a credit card in that there will be a small fee which the Contractor will be

required to pay and the Contractor will receive payment directly from the card issuer

rather than the Commonwealth. Any and all fees related to this type of payment are the

responsibility of the Contractor. In no case will the Commonwealth allow increases in

prices to offset credit card fees paid by the Contractor or any other charges incurred by

the Contractor, unless specifically stated in the terms of the Contract or purchase order.

9. TAXES

The Commonwealth is exempt from all excise taxes imposed by the Internal Revenue Service and has

accordingly registered with the Internal Revenue Service to make tax free purchases under Registration No.

23740001-K. With the exception of purchases of the following items, no exemption certificates are required

and none will be issued: undyed diesel fuel, tires, trucks, gas guzzler emergency vehicles, and sports fishing

equipment. The Commonwealth is also exempt from Pennsylvania state sales tax, local sales tax, public

transportation assistance taxes and fees and vehicle rental tax. The Department of Revenue regulations

provide that exemption certificates are not required for sales made to governmental entities and none will

be issued. Nothing in this paragraph is meant to exempt a construction contractor from the payment of

any of these taxes or fees which are required to be paid with respect to the purchase, use, rental, or lease

of tangible personal property or taxable services used or transferred in connection with the performance of

a construction contract.

10. WARRANTY

The Contractor warrants that all services performed by the Contractor, its agents and subcontractors shall

be free and clear of any defects in workmanship or materials. Unless otherwise stated in the contract, all

services and parts are warranted for a period of one year following completion of performance by the

Contractor and acceptance by the Commonwealth. The Contractor shall correct any problem with the

service and/or replace any defective part with a part of equivalent or superior quality without any

additional cost to the Commonwealth.

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11. PATENT, COPYRIGHT, AND TRADEMARK INDEMNITY

The Contractor warrants that it is the sole owner or author of, or has entered into a suitable legal

agreement concerning either: a) the design of any product or process provided or used in the

performance of the Contract which is covered by a patent, copyright, or trademark registration or other

right duly authorized by state or federal law or b) any copyrighted matter in any report document or other

material provided to the commonwealth under the contract. The Contractor shall defend any suit or

proceeding brought against the Commonwealth on account of any alleged patent, copyright or

trademark infringement in the United States of any of the products provided or used in the performance of

the Contract. This is upon condition that the Commonwealth shall provide prompt notification in writing of

such suit or proceeding; full right, authorization and opportunity to conduct the defense thereof; and full

information and all reasonable cooperation for the defense of same. As principles of governmental or

public law are involved, the Commonwealth may participate in or choose to conduct, in its sole discretion,

the defense of any such action. If information and assistance are furnished by the Commonwealth at the

Contractor’s written request, it shall be at the Contractor’s expense, but the responsibility for such expense

shall be only that within the Contractor’s written authorization. The Contractor shall indemnify and hold the

Commonwealth harmless from all damages, costs, and expenses, including attorney’s fees that the

Contractor or the Commonwealth may pay or incur by reason of any infringement or violation of the rights

occurring to any holder of copyright, trademark, or patent interests and rights in any products provided or

used in the performance of the Contract. If any of the products provided by the Contractor in such suit or

proceeding are held to constitute infringement and the use is enjoined, the Contractor shall, at its own

expense and at its option, either procure the right to continue use of such infringement products, replace

them with non-infringement equal performance products or modify them so that they are no longer

infringing. If the Contractor is unable to do any of the preceding, the Contractor agrees to remove all the

equipment or software which are obtained contemporaneously with the infringing product, or, at the

option of the Commonwealth, only those items of equipment or software which are held to be infringing,

and to pay the Commonwealth: 1) any amounts paid by the Commonwealth towards the purchase of the

product, less straight line depreciation; 2) any license fee paid by the Commonwealth for the use of any

software, less an amount for the period of usage; and 3) the pro rata portion of any maintenance fee

representing the time remaining in any period of maintenance paid for. The obligations of the Contractor

under this paragraph continue without time limit. No costs or expenses shall be incurred for the account of

the Contractor without its written consent.

12. OWNERSHIP RIGHTS

The Commonwealth shall have unrestricted authority to reproduce, distribute, and use any submitted

report, data, or material, and any software or modifications and any associated documentation that is

designed or developed and delivered to the Commonwealth as part of the performance of the Contract.

13. ASSIGNMENT OF ANTITRUST CLAIMS

The Contractor and the Commonwealth recognize that in actual economic practice, overcharges by the

Contractor’s suppliers resulting from violations of state or federal antitrust laws are in fact borne by the

Commonwealth. As part of the consideration for the award of the Contract, and intending to be legally

bound, the Contractor assigns to the Commonwealth all right, title and interest in and to any claims the

Contractor now has, or may acquire, under state or federal antitrust laws relating to the products and

services which are the subject of this Contract.

14. HOLD HARMLESS PROVISION

The Contractor shall hold the Commonwealth harmless from and indemnify the Commonwealth against

any and all claims, demands and actions based upon or arising out of any activities performed by the

Contractor and its employees and agents under this Contract and shall, at the request of the

Commonwealth, defend any and all actions brought against the Commonwealth based upon any such

claims or demands.

15. AUDIT PROVISIONS

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The Commonwealth shall have the right, at reasonable times and at a site designated by the

Commonwealth, to audit the books, documents and records of the Contractor to the extent that the

books, documents and records relate to costs or pricing data for the Contract. The Contractor agrees to

maintain records which will support the prices charged and costs incurred for the Contract. The Contractor

shall preserve books, documents, and records that relate to costs or pricing data for the Contract for a

period of three (3) years from date of final payment. The Contractor shall give full and free access to all

records to the Commonwealth and/or their authorized

representatives.

16. DEFAULT

a. The Commonwealth may, subject to the provisions of Paragraph 17, Force Majeure, and in

addition to its other rights under the Contract, declare the Contractor in default by written

notice thereof to the Contractor, and terminate (as provided in Paragraph 18, Termination

Provisions) the whole or any part of this Contract for any of the following reasons:

1) Failure to begin work within the time specified in the Contract or as otherwise

specified;

2) Failure to perform the work with sufficient labor, equipment, or material to insure

the completion of the specified work in accordance with the Contract terms;

3) Unsatisfactory performance of the work;

4) Failure or refusal to remove material, or remove and replace any work rejected as

defective or unsatisfactory;

5) Discontinuance of work without approval;

6) Failure to resume work, which has been discontinued, within a reasonable time

after notice to do so;

7) Insolvency or bankruptcy;

8) Assignment made for the benefit of creditors;

9) Failure or refusal within 10 days after written notice by the Contracting Officer, to

make payment or show cause why payment should not be made, of any amounts

due for materials furnished, labor supplied or performed, for equipment rentals, or

for utility services rendered;

10) Failure to protect, to repair, or to make good any damage or injury to property; or

11) Breach of any provision of this Contract.

b. In the event that the Commonwealth terminates this Contract in whole or in part as

provided in Subparagraph a. above, the Commonwealth may procure, upon such terms

and in such manner as it determines, services similar or identical to those so terminated,

and the Contractor shall be liable to the Commonwealth for any reasonable excess costs

for such similar or identical services included within the terminated part of the Contract.

c. If the Contract is terminated as provided in Subparagraph a. above, the Commonwealth,

in addition to any other rights provided in this paragraph, may require the Contractor to

transfer title and deliver immediately to the Commonwealth in the manner and to the

extent directed by the Issuing Office, such partially completed work, including, where

applicable, reports, working papers and other documentation, as the Contractor has

specifically produced or specifically acquired for the performance of such part of the

Contract as has been terminated. Except as provided below, payment for completed

work accepted by the Commonwealth shall be at the Contract price. Except as provided

below, payment for partially completed work including, where applicable, reports and

working papers, delivered to and accepted by the Commonwealth shall be in an amount

agreed upon by the Contractor and Contracting Officer. The Commonwealth may

withhold from amounts otherwise due the Contractor for such completed or partially

completed works, such sum as the Contracting Officer determines to be necessary to

protect the Commonwealth against loss.

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d. The rights and remedies of the Commonwealth provided in this paragraph shall not be

exclusive and are in addition to any other rights and remedies provided by law or under

this Contract.

e. The Commonwealth’s failure to exercise any rights or remedies provided in this paragraph

shall not be construed to be a waiver by the Commonwealth of its rights and remedies in

regard to the event of default or any succeeding event of default.

f. Following exhaustion of the Contractor’s administrative remedies as set forth in Paragraph

19, the Contractor's exclusive remedy shall be to seek damages in the Board of Claims.

17. FORCE MAJEURE

Neither party will incur any liability to the other if its performance of any obligation under this Contract is

prevented or delayed by causes beyond its control and without the fault or negligence of either party.

Causes beyond a party’s control may include, but aren’t limited to, acts of God or war, changes in

controlling law, regulations, orders or the requirements of any governmental entity, severe weather

conditions, civil disorders, natural disasters, fire, epidemics and quarantines, general strikes throughout the

trade, and freight embargoes.

The Contractor shall notify the Commonwealth orally within five (5) days and in writing within ten (10) days

of the date on which the Contractor becomes aware, or should have reasonably become aware, that

such cause would prevent or delay its performance. Such notification shall (i) describe fully such cause(s)

and its effect on performance, (ii) state whether performance under the contract is prevented or delayed

and (iii) if performance is delayed, state a reasonable estimate of the duration of the delay. The Contractor

shall have the burden of proving that such cause(s) delayed or prevented its performance despite its

diligent efforts to perform and shall produce such supporting documentation as the Commonwealth may

reasonably request. After receipt of such notification, the Commonwealth may elect either to cancel the

Contract or to extend the time for performance as reasonably necessary to compensate for the

Contractor’s delay.

In the event of a declared emergency by competent governmental authorities, the Commonwealth by

notice to the Contractor, may suspend all or a portion of the Contract.

18. TERMINATION PROVISIONS

The Commonwealth has the right to terminate this Contract for any of the following reasons. Termination

shall be effective upon written notice to the Contractor.

a. TERMINATION FOR CONVENIENCE: The Commonwealth shall have the right to terminate

the Contract for its convenience if the Commonwealth determines termination to be in its

best interest. The Contractor shall be paid for work satisfactorily completed prior to the

effective date of the termination, but in no event shall the Contractor be entitled to

recover loss of profits.

b. NON-APPROPRIATION: The Commonwealth’s obligation to make payments during any

Commonwealth fiscal year succeeding the current fiscal year shall be subject to

availability and appropriation of funds. When funds (state and/or federal) are not

appropriated or otherwise made available to support continuation of performance in a

subsequent fiscal year period, the Commonwealth shall have the right to terminate the

contract. The contractor shall be reimbursed for the reasonable value of any nonrecurring

costs incurred but not amortized in the price of the supplies or services delivered under this

contract. Such reimbursement shall not include loss of profit, loss of use of money, or

administrative or overhead costs. The reimbursement amount may be paid for any

appropriations available for that purpose

c. TERMINATION FOR CAUSE: The Commonwealth shall have the right to terminate the

Contract for Contractor default under Paragraph 16, Default, upon written notice to the

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Contractor. The Commonwealth shall also have the right, upon written notice to the

Contractor, to terminate the Contract for other cause as specified in this Contract or by

law. If it is later determined that the Commonwealth erred in terminating the Contract for

cause, then, at the Commonwealth’s discretion, the Contract shall be deemed to have

been terminated for convenience under the Subparagraph 18.a.

19. CONTRACT CONTROVERSIES

a. In the event of a controversy or claim arising from the Contract, the Contractor must,

within six months after the cause of action accrues, file a written claim with the contracting

officer for a determination. The claim shall state all grounds upon which the Contractor

asserts a controversy exists. If the Contractor fails to file a claim or files an untimely claim,

the Contractor is deemed to have waived its right to assert a claim in any forum.

b. The contracting officer shall review timely-filed claims and issue a final determination, in

writing, regarding the claim. The final determination shall be issued within 120 days of the

receipt of the claim, unless extended by consent of the contracting officer and the

Contractor. The contracting officer shall send his/her written determination to the

Contractor. If the contracting officer fails to issue a final determination within the 120 days

(unless extended by consent of the parties), the claim shall be deemed denied. The

contracting officer's determination shall be the final order of the purchasing agency.

c. Within fifteen (15) days of the mailing date of the determination denying a claim or within

135 days of filing a claim if, no extension is agreed to by the parties, whichever occurs first,

the Contractor may file a statement of claim with the Commonwealth Board of Claims.

Pending a final judicial resolution of a controversy or claim, the Contractor shall proceed

diligently with the performance of the Contract in a manner consistent with the

determination of the contracting officer and the Commonwealth shall compensate the

Contractor pursuant to the terms of the Contract.

20. ASSIGNABILITY AND SUBCONTRACTING

a. Subject to the terms and conditions of this Paragraph 20, this Contract shall be binding

upon the parties and their respective successors and assigns.

b. The Contractor shall not subcontract with any person or entity to perform all or any part of

the work to be performed under this Contract without the prior written consent of the

Contracting Officer, which consent maybe withheld at the sole and absolute discretion of

the Contracting Officer.

c. The Contractor may not assign, in whole or in part, this Contract or its rights, duties,

obligations, or responsibilities hereunder without the prior written consent of the

Contracting Officer, which consent may b withheld at the sole and absolute discretion of

the Contracting Officer.

d. Notwithstanding the foregoing, the Contractor may, without the consent of the

Contracting Officer, assign its rights to payment to be received under the Contract,

provided that the Contractor provides written notice of such assignment to the

Contracting Officer together with a written acknowledgement from the assignee that any

such payments are subject to all of the terms and conditions of this Contract.

e. For the purposes of this Contract, the term “assign” shall include, but shall not be limited

to, the sale, gift, assignment, pledge, or other transfer of any ownership interest in the

Contractor provided, however, that the term shall not apply to the sale or other transfer of

stock of a publicly traded company.

f . Any assignment consented to by the Contracting Officer shall be evidenced by a written

assignment agreement executed by the Contractor and its assignee in which the assignee

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agrees to be legally bound by all of the terms and conditions of the Contract and to

assume the duties, obligations, and responsibilities being assigned.

g. A change of name by the Contractor, following which the Contractor’s federal

identification number remains unchanged, shall not be considered to be an assignment

hereunder. The Contractor shall give the Contracting Officer written notice of any such

change of name.

21. NONDISCRIMINATION/SEXUAL HARASSMENT CLAUSE

During the term of the Contract, the Contractor agrees as follows:

a. In the hiring of any employees for the manufacture of supplies, performance of work, or

any other activity required under the Contract or any subcontract, the Contractor,

subcontractor or any person acting on behalf of the Contractor or subcontractor shall not

by reason of gender, race, creed, or color discriminate against any citizen of this

Commonwealth who is qualified and available to perform the work to which the

employment relates.

b. Neither the Contractor nor any subcontractor nor any person on their behalf shall in any

manner discriminate against or intimidate any employee involved in the manufacture of

supplies, the performance of work or any other activity required under the Contract on

account of gender, race, creed, or color.

c. The Contractor and any subcontractors shall establish and maintain a written sexual

harassment policy and shall inform their employees of the policy. The policy must contain a

notice that sexual harassment will not be tolerated and employees who practice it will be

disciplined

d. The Contractor shall not discriminate by reason of gender, race, creed, or color against

any subcontractor or supplier who is qualified to perform the work to which the contract

relates.

e. The Contractor and each subcontractor shall furnish all necessary employment documents

and records to and permit access to its books, records, and accounts by the contracting

officer and the Department of General Services’ Bureau of Contract Administration and

Business Development for purposes of investigation to ascertain compliance with the

provisions of this Nondiscrimination/Sexual Harassment Clause. If the Contractor or any

subcontractor does not possess documents or records reflecting the necessary information

requested, it shall furnish such information on reporting forms supplied by the contracting

officer or the Bureau of Contract Administration and Business Development

f. The Contractor shall include the provisions of this Nondiscrimination/Sexual Harassment

Clause in every subcontract so that such provisions will be binding upon each

subcontractor.

g. The Commonwealth may cancel or terminate the Contract, and all money due or to

become due under the Contract may be forfeited for a violation of the terms and

conditions of this Nondiscrimination/Sexual Harassment Clause. In addition, the agency

may proceed with debarment or suspension and may place the Contractor in the

Contractor Responsibility File.

22. CONTRACTOR INTEGRITY PROVISIONS

a. For purposes of this clause only, the words “confidential information,” “consent,”

“contractor,” “financial interest,” and “gratuity” shall have the following definitions.

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1) Confidential information means information that is not public knowledge, or

available to the public on request, disclosure of which would give an unfair, unethical, or

illegal advantage to another desiring to contract with the Commonwealth.

2) Consent means written permission signed by a duly authorized officer or employee

of the Commonwealth, provided that where the material facts have been disclosed, in

writing, by prequalification, bid, proposal, or contractual terms, the Commonwealth shall

be deemed to have consented by virtue of execution of this agreement.

3) Contractor means the individual or entity that has entered into the Contract with

the Commonwealth, including directors, officers, partners, managers, key employees and

owners of more than a five percent interest.

4) Financial interest means:

a) Ownership of more than a five percent interest in any business; or

b) Holding a position as an officer, director, trustee, partner, employee, or the like,

or holding any position of management.

5) Gratuity means any payment of more than nominal monetary value in the form of

cash, travel, entertainment, gifts, meals, lodging, loans, subscriptions, advances, deposits

of money, services, employment, or contracts of any kind.

b. The Contractor shall maintain the highest standards of integrity in the performance of the

Contract and shall take no action in violation of state or federal laws, regulations, or other

requirements that govern contracting with the Commonwealth.

c. The Contractor shall not disclose to others any confidential information gained by virtue of

the Contract.

d. The Contractor shall not, in connection with this or any other agreement with the

Commonwealth, directly, or indirectly, offer, confer, or agree to confer any pecuniary

benefit on anyone as consideration for the decision, opinion, recommendation, vote,

other exercise of discretion, or violation of a known legal duty by any officer or employee

of the Commonwealth.

e. The Contractor shall not, in connection with this or any other agreement with the

Commonwealth, directly or indirectly, offer, give, or agree or promise to give to anyone

any gratuity for the benefit of or at the direction or request of any officer or employee of

the Commonwealth.

f. Except with the consent of the Commonwealth, neither the Contractor nor anyone in

privity with him or her shall accept or agree to accept from, or give or agree to give to,

any person, any gratuity from any person in connection with the performance of work

under the Contract except as provided therein.

g. Except with the consent of the Commonwealth, the Contractor shall not have a financial

interest in any other contractor, subcontractor, or supplier providing services, labor, or

material on this project.

h. The Contractor, upon being informed that any violation of these provisions has occurred or

may occur, shall immediately notify the Commonwealth in writing.

i. The Contractor, by execution of the Contract and by the submission of any bills or invoices

for payment pursuant thereto, certifies, and represents that he or she has not violated any

of these provisions.

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j. The Contractor, upon the inquiry or request of the Inspector General of the

Commonwealth or any of that official’s agents or representatives, shall provide, or if

appropriate, make promptly available for inspection or copying, any information of any

type or form deemed relevant by the Inspector General to the Contractor’s integrity or

responsibility, as those terms are defined by the Commonwealth’s statutes, regulations, or

management directives. Such information may include, but shall not be limited to, the

Contractor’s business or financial records, documents or files of any type or form which

refers to or concern the Contract. Such information shall be retained by the Contractor for

a period of three years beyond the termination of the Contract unless otherwise provided

by law.

k. For violation of any of the above provisions, the Commonwealth may terminate this and

any other agreement with the Contractor, claim liquidated damages in an amount equal

to the value of anything received in breach of these provisions, claim damages for all

expenses incurred in obtaining another Contractor to complete performance hereunder,

and debar and suspend the Contractor from doing business with the Commonwealth.

These rights and remedies are cumulative, and the use or nonuse of any one shall not

preclude the use of all or any other. These rights and remedies are in addition to those the

Commonwealth may have under law, statute, regulation, or otherwise.

23. CONTRACTOR RESPONSIBILITY PROVISIONS

a. The Contractor certifies, for itself and all its subcontractors, that as of the date of its

execution of this Bid/Contract, that neither the Contractor, nor any subcontractors, nor any

suppliers are under suspension or debarment by the Commonwealth or any governmental entity,

instrumentality, or authority and, if the Contractor cannot so certify, then it agrees to submit, along

with its Bid, a written explanation of why such certification cannot be made.

b. The Contractor also certifies, that as of the date of its execution of this Bid/Contract, it has

no tax liabilities or other Commonwealth obligations.

c. The Contractor’s obligations pursuant to these provisions are ongoing from and after the

effective date of the contract through the termination date thereof. Accordingly, the Contractor

shall have an obligation to inform the Commonwealth if, at any time during the term of the

Contract, it becomes delinquent in the payment of taxes, or other Commonwealth obligations, or

if it or any of its subcontractors are suspended or debarred by the Commonwealth, the federal

government, or any other state or governmental entity. Such notification shall be made within 15

days of the date of suspension or debarment.

d. The failure of the Contractor to notify the Commonwealth of its suspension or debarment

by the Commonwealth, any other state, or the federal government shall constitute an event of

default of the Contract with the Commonwealth.

e. The Contractor agrees to reimburse the Commonwealth for the reasonable costs of

investigation incurred by the Office of State Inspector General for investigations of the Contractor’s

compliance with the terms of this or any other agreement between the Contractor and the

Commonwealth, which results in the suspension or debarment of the Contractor. Such costs shall

include, but shall not be limited to, salaries of investigators, including overtime; travel and lodging

expenses; and expert witness and documentary fees. The Contractor shall not be responsible for

investigative costs for investigations that do not result in the Contractor’s suspension or debarment.

f . The Contractor may obtain a current list of suspended and debarred Commonwealth

contractors by either searching the internet at http://www.dgs.state.pa.us or contacting the:

Department of General Services

Office of Chief Counsel

603 North Office Building

Harrisburg, PA 17125

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Telephone No. (717) 783-6472

FAX No. (717) 787-9138

24. AMERICANS WITH DISABILITIES ACT

a. Pursuant to federal regulations promulgated under the authority of The Americans With

Disabilities Act, 28 C.F.R. § 35.101 et seq., the Contractor understands and agrees that it

shall not cause any individual with a disability to be excluded from participation in this

Contract or from activities provided for under this Contract on the basis of the disability. As

a condition of accepting this contract, the Contractor agrees to comply with the “General

Prohibitions Against Discrimination,” 28 C.F.R. § 35.130, and all other regulations

promulgated under Title II of The Americans With Disabilities Act which are applicable to all

benefits, services, programs, and activities provided by the Commonwealth of

Pennsylvania through contracts with outside contractors.

b. The Contractor shall be responsible for and agrees to indemnify and hold harmless the

Commonwealth of Pennsylvania from all losses, damages, expenses, claims, demands,

suits, and actions brought by any party against the Commonwealth of Pennsylvania as a

result of the Contractor’s failure to comply with the provisions of subparagraph a above.

25. HAZARDOUS SUBSTANCES

The Contractor shall provide information to the Commonwealth about the identity and hazards of

hazardous substances supplied or used by the Contractor in the performance of the Contract. The

Contractor must comply with Act 159 of October 5, 1984, known as the “Worker and Community Right to

Know Act” (the “Act”) and the regulations promulgated pursuant thereto at 4 Pa. Code Section 301.1 et

seq.

a. Labeling. The Contractor shall insure that each individual product (as well as the carton,

container or package in which the product is shipped) of any of the following substances

(as defined by the Act and the regulations) supplied by the Contractor is clearly labeled,

tagged or marked with the information listed in Paragraph (1) through (4):

1) Hazardous substances:

a) The chemical name or common name,

b) A hazard warning, and

c) The name, address, and telephone number of the manufacturer.

2) Hazardous mixtures:

a) The common name, but if none exists, then the trade name,

b) The chemical or common name of special hazardous substances comprising

.01% or more of the mixture,

c) The chemical or common name of hazardous substances consisting 1.0% or

more of the mixture,

d) A hazard warning, and

e) The name, address, and telephone number of the manufacturer.

3) Single chemicals:

a) The chemical name or the common name,

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b) A hazard warning, if appropriate, and

c) The name, address, and telephone number of the manufacturer.

4) Chemical Mixtures:

a) The common name, but if none exists, then the trade name,

b) A hazard warning, if appropriate,

c) The name, address, and telephone number of the manufacturer, and

d) The chemical name or common name of either the top five substances by

volume or those substances consisting of 5.0% or more of the mixture.

A common name or trade name may be used only if the use of the name more easily or

readily identifies the true nature of the hazardous substance, hazardous mixture, single

chemical, or mixture involved.

Container labels shall provide a warning as to the specific nature of the hazard arising

from the substance in the container.

The hazard warning shall be given in conformity with one of the nationally recognized and

accepted systems of providing warnings, and hazard warnings shall be consistent with one

or more of the recognized systems throughout the workplace. Examples are:

· NFPA 704, Identification of the Fire Hazards of Materials.

· National Paint and Coatings Association: Hazardous Materials Identification

System.

· American Society for Testing and Materials, Safety Alert Pictorial Chart.

· American National Standard Institute, Inc., for the Precautionary Labeling of

Hazardous Industrial Chemicals.

Labels must be legible and prominently affixed to and displayed on the product and the

carton, container, or package so that employees can easily identify the substance or

mixture present therein.

b. Material Safety Data Sheet. The contractor shall provide Material Safety Data Sheets

(MSDS) with the information required by the Act and the regulations for each hazardous

substance or hazardous mixture. The Commonwealth must be provided an appropriate

MSDS with the initial shipment and with the first shipment after an MSDS is updated or

product changed. For any other chemical, the contractor shall provide an appropriate

MSDS, if the manufacturer, importer, or supplier produces or possesses the MSDS. The

contractor shall also notify the Commonwealth when a substance or mixture is subject to

the provisions of the Act. Material Safety Data Sheets may be attached to the carton,

container, or package mailed to the Commonwealth at the time of shipment.

26. COVENANT AGAINST CONTINGENT FEES

The Contractor warrants that no person or selling agency has been employed or retained to solicit or

secure the Contract upon an agreement or understanding for a commission, percentage, brokerage, or

contingent fee, except bona fide employees or bona fide established commercial or selling agencies

maintained by the Contractor for the purpose of securing business. For breach or violation of this warranty,

the Commonwealth shall have the right to terminate the Contract without liability or in its discretion to

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deduct from the Contract price or consideration, or otherwise recover the full amount of such commission,

percentage, brokerage, or contingent fee.

27. APPLICABLE LAW

This Contract shall be governed by and interpreted and enforced in accordance with the laws of the

Commonwealth of Pennsylvania (without regard to any conflict of laws provisions) and the decisions of the

Pennsylvania courts. The Contractor consents to the jurisdiction of any court of the Commonwealth of

Pennsylvania and any federal courts in Pennsylvania, waiving any claim or defense that such forum is not

convenient or proper. The Contractor agrees that any such court shall have in personam jurisdiction over it,

and consents to service of process in any manner authorized by Pennsylvania law.

28. INTEGRATION

The Contract, including all referenced documents, constitutes the entire agreement between the parties.

No agent, representative, employee or officer of either the Commonwealth or the Contractor has authority

to make, or has made, any statement, agreement or representation, oral or written, in connection with the

Contract, which in any way can be deemed to modify, add to or detract from, or otherwise change or

alter its terms and conditions. No negotiations between the parties, nor any custom or usage, shall be

permitted to modify or contradict any of the terms and conditions of the Contract. No modifications,

alterations, changes, or waiver to the Contract or any of its terms shall be valid or binding unless

accomplished by a written amendment signed by both parties. All such amendments will be made using

the appropriate Commonwealth form.

29. CHANGE ORDERS

The Commonwealth reserves the right to issue change orders at any time during the term of the Contract

or any renewals or extensions thereof: 1) to increase or decrease the quantities resulting from variations

between any estimated quantities in the Contract and actual quantities; 2) to make changes to the

services within the scope of the Contract; 3) to notify the Contractor that the Commonwealth is exercising

any Contract renewal or extension option; or 4) to modify the time of performance that does not alter the

scope of the Contract to extend the completion date beyond the Expiration Date of the Contract or any

renewals or extensions thereof. Any such change order shall be in writing signed by the Contracting

Officer. The change order shall be effective as of the date appearing on the change order, unless the

change order specifies a later effective date. Such increases, decreases, changes, or modifications will

not invalidate the Contract, nor, if performance security is being furnished in conjunction with the Contract,

release the security obligation. The Contractor agrees to provide the service in accordance with the

change order. Any dispute by the Contractor in regard to the performance required under any change

order shall be handled through Paragraph 19, “Contract Controversies”.

For purposes of this Contract, “change order” is defined as a written order signed by the Contracting

Officer directing the Contractor to make changes authorized under this clause.

Commonwealth of Pennsylvania STD-274 Rev. 05/07/04

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EXHIBIT A-1

CONSTRUCTION PRODUCTS

RECYCLED CONTENT

(A) REQUIREMENT

All construction products offered by the bidder, or included in the final product offered by the bidder, and sold to the

Commonwealth must contain the minimum percentage of post-consumer and recovered material content as shown

below for the applicable products:

Construction Products

Material

% of Post-

Consumer

Materials

% of Total

Recovered

Materials

Structural Fiberboard Recovered Materials - 80

Laminated Paperboard Post-consumer Paper 100 -

Rock Wool Insulation Slag - 75

Fiberglass Insulation Glass Cullet - 20

Cellulose Insulation (loose-fill and spray-on) Post-consumer Paper 75 -

Perlite Composite Board Insulation Post-consumer Paper 23 -

Plastic Rigid Foam, Polyisocyanurate/

Polyurethane: Rigid Foam Insulation

Recovered Material - 9

Foam-in-Place Insulation Recovered Material - 5

Glass Fiber Reinforced Insulation Recovered Material - 6

Phenolic Rigid Foam Insulation Recovered Material - 5

Floor Tiles (heavy duty/commercial use) Rubber

Plastic

90

-

-

90

Patio Blocks Rubber or Rubber Blends

Plastic or Plastic Blends

90

-

-

90

Polyester Carpet Fiber Face Polyethylene terephthalate (PET)

resin

25 -

Latex Paint:

--Consolidated1

--Reprocessed2

-----White, Off-White, Pastel Colors

-----Grey, Brown, Earthtones, and

Other Dark Colors

Recovered Material

Recovered Material

Recovered Material

100

20

50

-

-

-

Shower and Restroom Dividers/Partitions: Plastic 20 -

Steel4

16

67

9

33

Carpet Cushion:

--Bonded Polyurethane

--Jute

--Synthetic Fibers

--Rubber

Old Carpet Cushion

Burlap

Carpet Fabrication Scrap

Tire Rubber

15

40

-

60

-

-

100

-

Railroad Grade Crossing Surfaces

--Concrete

--Rubber3

--Steel4

Coal Fly Ash

Tire Rubber

Steel

-

-

16

67

15

85

9

33

“Post-consumer” material is “material or finished product that has served its intended use and has been diverted or

recovered from waste destined for disposal, having completed it life as a consumer item. Post-consumer material is part

of the broader category of recovered material.”

“Recovered Materials” refers to waste materials and by-products which have been recovered or diverted from solid

waste, but does not include those materials and by-products generated from, and commonly reused within, an original

manufacturing process

1 Consolidated latex paint used for covering graffiti, where color and consistency of performance are not primary concerns. 2 Reprocessed latex paint used for interior and exterior architectural applications such as wallboard, ceiling, and trim; gutterboards; and

concrete, stucco, masonry, wood, and metal surfaces.

3The recommended recovered materials content for rubber railroad grade crossing surfaces are based on the weight of the raw

materials, exclusive of any additives such as binders or additives 4 The recommended recovered materials content levels for steel in this table reflect the fact that the designated items can be made from

steel manufactured from either a Basic Oxygen Furnace (BOF) or an Electric Arc Furnace (EAF). Steel from the BOF process contains 25-

30% total recovered materials, of which 16% is post-consumer steel. Steel from the EAF process contains a total of 100% recovered steel,

of which 67% is post-consumer.

Commonwealth of Pennsylvania STD-274 Rev. 05/07/04

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(B) BIDDER’S CERTIFICATION

Bidder certifies that the construction product(s) which the bidder is offering contains the required minimum percentage

of post-consumer and recovered material content as shown above for the product.

(C) MANUFACTURER/MILL CERTIFICATION

In addition to the Bidders Certification in Subsection (B), a manufacturer certification must be completed and signed by

the manufacturer before payment will be made to the successful bidder for the delivered items. The enclosed

Manufacturer/Mill Certification form must be used. Bidders are not required to submit the completed and signed

Manufacturer/MIll Certification form with their bids. THE COMMONWEALTH SHALL HAVE NO OBLIGATION TO PAY FOR THE

ITEM(S) UNTIL A PROPERLY COMPLETED AND SIGNED MANUFACTURER/MILL CERTIFICATION IS SUBMITTED FOR THE DELIVERED

ITEM.

(D) ENFORCEMENT

Awarded bidders may be required, after delivery of the construction product(s), to provide the Commonwealth with

documentary evidence that the construction product(s) were in fact produced with the required minimum percentage

of post-consumer and recovered material content.

Commonwealth of Pennsylvania STD-274 Rev. 05/07/04

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EXHIBIT A-2

VEHICULAR PRODUCTS

RECYCLED CONTENT

(A) REQUIREMENT

All vehicular products offered by the bidder, or included in the final product offered by the bidder, and sold to the

Commonwealth must contain the minimum percentage of post-consumer and recovered material content as shown

below for the applicable products:

Vehicular Product

Requirements

Re-Refined Oil

25% re-refined oil base stock for engine lubricating oils,

hydraulic fluids, and gear oils.

“Post-consumer” material is “material or finished product that has served its intended use and has been diverted or

recovered from waste destined for disposal, having completed its life as a consumer item. Post-consumer material is

part of the broader category of recovered material.”

“Recovered Materials” refers to waste materials and by-products which have been recovered or diverted from solid

waste, but does not include those materials and by-products generated from, and commonly reused within, an original

manufacturing process.

“Re-refined oil” is oil that is manufactured with a minimum of twenty-five percent basestock made from used oil that has

been recovered and processed to make it reusable as oil. Once the oil has been refined, no difference can be

detected between re-refined and virgin oil.

(B) BIDDER’S CERTIFICATION

Bidder certifies that the vehicular product(s) which the bidder is offering contains the required minimum percentage of

post-consumer and recovered material content as shown above for the product.

(C) MANUFACTURER/MILL CERTIFICATION

In addition to the Bidders Certification in Subsection (B), a manufacturer certification must be completed and signed by

the manufacturer before payment will be made to the successful bidder for the delivered items. The enclosed

Manufacturer/Mill Certification form must be used. Bidders are not required to submit the completed and signed

Manufacturer/Mill Certification form with their bids. THE COMMONWEALTH SHALL HAVE NO OBLIGATION TO PAY FOR THE

ITEM(S) UNTIL A PROPERLY COMPLETED AND SIGNED MANUFACTURER/MILL CERTIFICATION IS SUBMITTED FOR THE

REFERENCED ITEM.

(D) ENFORCEMENT

Awarded bidders may be required, after delivery of the vehicular product(s), to provide the Commonwealth with

documentary evidence that the vehicular product(s) were in fact produced with the required minimum percentage of

post-consumer and recovered material content.

Commonwealth of Pennsylvania STD-274 Rev. 05/07/04

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EXHIBIT A-3

PAPER PRODUCTS

RECYCLED CONTENT

(A) REQUIREMENT

All paper offered by the bidder, or included in the final product offered by the bidder, and sold to the Commonwealth

must contain the minimum percentage of post-consumer content as shown below for the applicable products:

Item

Notes

Post-Consumer Content

(%)

Printing and Writing Papers

Reprographic

Business papers such as bond, electrostatic,

copy, mimeo, duplicator and reproduction

30

Offset

Used for book publishing, commercial

printing, direct mail, technical documents,

and manuals

30

Tablet

Office paper such as note pads and

notebooks

30

Forms bond

Bond type papers used for business forms

such as continuous, cash register, sales

book, unit sets, and computer printout,

excluding carbonless

30

Envelope

Wove

Kraft, white and colored (including manila)

Kraft, unbleached

Excludes custom envelopes

30

10

10

Cotton fiber

High-quality papers used for stationery,

invitations, currency, ledgers, maps, and

other specialty items

30

Text and cover

Premium papers used for cover stock,

books, and stationery and matching

envelopes

30

Supercalendered

Groundwood paper used for advertising

and mail order inserts, catalogs, and some

magazines

10

Machine finished groundwood

Groundwood paper used in magazines and

catalogs

10

Papeteries

Used for invitations and greeting cards

30

Check safety

Used in the manufacture of commercial

and government checks

10

Coated

Used for annual reports, posters, brochures,

and magazines. Have gloss, dull, or matte

finishes

10

Carbonless

Used for multiple-impact copy forms

30

File folders

Manila or colored

30

Dyed filing products

Used for multicolored hanging folders and

wallet files

20

Index and card stock

Used for index cards and postcards

20

Pressboard

High-strength paperboard used in binders

and report covers

20

Commonwealth of Pennsylvania STD-274 Rev. 05/07/04

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Tags and tickets Used for toll and lottery tickets, licenses, and

identification and tabulating cards

20

Newsprint

Newsprint

Groundwood paper used in newspapers

20

Commercial Sanitary Tissue Products

Bathroom tissue

Used in rolls or sheets

20

Paper towels

Used in rolls or sheets

40

Paper napkins

Used in food service applications

30

Facial tissue

Used for personal care

10

General-purpose

industrial wipers

Used in cleaning and wiping applications

40

Paperboard and Packaging Products

Corrugated containers

(<300 psi)

(300 psi)

Used for packaging and shipping a variety

of goods

25

25

Solid fiber boxes

Used for specialized packaging needs such

as dynamite packaging and army ration

boxes

40

Folding cartons Used to package a wide variety of foods,

household products, cosmetics,

pharmaceuticals, detergent, and hardware

40

Industrial paperboard

Used to create tubes, cores, cans and

drums

45

Miscellaneous

Includes “chipboard” pad backings, book

covers, covered binders, mailing tubes,

game boards, and puzzles

75

Padded mailers

Made from kraft paper that is usually brown

but can be bleached white

5

Carrierboard

A type of folding carton designed for

multipack beverage cartons

10

Brown papers

Used for bags and wrapping paper

5

Miscellaneous Paper Products

Tray liners

Used to line food service trays. Often

contain printed information.

50

“Post-consumer” content is “material or finished product that has served its intended use and has been diverted or

recovered from waste destined for disposal, having completed it life as a consumer item. Post-consumer content is part

of the broader category of recovered material.”

The Commonwealth of Pennsylvania recognizes that paper products are universally made with scrap material

recovered from the manufacturing process; use of such materials is a standard practice, both efficient and economical

for the paper maker; therefore, bidders of paper products need not certify that their products are made with “pre-

consumer,” “recovered.” or “secondary” paper fiber.

Commonwealth of Pennsylvania STD-274 Rev. 05/07/04

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(B) BIDDER’S CERTIFICATION

Bidder certifies that the paper product(s) which the bidder is offering contains the required minimum percentage of

post-consumer content as shown above for the product.

(C) MANUFACTURER/MILL CERTIFICATION

In addition to the Bidders Certification in Subsection (B), a mill certification must be completed and signed by the mill

before payment will be made to the successful bidder for the delivered items. The enclosed Manufacturer/Mill

Certification form must be used. Bidders are not required to submit the completed and signed Manufacturer/Mill

Certification form with their bids. THE COMMONWEALTH SHALL HAVE NO OBLIGATION TO PAY FOR THE ITEM(S) UNTIL A

PROPERLY COMPLETED AND SIGNED MANUFACTURER/MILL CERTIFICATION IS SUBMITTED FOR THE DELIVERED ITEM.

(D) ENFORCEMENT

Awarded bidders may be required, after delivery of the paper product(s), to provide the Commonwealth with

documentary evidence that the paper product(s) were in fact produced with the required minimum percentage of

post-consumer content.

Commonwealth of Pennsylvania STD-274 Rev. 05/07/04

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EXHIBIT A-4

LANDSCAPING PRODUCTS

RECYCLED CONTENT

(A) REQUIREMENT

All landscaping products offered by the bidder, or included in the final product offered by the bidder, and sold to the

Commonwealth must contain the minimum percentage of post-consumer and recovered material content as shown

below for the applicable products:

Landscaping Products Recovered Material Content

Hydraulic Mulch:

------Paper

------Wood/Paper

100% (post-consumer)

100% (total)

Compost Made From

Yard Trimmings and/or

Food Waste

Purchase or use compost made from yard trimmings, leaves, grass

clippings and/or food wastes for applications such as landscaping,

seeding of grass or other plants, as nutritious mulch under trees and

shrubs, and in erosion control and soil reclamation. DGS further

recommends implementing a composting system for these materials

when agencies have an adequate volume and sufficient space.

Garden Hose:

------Rubber and/or Plastic

Soaker Hose:

------Rubber and/or Plastic

60% (post-consumer)

60% (post-consumer)

Lawn and Garden Edging:

------Rubber and/or Plastic

30% (post-consumer)/30-100% (total)

Landscaping Timber and Posts:

------HDPE

------Mixed Plastics/Sawdust

------HDPE/Fiberglass

------Other mixed Resins

25% (post-consumer) + 50% (recovered)

50% (post-consumer) + 50% (recovered)

75% (post-consumer) + 20% (recovered)

50% (post-consumer) + 45% (recovered)

“Post-consumer” material is “material or finished product that has served its intended use and has been diverted or

recovered from waste destined for disposal, having completed it life as a consumer item. Post-consumer material is part

of the broader category of recovered material.”

“Recovered Materials” refers to waste materials and by-products which have been recovered or diverted from solid

waste, but does not include those materials and by-products generated from, and commonly reused within, an original

manufacturing process

(B) BIDDER’S CERTIFICATION

Bidder certifies that the landscaping product(s) which the bidder is offering contains the required minimum percentage

of post-consumer and recovered material content as shown above for the product.

(C) MANUFACTURER/MILL CERTIFICATION

In addition to the Bidders Certification in Subsection (B), a manufacturer certification must be completed and signed by

the manufacturer before payment will be made to the successful bidder for the delivered items. The enclosed

Manufacturer/Mill Certification form must be used. Bidders are not required to submit the completed and signed

Manufacturer/Mill Certification form with their bids. THE COMMONWEALTH SHALL HAVE NO OBLIGATION TO PAY FOR THE

ITEM(S) UNTIL A PROPERLY COMPLETED AND SIGNED MANUFACTURER/MILL CERTIFICATION IS SUBMITTED FOR THE DELIVERED

ITEM.

(D) ENFORCEMENT

Awarded bidders may be required, after delivery of the landscaping product(s), to provide the Commonwealth with

documentary evidence that the landscaping product(s) were in fact produced with the required minimum percentage

of post-consumer and recovered material content.

Commonwealth of Pennsylvania STD-274 Rev. 05/07/04

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EXHIBIT A-5

MISCELLANEOUS PRODUCTS

RECYCLED CONTENT

(A) REQUIREMENT

All miscellaneous products offered by the bidder, or included in the final product offered by the bidder, and sold to the

Commonwealth must contain the minimum percentage of post-consumer and recovered material content as shown

below for the applicable products:

Miscellaneous Products

Recovered Material Content

Awards and Plaques

----------Glass

----------Wood

----------Paper

----------Plastic and Plastic/Wood Composites

75% (post-consumer) + 25% (recovered)

100% (total)

40% (post-consumer)

50% (post-consumer) + 45% (recovered)

Industrial Drums

----------Steel1

----------Plastic (HDPE)

----------Fiber (paper)

16% (post-consumer) + 9% (recovered)

30% (post-consumer)

100% (post-consumer)

Mats

---------Rubber

---------Plastic

---------Rubber/Plastic Composite

75% (post-consumer) +10% (recovered)

10% (post-consumer) + 90% (recovered)

100% (post-consumer)

Pallets

---------Wood

---------Plastic

---------Thermoformed

---------Paperboard

95% (post-consumer)

100% (post-consumer)

25% (post-consumer)

50% (post-consumer)

Signage

---------Plastic

---------Aluminum

---------Plastic Sign Posts/Supports

---------Steel Sign Posts/Supports2

80% (post-consumer)

25% (post-consumer)

80% (post-consumer)

16% (post-consumer) + 9% (recovered)

67% (post-consumer) + 33% (recovered)

Sorbents

---------Paper

---------Textiles

---------Plastics

---------Wood3

---------Other Organics/Multimaterials4

90% (post-consumer) +10% (recovered)

95% (post-consumer)

25% (total)

100% (total)

100% (total)

Manual-Grade Strapping

----------Polyester

----------Polypropylene

----------Steel2

50% (post-consumer)

10% (total)

16% (post-consumer) +9% (recovered)

67% (post-consumer) +33% (recovered)

“Post-consumer” material is “material or finished product that has served its intended use and has been diverted or

recovered from waste destined for disposal, having completed it life as a consumer item. Post-consumer material is part

of the broader category of recovered material.”

“Recovered Materials” refers to waste materials and by-products which have been recovered or diverted from solid

waste, but does not include those materials and by-products generated from, and commonly reused within, an original

manufacturing process

1Steel used in steel drums is manufactured using the Basic Oxygen Furnace (BOF) process, which contains 25-30% total recovered material,

of which 16% is post-consumer steel. Steel used in manual-grade strapping is manufactured using either the BOF process or the Electric

Arc Furnace (EAF) process, which contains 100% total recovered materials, of which 67% is post-consumer steel. 2 The recommended recovered materials content levels for steel in this table reflect the fact that the designated items can be made from

steel manufactured in either a Basic Oxygen Furnace (BOF) or an Electric Arc Furnace (EAF). Steel from the BOF process contains 25-30%

total recovered materials, of which 16% is post-consumer steel. Steel from the EAF process contains a total of 100% recovered steel, of

which 67% is post-consumer. 3 “Wood” includes materials such as sawdust and lumber mill trimmings. 4 Examples of other organics include, but are not limited to, peanut hulls and corn stover. An example of multimaterial sorbents would

include, but not be limited to, a polymer and cellulose fiber combination. 2 The recommended recovered materials content levels for steel in this table reflect the fact that the designated items can be made from

steel manufactured in either a Basic Oxygen Furnace (BOF) or an Electric Arc Furnace (EAF). Steel from the BOF process contains 25-30%

total recovered materials, of which 16% is post-consumer steel. Steel from the EAF process contains a total of 100% recovered steel, of

which 67% is post-consumer.

Commonwealth of Pennsylvania STD-274 Rev. 05/07/04

21

(B) BIDDER’S CERTIFICATION

Bidder certifies that the miscellaneous product(s) which the bidder is offering contains the required minimum percentage

of post-consumer and recovered material content as shown above for the product.

(C) MANUFACTURER/MILL CERTIFICATION

In addition to the Bidders Certification in Subsection (B), a manufacturer certification must be completed and signed by

the manufacturer before payment will be made to the successful bidder for the delivered items. The enclosed

Manufacturer/Mill Certification form must be used. Bidders are not required to submit the completed and signed

Manufacturer/Mill Certification form with their bids. THE COMMONWEALTH SHALL HAVE NO OBLIGATION TO PAY FOR THE

ITEM(S) UNTIL A PROPERLY COMPLETED AND SIGNED MANUFACTURER/MILL CERTIFICATION IS SUBMITTED FOR THE DELIVERED

ITEM.

(D) ENFORCEMENT

Awarded bidders may be required, after delivery of the miscellaneous product(s), to provide the Commonwealth with

documentary evidence that the miscellaneous product(s) were in fact produced with the required minimum

percentage of post-consumer and recovered material content.

Commonwealth of Pennsylvania STD-274 Rev. 05/07/04

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EXHIBIT A-6

NONPAPER OFFICE PRODUCTS

RECYCLED CONTENT

(A) REQUIREMENT

All nonpaper office products offered by the bidder, or included in the final product offered by the bidder, and sold to

the Commonwealth must contain the minimum percentage of post-consumer and recovered material content as

shown below for the applicable products:

Nonpaper Office Product

Recovered Material Content

Recycling Containers and Waste Receptacles:

----------Plastic

----------Steel1

----------Paper

------------Corrugated

------------Solid Fiber Boxes

------------Industrial Paperboard

20% (post-consumer)

16% (post-consumer) +9% (recovered)

25% (post-consumer)

40% (post-consumer)

40% (post-consumer) + 60% (recovered)

Plastic Desktop Accessories (polystyrene) including desk

organizers, sorters, and trays, and memo, note, and pencil holders.

25% (post-consumer)

Binders:

----------Plastic-Covered

----------Paper-Covered

----------Pressboard

----------Solid Plastic

------------HDPE

------------PE

------------PET

------------Misc. Plastics

25%

75% (post-consumer) +15% (recovered)

20% (post-consumer) + 30% (recovered)

90% (post-consumer)

30% (post-consumer)

100% (post-consumer)

80% (post-consumer)

Trash Bags (plastic)

10% (post-consumer)

Toner Cartridges

Return used toner cartridges for remanufacturing

and reuse or purchase a remanufactured or

recycled-content replacement cartridge.

Printer Ribbons

Procure printer ribbon reinking or reloading services

or procure reinked or reloaded printer ribbons.

Plastic Envelopes

25% (post-consumer)

Plastic Clipboards:

------------HDPE

------------PS

------------Misc. Plastics

90% (post-consumer)

50% (post-consumer)

15% (post-consumer)

Plastic File Folders

------------HDPE

90% (post-consumer)

Plastic Clip Portfolios

------------HDPE

90% (post-consumer)

Plastic Presentation Folders

------------HDPE

90% (post-consumer)

“Post-consumer” material is “material or finished product that has served its intended use and has been diverted or

recovered from waste destined for disposal, having completed it life as a consumer item. Post-consumer material is part

of the broader category of recovered material.”

1 The recommended recovered materials content levels for steel in this table reflect the fact that the designated item is made from steel

manufactured from in a Basic Oxygen Furnace (BOF). Steel from the BOF process contains 25-30% total recovered materials, of which 16%

is post-consumer steel.

Commonwealth of Pennsylvania STD-274 Rev. 05/07/04

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“Recovered Materials” refers to waste materials and by-products which have been recovered or diverted from solid

waste, but does not include those materials and by-products generated from, and commonly reused within, an original

manufacturing process

(B) BIDDER’S CERTIFICATION

Bidder certifies that the nonpaper office products which the bidder is offering contains the required minimum

percentage of post-consumer and recovered material content as shown above for the product.

(C) MANUFACTURER/MILL CERTIFICATION

In addition to the Bidders Certification in Subsection (B), a manufacturer certification must be completed and signed by

the manufacturer before payment will be made to the successful bidder for the delivered items. The enclosed

Manufacturer/Mill Certification form must be used. Bidders are not required to submit the completed and signed

Manufacturer/Mill Certification form with their bids. THE COMMONWEALTH SHALL HAVE NO OBLIGATION TO PAY FOR THE

ITEM(S) UNTIL A PROPERLY COMPLETED AND SIGNED MANUFACTURER/MILL CERTIFICATION IS SUBMITTED FOR THE DELIVERED

ITEM.

(D) ENFORCEMENT

Awarded bidders may be required, after delivery of the paper, to provide the Commonwealth with documentary

evidence that the nonpaper office product(s) were in fact produced with the required minimum percentage of post-

consumer and recovered material content.

Commonwealth of Pennsylvania STD-274 Rev. 05/07/04

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EXHIBIT A-7

PARK & RECREATION PRODUCTS

RECYCLED CONTENT

(A) REQUIREMENT

All park and recreation products offered by the bidder, or included in the final product offered by the bidder, and sold

to the Commonwealth must contain the minimum percentage of post-consumer and recovered material content as

shown below for the applicable products:

Park & Recreation Product

Recovered Material Content1

Park Benches & Picnic Tables:

-----Plastic2

-----Plastic Composites

-----Aluminum

-----Concrete

-----Steel3

90% (post-consumer) + 10% (recovered)

50% (post-consumer) + 50% (recovered)

25% (post-consumer)

15% (total)

16% (post-consumer) + 9% (recovered)

67% (post-consumer) + 33% (recovered)

Plastic Fencing for Specified Uses4 60% (post-consumer) + 30% (recovered)

Playground Equipment

-----Plastic3

-----Plastic Composites

-----Steel4

-----Aluminum

90% (post-consumer) + 10% (recovered)

50% (post-consumer) + 45% (recovered)

16% (post-consumer) + 9% (recovered)

67% (post-consumer) + 33% (recovered)

25% (post-consumer)

Playground Surfaces:

-----Plastic or Rubber

90% (post-consumer)

Running Tracks:

-----Plastic or Rubber

90% (post-consumer)

“Post-consumer” material is “material or finished product that has served its intended use and has been diverted or

recovered from waste destined for disposal, having completed it life as a consumer item. Post-consumer material is part

of the broader category of recovered material.”

“Recovered Materials” refers to waste materials and by-products which have been recovered or diverted from solid

waste, but does not include those materials and by-products generated from, and commonly reused within, an original

manufacturing process

(B) BIDDER’S CERTIFICATION

Bidder certifies that the park and recreational product(s) which the bidder is offering contains the required minimum

percentage of post-consumer and recovered material content as shown above for the product.

(C) MANUFACTURER/MILL CERTIFICATION

In addition to the Bidders Certification in Subsection (B), a manufacturer certification must be completed and signed by

the manufacturer before payment will be made to the successful bidder for the delivered items. The enclosed

Manufacturer/Mill Certification form must be used. Bidders are not required to submit the completed and signed

Manufacturer/Mill Certification form with their bids. THE COMMONWEALTH SHALL HAVE NO OBLIGATION TO PAY FOR THE

ITEM(S) UNTIL A PROPERLY COMPLETED AND SIGNED MANUFACTURER/MILL CERTIFICATION IS SUBMITTED FOR THE DELIVERED

ITEM.

(D) ENFORCEMENT

Awarded bidders may be required, after delivery of the park and recreational product(s), to provide the

Commonwealth with documentary evidence that the park and recreational product(s) were in fact produced with the

required minimum percentage of post-consumer and recovered material content.

1 The recommended recovered materials content levels are based on the dry weight of the raw materials, exclusive of any additives such

as adhesives, binders, or coloring agents. 2 “Plastic” includes both single and mixed plastic resins. Park benches and picnic tables made with recovered plastic may also contain

other recovered materials such as sawdust, wood, or fiberglass. The percentage of these materials contained in the product would also

count toward the recovered materials content level of the item. 3 The recommended recovered materials content levels for steel in this table reflect the fact that the designated items can be made from

steel manufactured from either a Basic Oxygen Furnace (BOF) or an Electric Arc Furnace (AF). Steel from the BOF process contains 25-

30% total recovered materials, of which 16% is post-consumer steel. Steel from the EAF process contains a total of 100% recovered steel,

of which 67% is post-consumer. 4 Designation includes fencing containing recovered plastic for use in controlling snow or sand drifting and as a warning/safety barrier in

construction or other applications.

Commonwealth of Pennsylvania STD-274 Rev. 05/07/04

25

EXHIBIT A-8

TRANSPORTATION PRODUCTS

RECYCLED CONTENT

(A) REQUIREMENT

All transportation products offered by the bidder, or included in the final product offered by the bidder, and sold to the

Commonwealth must contain the minimum percentage of post-consumer and recovered material content as shown

below for the applicable products:

Transportation Products Recovered Material Content1

Traffic Cones:

-----Plastic (PVC and LDPE)

-----Crumb Rubber

50% (recovered)

50% (recovered)

Traffic Barricades (type I and II only):

-----Plastic (HDPE, LDPE, PET)

-----Steel2

-----Fiberglass

80% (post-consumer) + 20% (recovered)

16% (post-consumer) + 9% (recovered)

67% (post-consumer) + 33% (recovered)

100% (recovered)

Parking Stops:

-----Plastic and/or Rubber

-----Concrete Containing Coal Fly Ash

-----Concrete Containing Ground

Granulated Blast Furnace Slag

100% (recovered)

20% (recovered)

15% when used as a partial cement replacement as an admixture in

concrete.

25% (recovered)

Traffic Control Devices:

-----Channelizers:

---------Plastic

---------Rubber (base only)

------Delineators:

---------Plastic

---------Rubber (base only)

---------Steel (base only)2

-----Flexible Delineators

25% (post-consumer)

100% (post-consumer)

25% (post-consumer)

100% (post-consumer)

16% (post-consumer) + 9% (recovered)

67% (post-consumer) + 33% (recovered)

25% (post-consumer)

“Post-consumer” material is “material or finished product that has served its intended use and has been diverted or

recovered from waste destined for disposal, having completed it life as a consumer item. Post-consumer material is part

of the broader category of recovered material.”

“Recovered Materials” refers to waste materials and by-products which have been recovered or diverted from solid

waste, but does not include those materials and by-products generated from, and commonly reused within, an original

manufacturing process

(B) BIDDER’S CERTIFICATION

Bidder certifies that the transportation product(s) which the bidder is offering contains the required minimum percentage

of post-consumer and recovered material content as shown above for the product.

(C) MANUFACTURER/MILL CERTIFICATION

In addition to the Bidders Certification in Subsection (B), a manufacturer certification must be completed and signed by

the manufacturer before payment will be made to the successful bidder for the delivered items. The enclosed

Manufacturer/Mill Certification form must be used. Bidders are not required to submit the completed and signed

Manufacturer/Mill Certification form with their bids. THE COMMONWEALTH SHALL HAVE NO OBLIGATION TO PAY FOR THE

ITEM(S) UNTIL A PROPERLY COMPLETED AND SIGNED MANUFACTURER/MILL CERTIFICATION IS SUBMITTED FOR THE DELIVERED

ITEM.

(D) ENFORCEMENT

Awarded bidders may be required, after delivery of the transportation product(s), to provide the Commonwealth with

documentary evidence that the transportation product(s) were in fact produced with the required minimum

percentage of post-consumer and recovered material content.

1 Content levels are based on the dry weight of the raw materials, exclusive of any additives such as adhesives, binders, or coloring

agents. 2 The recommended recovered materials content levels for steel in this table reflect the fact that the designated items can be made from

steel manufactured from either a Basic Oxygen Furnace (BOF) or an Electric Arc Furnace (EAF). Steel from the BOF process contains 25-

30% total recovered materials, of which 16% is post-consumer steel. Steel from the EAF process contains a total of 100% recovered steel,

of which 67% is post-consumer.

Commonwealth of Pennsylvania STD-274 Rev. 05/07/04

26

MANUFACTURER/MILL CERTIFICATION

(To be submitted with invoice for each order)

TO BE COMPLETED BY MANUFACTURER/MILL:

NAME OF MANUFACTURER/MILL: ______________________________________________________

ADDRESS OF MANUFACTURER/MILL: ____________________________________________________

FEDERAL EMPLOYER I.D. NO.: __________________________________________________________

CONTRACT OR REQUISITION NO. ______________________________________________________

NAME OF CONTRACTOR: _____________________________________________________________

ADDRESS OF CONTRACTOR:___________________________________________________________

Type of product(s) which the manufacturer/mill furnished to the contractor: _____________

_____________________________________________________________________________________

_____________________________________________________________________________________

CERTIFICATION: I, the undersigned officer of the above-named manufacturer/mill, do hereby

certify that I am authorized to provide this certification on behalf of the above-named

manufacturer/mill and that the type of product(s) listed above which my company furnished to

the contractor named above for the referenced contract or purchase requisition, contained not

less than ______% post-consumer materials and ______% recovered materials as those terms are

defined in the invitation for bids. I understand that this document is subject to the provisions of

the Unsworn Falsification of Authorities Act (18 P.S. Section 4904).

_____________________________________

Signature

_____________________________________

Name of Signatory

_____________________________________

Title Date

CN #00020848 PPO and Medical Bill Review RFP

Instructions to Offerors: The following appendices are made part of the RFP and subsequent contract: Appendices marked with "*" must be returned with your proposal.

Appendix A: http://www.dgs.state.pa.us/dgs/lib/dgs/forms/comod/procurementforms/std274_sap.docAppendix B: Domestic Workforce Utiliziation Certification *Appendix C: Cost Proposal *Appendix D: Locations and Number of Policy HoldersAppendix E: Payroll Class CodeAppendix F: Part A & B Bill DataAppendix G: Confidentiality CertificationAppendix H: Interface SWIF to Offeror (updated)Appendix I: Interface Offeror to SWIF (updated)Appendix J: Image InterfaceAppendix K: Premium BandsAppendix L: Medical Bill WorkflowAppendix M: SWIF Trauma Bill Data (added)Appendix N: Signature Page*

Exhibit C -Cost Submittal

Instructions to Offerors:

CN #00020848

Offeror is required to populate all YELLOW cells.

All other cells are locked.The spreadsheet will automatically calculate Total Costs to the Commonwealth

Note: No negative percentages can be entered.

ALL REQUIRED (YELLOW) CELLS MUST BE POPULATED OR PROPOSAL WILL BE REJECTED.

Cost Proposals For SWIF Claims Administration and Panel/PPO/Discount Services

Medical Bill Review:

Estimated Annual Volume of Part A Medical Bills Processed 57,000Estimated Annual Volume of Part B Medical Bills Processed 193,000Estimated Annual Volume of Part B Medical Bill Line Items Processed 614,879Estimated Annual Volume of All Medical Bills Processed 250,000

Enter Unit Price per Part A Medical Bill Processed <--- Enter Price Here

Enter Unit Price per line of Part B Medical Bill Processed <--- Enter Price Here

Estimated Annual Bill Processing Fees (automatically calculated) -$

Panel/PPO/Discount

Baseline: Estimated Annual Value of Medical Bills Paid (WCA Fee Schedule) 105,000,000$

Anticipated Overall Percentage Savings Through Panel/PPO/Discounts <--- Enter Percentage Here

Anticipated Overall Savings Through Panel/PPO/Discounts -$

Enter Guaranteed Percentage Savings Earned Through Panel/PPO/Discounts <--- Enter Percentage Here

Est. Guaranteed Annual Savings to the Commonwealth (automatically calculated) -$

Savings in Excess of Guarantee -$

Split of Savings in Excess of Guarantee

Excess Savings up to $5 million -$

Commonwealth Split (fixed 60%) -$ Vendor Split (fixed 40%) -$

Excess Savings of $ 5 million - $10 million -$ Commonwealth Split (fixed 55%) -$

Vendor Split (fixed 45%) -$

Excess Savings of $10 million - $15 million -$ Commonwealth Split (fixed 50%) -$

Vendor Split (fixed 50%) -$

Excess Savings over $15 million -$ Commonwealth Split (fixed 45%) -$

Vendor Split (fixed 55%) -$

Total Est. Savings to Commonwealth (automatically calculated) -$

Total Est. Savings Retained by Vendor (automatically calculated) -$

One Time Start-up Costs

Cost to develop and implement interface from vendor to SWIF <--- Enter Fixed Price Here

Cost Summary

Bill Processing Fees (automatically calculated) -$

One Time Start-up Costs (automatically calculated) -$

Estimated Net Cost / Benefit to be Evaluated (automatically calculated) -$

2001 2002 2003 2004 2005

Per Year

Number of Policies - as of Year End 24,602 32,215 41,311 48,844 51,615 New Policies Written 7,504 13,716 17,515 18,114 13,052 Active Payment Plans 5,849 6,007 6,660 6,660 7,021 Number of Medical Bill Paid 120,833 168,709 211,528 248,692 249,462 Average Cost Medical Bill Paid 298$ 310$ 327$ 373$ 420$

Lost Time Injury Reports 2,988 4,929 6,835 8,070 9,895 Medical Only Injury Reports 7,842 11,651 15,092 18,793 26,509 Total Injury Reports 10,830 16,580 21,927 26,863 36,404

Medical Paid $35,991,000 $52,238,000 $69,203,000 $92,708,000 $104,756,426Indemnity Paid $108,513,000 $105,029,000 $111,484,000 $133,269,000 $154,599,294

Total No. of Policyholders: As Of Year EndPolicies with premium under $2,000 16,451 19,866 25,602 29,790 31,842 Policies with premium $2,001 to $10,000 6,007 8,538 10,870 13,092 13,435 Policies with premium $10,001 to $50,000 1,769 3,059 3,893 4,761 5,042 Policies with premium over $50,000 375 752 946 1,201 1,296 Total Policies 24,602 32,215 41,311 48,844 51,615

No. of Policyholders by District OfficePhiladelphia 7,086 9,570 12,852 15,283 16,435 Harrisburg 2,208 2,913 3,756 4,597 4,972 Pottsville 2,135 2,811 3,892 4,842 5,122 Sunbury 1,186 1,565 1,947 2,378 2,460 Pittsburgh 5,582 6,930 8,407 9,752 10,193 Scranton 1,738 2,271 2,956 3,591 3,860 Erie 1,143 1,636 2,050 2,406 2,584 Johnstown 1,856 2,474 3,043 3,517 3,652 Out-of –State 1,668 2,045 2,408 2,478 2,337 Total 24,602 32,215 41,311 48,844 51,615

STATE WORKERS' INSURANCE FUND - PAYROLL RANKED BY CLASS CODE - TOP 50 CLASSES

CLASS CLASS 12/31/2005 12/31/2004 12/31/2003 12/31/2002 12/31/2001

CODE DESCRIPTION PAYROLL PAYROLL PAYROLL PAYROLL PAYROLL

953 OFFICE CLERICAL 1,769,623,706 1,713,426,545 1,493,867,757 1,235,954,928 817,474,574 951 OUTSIDE SALESMAN 624,384,125 651,171,845 572,393,393 487,295,403 352,412,197 957 PHYSICIAN OR DENTIST OFFICE 563,157,966 574,240,875 497,276,681 400,496,673 341,616,108

7405 * AIRCRAFT OPERATION SCHEDULED 340,957,223 341,909 136,620 158,677 133,774 7445 * CATASTROPHE RESERVE 340,957,223 341,909 136,620 158,677 133,774 7428 * AIRPORT OPERATION GROUND 242,182,482 17,197,088 16,386,230 13,418,011 10,172,591

811 TRUCKING N O C 194,802,876 178,402,735 124,361,645 104,866,459 50,305,265 891 PRE-SCHOOL 181,823,483 178,568,912 143,149,781 106,210,067 69,658,861 889 EMPL CONTR TEMP CLERICAL STAFF 148,154,643 145,776,015 119,302,952 116,390,650 90,663,010 652 CARPENTRY - RESIDENTIAL 141,163,354 132,276,069 96,451,339 79,115,184 53,344,841 965 COLLEGE OR SCHOOL N O C 139,019,748 139,793,017 107,032,591 69,696,425 59,856,970 971 COMMERCIAL BUILDING CLEANING 107,336,925 112,232,008 102,670,153 79,117,822 52,906,517 956 LAW FIRM 104,456,095 182,237,138 144,874,713 104,302,698 98,829,888 955 ENGINEERING CONSULTING FIRM 97,542,128 100,961,188 97,257,211 75,945,891 48,438,518 975 RESTAURANT N O C 97,173,316 119,658,686 99,163,044 60,432,833 37,118,282 815 AUTOMOBILE SERVICE CENTER 96,284,657 99,957,913 72,957,519 42,495,350 23,716,038 985 POLICE & FIREFIGHTER 83,273,188 73,633,421 63,627,869 37,773,978 16,858,050 807 AMBULANCE SERVICE-NON VOL 77,938,009 78,965,474 80,942,009 44,617,418 12,352,591 897 FAST-FOOD RESTAURANT 74,771,215 64,756,344 47,214,662 33,628,989 19,385,527 941 SOCIAL REHAB FACILITY 73,797,751 65,090,564 60,768,824 40,469,563 35,234,643 609 EXCAVATION N O C 72,446,710 71,140,907 53,337,478 35,483,192 21,530,551 928 RETAIL STORE N O C 70,324,155 73,190,370 77,786,308 52,109,312 37,359,135 976 YMCA YWCA 69,178,567 69,913,077 53,785,492 42,147,247 25,810,654 663 PLUMBING N O C 68,037,424 75,520,089 61,277,923 32,359,154 17,545,953 943 HOME HEALTH CARE NON-PROF STF 65,172,221 43,075,701 24,770,336 16,773,158 7,446,970 675 MILLWRIGHTING 62,740,613 51,534,848 41,556,680 36,454,989 24,966,942 651 CARPENTRY N O C 59,758,531 62,421,330 51,120,848 46,023,269 24,860,441 942 HOME HEALTH CARE PROF STAFF 59,177,315 60,901,411 51,373,318 42,491,512 25,838,431 661 ELECTRICAL CONTRACTOR 56,741,967 51,478,227 34,575,944 26,645,259 9,875,042 986 SHELTER OR HALFWAY HOUSE RES 56,016,912 50,395,147 38,123,563 24,376,885 18,920,732 12 LANDSCAPE CONTRACTOR 52,375,730 46,996,047 28,404,789 2,482,788

899 BAR 51,951,665 46,044,128 38,359,702 26,639,834 16,181,402 980 CITY TOWN OR BORO 51,808,536 51,761,237 46,010,039 32,238,664 16,906,407 664 HEATING AIR COND & VENT CONT 50,487,988 46,346,193 30,509,358 22,974,506 11,963,141 653 MASONRY N O C 49,977,081 46,603,663 40,055,452 35,456,104 18,524,478 461 MACHINE SHOP N O C 49,845,111 53,152,567 37,973,960 43,953,419 23,624,603 946 EMPL CONTR TEMP MED STAFFING 48,202,570 49,182,547 48,176,637 49,130,930 20,176,108 305 CARPENTRY SHOP 47,911,427 41,730,525 46,855,078 19,862,711 10,396,735 818 AUTOMOBILE DEALER 47,682,777 42,390,017 41,286,828 30,532,636 19,765,335 917 GROCERY STORE RETAIL 47,217,340 60,462,125 36,573,334 24,209,694 7,905,102 960 NURSING & CONV HOMES LIC 46,805,104 22,481,993 24,690,000 6,353,460 987,910 995 RUBBISH OR GARBAGE REMOVAL 45,902,778 38,295,388 31,884,782 23,677,783 11,818,517 608 FLAT CEMENT WORK 44,772,748 44,145,731 32,404,626 29,201,925 17,240,619 855 LUMBER & BLDG MATERIAL DEALR 42,452,227 35,023,847 26,287,552 21,585,808 8,326,705 969 AMUSEMENTS OUTDOOR 42,426,598 40,355,518 45,623,402 26,749,721 18,559,396 903 LABOR UNION 41,867,971 35,507,857 30,772,677 3,001,452 659 ROOFING 40,401,116 42,094,305 36,487,124 26,741,626 18,248,437 963 CHURCH 38,595,558 35,661,562 36,852,836 27,585,509 24,773,835 894 SCHOOL FOR THE DISTURBED 37,304,673 36,414,769 31,917,993 30,386,022 22,618,812 962 ACCOUNTING OR AUDITING FIRM 37,029,448 41,526,197 41,430,148 36,177,241 29,151,546 967 THEATRE 36,277,565 40,700,521 37,108,958 19,539,439 18,182,866

* Payroll all related to Policy with US Air effective 2/15/2005 to 9/30/2005

BILL TYPE DESCRIPTION NO. OF BILLS BILLED AMT REPRICED AMT AMT SAVED % SAVED

2005

PART AHOSPITAL 40,546 $88,627,338 $33,597,144 $55,030,194 62NURSING CARE 693 $2,212,335 $1,962,101 $250,234 11TOTAL FOR PART A 41,239 $90,839,673 $35,559,245 $55,280,427 61

PART BDOCTORS 91,248 $41,900,471 $24,310,609 $17,589,862 42CHIROPRACTORS 11,832 $5,011,533 $3,823,289 $1,188,243 24PHYSICAL THERAPY 27,445 $14,437,200 $9,892,671 $4,544,529 31AMBULANCE 1,337 $954,403 $771,390 $183,013 19PRESCRIPTIONS 46,039 $12,912,305 $11,650,460 $1,261,844 10TOTAL FOR PART B 177,901 $75,215,910 $50,448,419 $24,767,491 332005 TOTALS 219,140 $166,055,583 $86,007,665 $80,047,918 48

2004

PART AHOSPITAL 36,010 66,136,812.53 28,427,573.32 37,709,239.21 57NURSING CARE 859 1,994,935.31 1,635,717.04 359,218.27 18TOTAL FOR PART A 36,869 68,131,747.84 30,063,290.36 38,068,457.48 56

PART BDOCTORS 109,168 43,999,960.48 25,418,372.43 18,581,588.05 42CHIROPRACTORS 12,870 4,554,233.29 3,299,359.46 1,254,873.83 28PHYSICAL THERAPY 18,364 7,922,504.43 5,393,237.52 2,529,266.91 32AMBULANCE 1,078 731,833.59 584,416.86 147,416.73 20PRESCRIPTIONS 48,395 12,634,828.29 11,578,969.54 1,055,858.75 8TOTAL FOR PART B 189,875 69,843,360.08 46,274,355.81 23,569,004.27 342004 TOTALS 226,744 137,975,107.92 76,337,646.17 61,637,461.75 45

2003

PART AHOSPITAL 32,163 60,525,091.60 25,440,966.83 35,084,124.77 58NURSING CARE 882 1,606,507.38 1,488,081.58 118,425.80 7TOTAL FOR PART A 33,045 62,131,598.98 26,929,048.41 35,202,550.57 57

PART BDOCTORS 96,452 40,207,279.95 22,534,994.89 17,672,285.06 44CHIROPRACTORS 12,535 4,676,448.38 3,302,286.23 1,374,162.15 29PHYSICAL THERAPY 15,492 6,663,103.86 4,513,513.87 2,149,589.99 32AMBULANCE 991 582,507.54 466,611.15 115,896.39 20

PRESCRIPTIONS 43,543 10,925,770.97 10,044,693.52 881,077.45 8TOTAL FOR PART B 169,013 63,055,110.70 40,862,099.66 22,193,011.04 352003 TOTALS 202,058 125,186,709.68 67,791,148.07 57,395,561.61 46

2002

PART AHOSPITAL 25,839 37,936,015.57 18,739,549.43 19,196,466.14 51NURSING CARE 837 1,495,966.49 1,384,953.42 111,013.07 7TOTAL FOR PART A 26,676 39,431,982.06 20,124,502.85 19,307,479.21 49

PART BDOCTORS 75,656 28,406,519.32 16,500,563.69 11,905,955.63 42CHIROPRACTORS 10,044 3,354,962.21 2,354,174.41 1,000,787.80 30PHYSICAL THERAPY 9,339 4,143,265.03 2,770,720.02 1,372,545.01 33AMBULANCE 701 372,285.59 299,815.05 72,470.54 19PRESCRIPTIONS 36,913 8,858,086.29 8,230,496.96 627,589.33 7TOTAL FOR PART B 132,653 45,135,118.44 30,155,770.13 14,979,348.31 332002 TOTALS 159,329 84,567,100.50 50,280,272.98 34,286,827.52 41

2001

PART AHOSPITAL 16,287 22,724,873.69 12,438,484.93 10,286,408.76 45NURSING CARE 781 1,201,286.66 1,124,067.49 77,219.17 6TOTAL FOR PART A 17,068 23,926,160.35 13,562,532.42 10,363,627.93 43

PART BDOCTORS 52,017 21,287,323.66 12,132,920.90 9,154,402.76 43CHIROPRACTORS 7,747 2,695,757.62 1,929,468.96 766,288.66 28PHYSICAL THERAPY 4,931 2,393,815.92 1,722,065.09 671,750.83 28AMBULANCE 305 177,530.20 144,973.10 32,557.10 18PRESCRIPTIONS 29,549 7,127,390.83 6,405,941.54 721,449.29 10TOTAL FOR PART B 94,549 33,681,818.23 22,335,369.59 11,346,448.64 342001 TOTALS 111,617 57,607,978.58 35,897,902.01 21,710,076.57 38

NOTE: This spreadsheet does not include data relating to trauma bills.

State Workers’ Insurance Fund Preferred Provider Organizations

AND Comprehensive Medical Bill Review Services Contract

CONFIDENTIALITY CERTIFICATION

I am employed by, or have been engaged by, __________, to perform services under the Contract between the State Workers’ Insurance Fund (SWIF) and _______________ (the Contract).

I understand that in the performance of the Contract, I will receive, or have access to, information pertaining to SWIF, SWIF policyholders and SWIF claimants. I agree to keep all of this information confidential, including, but not limited to, medical or health information specific to an individual SWIF claimant. I agree that I will use any information I receive, or have access to, in the performance of this Contract only in conjunction with the performance of the Contract. I agree that I will not discuss with or reveal to anyone, in any manner, any of the information I receive, or have access to, in the performance of this Contract, except as necessary to perform services under this Contract or to other persons who have also signed this Confidentiality Certification. I agree that I will not reveal this information to my family, friends or business associates or use the information for any personal, commercial or other use. I have read this entire Certification and understand that information pertaining to SWIF, including, but not limited to, any medical or health information specific to an individual SWIF claimant, may be used only for the purpose of performing the Contract and that the use of this information for any other purpose is strictly prohibited. _____________________________ (Signature) _____________________________ (Name – Print or Type) ____________________________ (Date)

State Workers’ Insurance Fund Preferred Provider Organizations

AND Comprehensive Medical Bill Review Services Contract

CONFIDENTIALITY CERTIFICATION

I am employed by, or have been engaged by, __________, to perform services under the Contract between the State Workers’ Insurance Fund (SWIF) and _______________ (the Contract).

I understand that in the performance of the Contract, I will receive, or have access to, information pertaining to SWIF, SWIF policyholders and SWIF claimants. I agree to keep all of this information confidential, including, but not limited to, medical or health information specific to an individual SWIF claimant. I agree that I will use any information I receive, or have access to, in the performance of this Contract only in conjunction with the performance of the Contract. I agree that I will not discuss with or reveal to anyone, in any manner, any of the information I receive, or have access to, in the performance of this Contract, except as necessary to perform services under this Contract or to other persons who have also signed this Confidentiality Certification. I agree that I will not reveal this information to my family, friends or business associates or use the information for any personal, commercial or other use. I have read this entire Certification and understand that information pertaining to SWIF, including, but not limited to, any medical or health information specific to an individual SWIF claimant, may be used only for the purpose of performing the Contract and that the use of this information for any other purpose is strictly prohibited. _____________________________ (Signature) _____________________________ (Name – Print or Type) ____________________________ (Date)

Claim Information for Medical Bills Field Definitions

Policy Number Policy number assigned by PowerComp for insuredClaim Number Claim Number assigned by Powercomp for claimClaimant Name Name of claimant that injury occurred toClaimant Address Line 1 Claimant's primary residence address(line 1)Claimant Address Line 2 Claimant's primary residence address(line 2)City Claimant's primary city residence State Claimant's primary state of residence Zip Code Claimant's primary zip code of residence County Claimant's primary county of residence Country Claimant's primary country of residence Claimant Telephone Number Claimant's primary phone numberClaimant SSN Claimant's social security numberDate of Injury The date that the injury occurred for this claimClaimant Date of Birth Claimant's birth dateICD9 Code Primary Primary AMA Code for medical diagnosis or treatment ICD9 Codes (Secondary) Secondary AMA Code for medical diagnosis or treatment Primary Part of Body Primary part of body that was injuredNature of Injury How the injury occurred (fall, struck, burn, etc.)

Appendix H - Representative Interface List - From SWIF to Offeror

Bill Format - Header (medical bills) Field Definitions Bill Format - Line Item (medica Field Definitions

Record Type H = for header record Record Type L = for Line Item recordBill Format Type HCFA or Pharmacy Begin Service Date The beginning date for the services being billedClaim Number Claim Number assigned by Powercomp End Service Date The ending date for the services being billedClaimant Name Name of claimant that injury occurred to CPT Code Type of treatment providedClaimant Address Line 1 Claimant's primary residence address(line 1) HCPC Code Treatment supplies used including ambulance serviceClaimant Address Line 2 Claimant's primary residence address(line 2) NDC Code National Drug Code if drugs have been administeredClaimant City Claimant's primary city residence CDT Code Dental procedure codeClaimant State Claimant's primary state of residence UB92 Revenue Code UB92 Revenue Code present on UB92 bill Claimant Zip Code Claimant's primary zip code of residence ICD9 Code AMA Code for medical diagnosis or treatment Claimant County Claimant's primary county of residence Unit Type of units administered to patient(claimant) ML, ect.Claimant Country Claimant's primary country of residence Charged Amount Amount charged for this treatmentClaimant Telephone Number Claimant's primary phone number Paid Amount Amount actually paid Claimant SSN Claimant's social security number Approved Amount Amount approved to be paidDate of Injury The date that the injury occurred for this claim Fee Schedule Amount Fee amount that SWIF will pay for this line item as identified by zoneClaimant Date of Birth Claimant's birth date Reduction Reason Code Reason for Reduction of billed amount for a charge denied ICD9 Code Primary Primary AMA Code for medical diagnosis or treatment Description Description of reduction reason codeICD9 Codes (Secondary) Secondary AMA Code for medical diagnosis or treatment Inpatient Covered Days Number of days covered for this treatment as inpatientPrimary Part of Body Primary part of body that was injured DRG Claim Stay Length Average length of stay for DRG ClaimNature of Injury How the injury occurred (fall, struck, burn, etc.) DRG Number Diagnostic Related Grouping numberService Provider FEIN Federal identification number of physician that attended the claimant DRG Cover Charge Cover Charge for DRG claimService Provider Name Name of physician that attended to the claimant DRG Claim Discharge Status Discharge status for DRG claimService Provider Address Line 1 Address line 1 of physican that attended to the claimant Master Service Charge Charge Master Service Code of Type of service codeService Provider Address Line 2 Address line 2 of physican that attended to the claimant Modifier Code Modified reduction reason codeService Provider City City of physican that attended to the claimant FED amount Longshoreman Federal Payment AmountService Provider State State of physican that attended to the claimant CPTL FSP amount LongShoreman Capital Federal Specific PaymentService Provider Zip Code Zip code of physican that attended to the claimant CPTL HSP amount LongShoreman Capital Hospital Specific PaymentService Provider County County of physican that attended to the claimant IME OPCPTL amount LongShoreman Indirect Medical Education add onService Provider Telephone Number Telephone number of physican that attended to the claimant DSPPSH OPCPTL amount LongShoreman Disproportionate Share add onReceived Date Date claim was received by SWIF DD OTLR OPCPTL amount LongShoreman Day Outlier add onDate of Entry Date the claim was entered into the Powercomp system CST OTLR OPCPTL amount LongShoreman Cost Outlier add onService Effective Date Effective date of services performed for claimant DIR PRMD EDUC ADJ amount LongShoreman Direct and Paramedical Medical Education AdjustmentService End Date Ending Date of services performed for claimant for bill IME amount Indirect Medical Education add onProvider Patient Reference Number The patient number that the provider assigned to this claimant DSPPSH amount Disproportionate Share add onProvider Bill Reference Number The bill number that the provider assigned to this claimant CPTL RT amount Capital portion of the DRG calculationProvider Medicare Number The medicare number of the provider(physician) DIR MED EDUC amount Direct Medical Education add on

Medical Expense CodeThe type of expense the provider is charging (Scheduling Medical Examination, Independent Medical Exam (IME)) CST OTLR amount

Cost Outlier add on

Service Location Zip Code Zip code of location where treatment is provided HOLD HRMLS amount Hold Harmless rate

Reduction AmountReduction amount to billed amount for a charge denied due to insuffcient claim info, ect. PRMD EDUC amount

Paramedical Education add on

Reduction Percent Percentage of denied amount to total billed amount DD OTLR amount Day Outlier add onReduction Reason Code Reason for Reduction of billed amount for a charge denied DIAG RLT GRP amount DRG amountPPO Invoice Amount Amount of total bill less the discount agreed upon by the PPO and SWIFPPO Discount Amount Amount of discount as agreed upon between PPO and SWIFTotal Charged Amount Actual charged amount by providerBill Payer ID Code SWIF's payer I.d. number

Appendix IRepresentative Interface List

From Offeror to SWIF

Document Type HCFA 1500 - Part B Billings UB 92 - Part A Billings (Medical)

Claim Number 1465001Unique Powercomp Bill ID

4999982 (In order to display document from Powercomp)

Workflow Flag Y or NDocument Received Date

8/19/2004

Full Path of .tif D:\DIPIN\SWIFCWO04236-195224_002.TIFDocument Date 8/19/2004Document Description UB 92 - Part A Billings (Medical)

HCFA 1500 - Part B Billings Medical Flag Y or NDocument Tracking Number

Box #, page #

Representative Image Interface ListFrom Offeror to SWIF

Premium in Force at year end by Premium Band.

2005 2004 2003 2002 2001

0 - $2,000 $22,797,072 $21,775,553 $18,691,504 $14,505,640 $11,418,661

$2,001 - $10,000 $60,703,384 $58,847,494 $49,052,800 $38,420,242 $26,470,717

$10,001 - $50,000 $108,932,765 $101,302,303 $81,175,585 $62,291,951 $34,760,338

$50,001 and Over $148,621,986 $141,602,679 $111,884,493 $97,261,344 $46,423,011

Total $341,055,207 $323,528,029 $260,804,382 $212,479,177 $119,072,727

MEDICAL BILL WORKFLOW

Using the interface, SWIF electronically sends policy and claims data to Offeror

Offeror images bill and notes

Offeror recodes bill, reprices bill to WCA fee schedule,

and applies additional PPO / negotiated discounts

SWIF audits bills and approves payment or further investigates

the claim

Offeror receives medical bill directly from provider or from SWIF

Using the interface, Offeror electronically sends repriced file and

images to SWIF

SWIF Trauma Bill Data

Year Amount Billed Amount Paid Amount Saved % Saved

2005 22,840,564 20,820,090 $2,020,474 8.8

2004 16,467,139 14,632,657 $1,834,482 11.1

2003 8,205,833 7,211,828 $994,005 12.9

2002 6,238,295 5,682,089 $556,206 8.9

2001 2,603,521 2,453,083 $150,438 5.8

COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF GENERAL SERVICES

SWIF PPO and Medical Bill Payment RFP# __CN00020848_________________

Enclosed in three separately sealed submittals is the proposal of the Offeror identified below for the above-referenced RFP:

Offeror Information:

Offeror Name Offeror Mailing Address

Offeror Website Offeror Contact Person Contact Person’s Phone Number Contact Person’s Facsimile Number Contact Person’s E-Mail Address Offeror Federal ID Number

Submittals Enclosed and Separately Sealed:

� Technical Submittal

� Disadvantaged Business Submittal

� Cost Submittal

Signature Signature of an official authorized to bind the Offeror to the provisions contained in the Offeror’s proposal:

Printed Name: Title: FAILURE TO COMPLETE, SIGN AND RETURN THIS FORM WITH THE OFFEROR’S PROPOSAL MAY RESULT IN THE REJECTION OF THE OFFEROR’S PROPOSAL

8/30/2012 8:56 AM 1

RFP DGS-CN-00020848 QUESTIONS & RESPONSES

1. When the DGS assumed responsibility for reissuing the RFP on behalf of SWIF,

why didn’t the DGS issue an RFP which addressed only those services (repricing)

which have been outsourced for the past 1-1/2 years to “emergency” vendors?

This question is irrelevant to the preparation of a proposal in response to this RFP

and, therefore, no further response is required.

2. What was the DGS/SWIF’s reasoning for once again complicating this particular

procurement by adding panel development, PPO network, non-network,

adjudication, electronic transfer, and image storage services when these are not

services that SWIF has an immediate need for or at least has not issued

emergency procurements for? Wouldn’t the decision to add these services

significantly increase the chances of the RFP being withdrawn or the bids rejected

again?

This question is irrelevant to the preparation of a proposal in response to this RFP

and, therefore, no further response is required.

3. Did the DGS make any effort to recruit individuals who were experienced with

medical bill review, repricing, panel development, PPO network, and non-

network services to assist with the writing of this RFP? If so, what are the names

of those individuals and what are their relevant backgrounds? Are any of these

individuals’ potential offerors, affiliated or contracted with potential offerors, or

contracted with SWIF for any other services? Did these individuals have access

to the reasons the previous bids were withdrawn and/or rejected in the past? If so,

what were those reasons? Did they have access to the revisions made to the

previous RFP’s due to the prospective vendors’ RFP questions? If so, why didn’t

they incorporate them into this new RFP so that it wouldn’t need revised again?

This question is irrelevant to the preparation of a proposal in response to this RFP

and, therefore, no further response is required.

4. If this RFP is withdrawn or “all bids rejected”, will the DGS consider issuing an

RFP for only the repricing services which are currently being outsourced to

“emergency vendors”?

This question is irrelevant to the preparation of a proposal in response to this RFP

and, therefore, no further response is required.

5. Are the “emergency vendors” currently performing any other services listed in

this RFP, other than repricing? If so, please identify those.

8/30/2012 8:56 AM 2

The emergency vendors are entering and repricing medical bills.

6. Section IV-5.1 b(1) of this RFP states “Describe how the Offeror will work with

designated SWIF personnel during the implementation of the contract and

indicate capability to make an orderly transition of services to coincide with the

expiration of the current emergency procurements, without an interruption of

service to SWIF customers”. In order for an Offeror to adequately reply to this

requirement, can you please convey the actual expiration date of the current

emergency procurements? If this date is the actual last expiration date of the

emergency procurement and no further extensions are approved by the DGS, will

the DGS at minimum require that SWIF consider other vendors for the emergency

procurements if, for any reason, a vendor is not selected for this RFP?

The scope of work sought by the RFP exceeds the services being provided pursuant

to current emergency procurements. Potential Offerors should refer to the RFP

and formal question responses in preparing their RFP proposals. The

Commonwealth anticipates awarding a contract for the services sought by the RFP

as soon as possible. The current emergency procurements expire on October 31,

2006.

7. In order for Offerors to be competitive with the emergency vendors and since

contract procurement information is public information, can you please provide

the contract price and service terms between SWIF and the two current

emergency vendors? Specifically, what are the prices SWIF is paying to each

vendor for the following repricing services:

A. Per line repricing charge for Part B bills

B. Flat fee for Part A bills

C. Any and all additional fees such as incentive or implementation fees

If there is an alternative pricing structure other than the above, please provide

detailed information regarding the price and terms.

The scope of work sought by the RFP exceeds the services being provided pursuant

to current emergency procurements. Potential Offerors should refer to the RFP

and formal question responses in preparing their RFP proposals. The

Commonwealth anticipates awarding a contract for the services sought by the RFP

as soon as possible. The current emergency procurements expire on October 31,

2006. The Part A bill charge in the emergency procurements is $30. The Part B

bill per line charge in the emergency procurements is $1. The duplicate/flawed bill

fee is $5 per bill.

8. According to Section 1-15, offerors are to limit their response to 75 pages or less

(excluding exhibits and appendixes). Therefore, please clarify what format you

would prefer a vendor to respond to each Section. Specifically, would you prefer

8/30/2012 8:56 AM 3

that the vendor restated the SWIF requirement and then respond to the

requirement below each one? Or could a vendor just state the Section number and

paragraph and respond? Depending on the DGS’s preference, the number of

pages for the bid response may need increased.

Please format responses per the instructions on pages 9 through 16 of the RFP. It

is not necessary to restate the RFP requirements in the response. Referencing the

relevant RFP Section number and paragraph is acceptable and encouraged.

9. Section I-16 Alternate Proposals indicates that the Issuing Office will not accept

alternate proposals. In this particular instance, when SWIF has repeatedly

withdrawn RFP’s and rejected bid all bids, what is the DGS’s reasoning for not

allowing offerors to submit a more functional and cost effective alternative bid

response that makes fiscal and operational sense in addition to the required

response? Wouldn’t this be a good way for the DGS to understand how many

other Pennsylvania insurance carriers have successfully implemented these

services? To our knowledge, there is no other PA insurance carrier that has

implemented these services in the manner required in this RFP. What research

did the DGS/SWIF conduct to determine the requirements in this RFP?

This question is irrelevant to the preparation of a proposal in response to this RFP

and, therefore, no further response is required.

10. Section II-5 (5) Offeror and Personnel Qualifications requires offerors to describe

their experience with “providing comprehensive review and prepayment services

related to medical bills for injured workers submitted to Compensation Act”.

Since there is no provision in the PA WC Act for any type of prepayment

services, please clarify the definition and relevance of prepayment services as it

applies to this RFP.

Bills will continue to be paid by the Treasury of the Commonwealth of

Pennsylvania. “Prepayment” merely refers to the services that must be performed

by a Successful Offeror up to the point that it notifies SWIF that a bill should be

paid and identifies the amount that should be paid and SWIF take the necessary

actions to effect payment by the Treasury.

11. Section II-7 Objections and Additions to Standard Contract Terms and Conditions

explains how an offeror would identify terms and conditions (contained in

Appendix A) it would like to renegotiate and what terms they would like to add.

Where in the RFP response would an offeror object to a provision in Section I-19

Proposal Contents? Specifically, how would an offeror object to the provision

“All material submitted with the proposal becomes the property of the

Commonwealth of PA and may be returned only at the Issuing Office’s option.

The Issuing Office has the right to use any or all ideas presented in any proposal

regardless of whether the proposal becomes part of a contract.”?

8/30/2012 8:56 AM 4

If this requirement is mandatory and cannot be objected, does the DGS

recommend that all offerors keep their responses vague or reply that certain

information will be provided if offeror is selected as the official vendor to prevent

SWIF from utilizing our confidential and proprietary information for their own

benefit without compensation to us? Can SWIF legally or ethically continue to

issue RFP’s for the same services and continually withdraw and reject the bids so

that they can eventually collect enough of the offerors’ information to perform the

services on their own? What recourse, legal or otherwise, would an Offeror have

if they ultimately decided to do this?

“Material” in this provision does not mean intellectual property; it merely means

the proposal package. While the Commonwealth will have the right to use ideas

presented in vendors’ proposals, the provision is not intended to assert that the

Commonwealth may use vendor-owned information in violation of intellectual

property rights or without compensation. Offerors may not object to this provision

and should disclose sufficient information in their proposal upon which the

Commonwealth may properly evaluate the technical merits of the proposal.

Offerors must seek their own legal counsel. The remainder of the question is

irrelevant to preparation of responses to this RFP and, therefore, no further

response is required.

12. Sections IV-1.2 (d), IV-2.2 (b), and IV-3.3 indicate that “Offerors must be able to

determine whether services reported on bills are related to the work injury

suffered by the claimant and whether the services are appropriate to the injury.

Since the SWIF adjusters typically perform these services, is SWIF now

outsourcing their adjusting function via this RFP? Without access to the actual

injury report and the information gathered by the SWIF investigators, how could

the DGS/SWIF reasonably expect a medical bill review and repricing vendor to

perform this claims adjudication process? Since this is not a reasonable function

performed by medical bill review and repricing vendors, will the DGS consider

deleting this requirement? If not, please provide clarification.

SWIF adjusters are currently responsible for overall management of claim files.

SWIF adjusters will continue to perform this function after a successful offeror is

selected.

A successful offeror will have access to the information it needs to perform the

services required by the RFP through the interface, as described is Section IV-5.3 e

3 of the RFP.

13. Section IV-5.3 b. (1) indicates “Describe the processes the Offeror uses to make

an assessment and adjudication of the reasonableness and relatedness of the bill to

the accepted work injury, or injuries; the appropriateness of the services provided.

(Adjudication is the activity of assuring that SWIF pays for services in

conformance with the PA WC Act). Since reasonableness of the bill can only be

addressed via the official Utilization Review Process outlined in the Act, how can

8/30/2012 8:56 AM 5

the DGS make this a requirement of an Offeror? Also, determining the overall

relatedness of the bill to the accepted work injury is typically the responsibility of

the insurance adjuster. Again, is SWIF proposing to outsource their adjusting

services via this RFP? If so, please provide to what extent the offeror is expected

to provide this service?

The Commonwealth is not proposing outsourcing its adjuster function. A

successful offeror is expected to determine the relatedness of the services on a bill

to the accepted work injury. A successful offeror is expected to identify to SWIF

bills and/or claims that it believes should receive UR. SWIF will be responsible for

UR.

14. Section IV-5.3 c. (3) indicates “Describe the frequency that the Offeror reviews

and updates fee schedules and usual and customary charges. These reviews and

updates must occur at least monthly”. Since the PA Bureau of WC only issues fee

schedule updates on a quarterly basis, updates could not occur “at least monthly”.

Would the DGS consider changing this requirement based on this factual

information? Also, Since the PA Bureau of WC does not currently recognize any

usual and customary charge database, there are no updates for the offeror to

“review and update”. Will the DGS consider eliminating this requirement from

this RFP as it is not applicable to WC in PA?

The “reviews and updates” of fee schedules in Section IV-5.3 c refers to a

successful offeror’s PPO/network fee schedules that it has with providers.

15. Section IV-5.3 c. (4) indicates “Describe how the Offeror defends or assists

clients in defending the statistical methodology for establishing UCR’s.” Again,

since the PA Bureau of WC does not recognize any UCR database and there is no

current case law on the issue, this would be an unattainable requirement for any

repricing vendor doing business in PA. Therefore, would the DGS consider

deleting this requirement?

The Commonwealth will not delete this requirement. A successful offeror must be

able to defend its methodology for all calculations and data used to establish UCR

amounts to be paid by the Commonwealth.

16. Section IV-6.1 (b) indicates the following image quality requirement “Document

preparation – staples must be removed, torn edges must be taped, documents less

than 8” x 10” (ie receipts, sticky notes) must be taped to letter-sized carrier sheets

and all documents that are hard to read must be stamped “illegible original” and

the offeror must request a legible replacement copy from the provider”. Since

providers typically send their bills and documentation directly to SWIF, wouldn’t

SWIF be responsible for this function before scanning the bills to the repricing

vendor? If not, we believe this requirement is entirely too cumbersome and

unreasonable and has never, to our knowledge, been requested by any other

8/30/2012 8:56 AM 6

insurance carrier who outsources repricing services. In view of this, would the

DGS consider deleting or amending this requirement?

Per the requirements listed in Section IV-6.1 b of the RFP, the Commonwealth is

seeking a vendor to provide document preparation services. The Commonwealth

will not delete or amend this requirement.

17. The Chief Healthcare Cost Containment Officer of the PA Bureau of WC has

stated during annual repricing training sessions that repricing vendors are not to

contact providers to request information, and we believe this recommendation

provides protections for both the providers and the insurance carriers. Therefore,

would the DGS consider removing the requirement to have the vendor contact the

provider for replacement copies of documentation as this is contrary to what the

Bureau has recommended? Additionally, numerous providers submit illegible

documentation with their bills and this gives the medical bill review company the

ability to deny payment for the particular services that cannot be identified in the

documentation. Do you agree that the requirement to contact the provider to

obtain more legible documentation would be a disservice to SWIF and it’s

policyholders as the providers have an obligation to bill correctly the first time?

SWIF will work with the successful offeror to develop a process by which illegible

documentation will be identified so that the successful offeror will not responsible

for contacting providers to request replacement documentation.

18. Section IV-6.2 Data Processing indicates that “Every day that the data file is

provided to SWIF after 5:30 p.m. an Offeror may be assessed liquidated damages

in the amount of $15,000.” Since $15,000 seems to be an unreasonable and

excessive amount, how did the DGS/SWIF arrive at this “damage” amount?

Would SWIF consider extending this time period to allow for second shift

repricing? If not, what is their reasoning? If the SWIF offices do not open until 8

a.m., what is the reasoning behind requiring the data transfer be completed by

5:30 p.m. the previous day? Since this requirement does not indicate an

exemption for confirmed natural disasters, terrorism, or any other type of

emergency, would the DGS consider amending this to address these

unforeseeable emergencies? What about circumstances beyond the Offeror’s

control such as power outages, connectivity problems with dedicated T-1 line,

etc…? Will the Offeror be assessed liquated damages if the file(s) cannot be

delivered due to connection problems on SWIF’s end?

The Commonwealth will not consider extending the time period to allow for second

shift repricing. Depending on the day of the week and the time of the month, the

SWIF batch may run from 8 to 12 hours. In order to run the batch, users must be

locked out of the system. If the batch is not completed by 6AM, users at SWIF at

the headquarters in Scranton and in all of the district offices are unable to work.

The cost of having all staff idle is slightly less than $15,000 per hour.

8/30/2012 8:56 AM 7

A Successful Offeror will not by assessed liquidated damages if the file(s) cannot be

delivered due to connection problems on SWIF’s end.

A Successful Offeror may not be assessed liquidated damages if the file(s) cannot

be delivered due to confirmed emergencies beyond the control of the offeror.

19. Section IV-7.1 Panels indicates “After achieving the guaranteed savings amount,

the Offeror must also provide a monthly invoice that sets forth the savings that

have been achieved because of the use of panel providers”. Since functional

provider panels have been proven to significantly reduce indemnity costs as well

as medical costs, will SWIF provide the selected vendor with this indemnity cost

information to provide actual savings reports? Will reductions in indemnity costs

be considered in the overall savings equation? If not, what is the reasoning

behind this decision?

The Commonwealth will not consider reductions in indemnity costs as part of the

medical savings sought by this RFP.

20. Section IV-7.4 Service Level Agreements makes references that the Offeror will

be charged liquidated damages for data transfers after 5 p.m. Since Section IV-

6.2 indicates damages will be accessed after 5:30 p.m., not 5 p.m., this would

require clarification by the DGS/SWIF as it appears to be contradictory.

Section IV-7.4 contains a typographical error. Section IV-7.4 (1) should read as

follows:

A report that lists each of the days that data exchange was made

after 5 p.m. and the total liquidated damages amount potentially

owed (Number of Times Data Was Exchanged After 5:30 p.m. x

$15,000).

21. IT Requirements – General - What is the nature of the electronic transfer between

SWIF and the Offeror? Does SWIF provide an FTP site to log into? Does SWIF

require the Offeror to maintain an FTP site for SWIF to download data from? Is

special client software required for the Offeror to establish the transfer to and

from the Powercomp system?

The data interface exchange will occur across the T-1 line on the L&I network. No

special software will be required for the data exchange, however, as stated in

Section IV-5.3 e 7 of the RFP, data imports and exports must be in a format

mutually agreed to by the Offeror and SWIF.

22. IV-5.3 Medical Bill Review (e) Technical System Requirements for Medical Bill

Review General – In order to fully understand the Interface requirements and to

determine any enhancements required by an Offeror, definitions for the fields

contained in Appendices H, I, and J need to be provided by SWIF. Will SWIF

8/30/2012 8:56 AM 8

provide these definitions as part of a supplement to the RFP? Will there be a

provision on the interface for the billing provider’s data? How does the Offeror

obtain the unique Powercomp bill ID to be used in Appendix J? How is the full

path of the image file determined?

Appendices H and I have been amended to include field definitions. SWIF will

accommodate a provision for billing provider data on the interface. Once a bill is

interfaced into Powercomp®, the Powercomp® system will automatically generate

its own unique bill ID. SWIF expects that a successful offeror will likely create its

own bill ID for processing purposes.

The path of the image file is defined in the Onbase imagining application used by

SWIF, so, D:\DIPIN is just a directory SWIF will set up on its Windows server. All

images can start with this directory. In our example, \SWIFCWO04236-

195224_002.TIF is just the name of the tif file.

23. Is SWIF wholly responsible for maintaining the T-1 or partial T-1 line installed in

the Offeror’s office for the purpose of providing services under this RFP? What

requirements does the Offeror have to meet regarding the documents after they

are scanned and transferred to SWIF? Does the Offeror have to store them for a

certain period of time? Does the Offeror have to physically send them to SWIF?

Yes, SWIF is responsible for maintaining a T-1 line. SWIF requires that a

Successful Offeror retain a hard copy of medical records and imaged documents

for 14-days.

24. The [RFP requests] that offerors quote a single Unit Price for Part A medical bills

and it does not differentiate between inpatient (DRG) bills vs.

outpatient/rehabilitation Part A bills. Because repricing companies are typically

paid a unit price for inpatient (DRG) bills and paid a per line charge for Part A

outpatient/rehabilitation bills, will the DGS consider amending this cost submittal

to reflect the industry standard?

SWIF does not differentiate between different types of Part A bills and per the Cost

Submittal portion of the RFP seeks a single unit price for Part A bills. The

Commonwealth is not going to modify the Cost Submittal sheet.

25. The Cost Submittal indicates that an Offeror is to quote a guaranteed savings

percentage and the Offeror will not be paid any monies unless they exceed the

guaranteed savings percentage. If the Offeror does exceed the guaranteed savings

percentage, they would be paid 40% of savings above that about. Most local and

regional companies including DBE’s and MWBE’s lease their PPO networks and

they have a financial obligation to pay those networks a percentage of savings for

their network discounts. Since this reimbursement structure appears to penalize a

vendor for obtaining savings below the fee schedule until they reach a guaranteed

amount, would the DGS be receptive to eliminating this “guaranteed amount” in

8/30/2012 8:56 AM 9

lieu of a lower percentage of overall savings below the fee schedule? To our

knowledge, vendors in our industry have never been paid under such a payment

structure which would appear to carry a significant amount of financial risk for

them. Does the DGS/SWIF understand that these guaranteed savings percentages

could be significantly eschewed by excessive trauma bills which require 100%

reimbursement if they cannot be negotiated and this would not be a fair and

reasonable pricing structure for the Offerors?

The Commonwealth believes the proposed cost structure is reasonable. The

Commonwealth is not going to modify the Cost Submittal sheet.

26. The Cost Submittal indicates that these are panel/PPO/Discount savings. What is

meant by “Discount” savings? This savings amount requires clarification as the

DGS has not represented how the Offeror would be reimbursed for savings below

the fee schedule for manual medical bill review, applying National Correct

Coding Edits, and any other savings below the fee schedule.

As stated in Section IV-5.2 c, page 26 of the RFP, “Discount” refers to discounts

from health care providers that are not part of an offeror’s PPO but do provide

health care to SWIF claimants on a discounted (i.e. below Workers’ Compensation

Fee Schedule) basis.

27. Since the proposed reimbursement structure is not reasonable for the Offeror and

could be unnecessarily costly to SWIF, would the DGS be receptive to learning

how the majority of vendors are reimbursed in our industry? If not, would the

DGS be receptive to conducting a survey of various WC carriers in our state to

determine how they reimburse repricing companies for these services?

This question is irrelevant to the preparation of a proposal in response to this RFP

and, therefore, no further response is required.

28. With regard to Appendix F (Part A and Part B Bill Data), there are only physical

therapy (PT) figures listed for each year for Part B providers. Since the majority

of PT providers in this state are classified as Part A providers, why are there no

figures listed under the Part “A” column for each year for PT? If the answer is

that SWIF has no mechanism to differentiate Part “A” PT bills from Part A

hospital bills and included both payments in the “Hospital” column, how could

the DGS expect an Offeror to reasonably calculate guaranteed and anticipated

savings percentages as the discounts Offerors can obtain from hospitals vs. PT

providers vary dramatically?

SWIF does not maintain further detailed data on its Part A bills. SWIF expects a

successful offeror to use its experience in the marketplace to calculate savings with

a reasonable degree of certainty allowing for the variance in discounts between

hospitals and physical therapy providers.

8/30/2012 8:56 AM 10

29. Since Appendix F indicates that there is no data related to trauma bills, how can

an Offeror estimate guaranteed and anticipated savings on these bills for this

RFP? If trauma bill data is not provided, are Offerors to assume that discounts

they obtain on trauma bills will not be included in the overall savings equation?

Savings on trauma bills will be included in the overall savings equation. In 2005,

SWIF experienced approximately $18.7 million in trauma charges. Currently,

SWIF nurses negotiate trauma bill rates. Per section IV-5.2 b, page 25, of the

RFP, SWIF expects a successful vendor to negotiate trauma bill rates.

For trauma bills the savings will be measured as the difference between a baseline

savings of 10%, which is what SWIF would have saved if it continued to negotiate

trauma bills itself, and the savings to SWIF above the 10% baseline that result from

the successful offeror’s trauma bill negotiations. See Appendix M which provides

data regarding SWIF’s negotiation of trauma bills.

30. Where is the data for Part A providers who are Ambulatory Surgical Centers?

Part A providers who are Ambulatory Surgical Centers are included within the data

provided under the heading “Hospitals” on Appendix F.

31. If SWIF has no mechanism to provide Offerors with the information [referenced

in Questions 29, 20,and 31], would the DGS agree to modify the Cost Submittal

to eliminate the guaranteed savings percentage requirement in lieu of an overall

savings percentage?

The Commonwealth is not going to modify the Cost Submittal sheet.

32. Since SWIF made quite a substantial investment in new claims software,

PowerComp, which has repricing capability, what is the reasoning behind SWIF’s

decision to outsource this entire function? Has SWIF determined that

PowerComp’s repricing feature is not functional?

This question is irrelevant to the preparation of a proposal in response to this RFP

and, therefore, no further response is required.

33. Since SWIF is currently the largest WC carrier in Pennsylvania with the highest

volume of bills, wouldn’t it be more cost effective for SWIF to perform these

services in-house with its own employees? Has SWIF done any studies to support

the cost savings they are trying to achieve by outsourcing this function?

This question is irrelevant to the preparation of a proposal in response to this RFP

and, therefore, no further response is required.

34. Should this RFP be withdrawn or bids rejected, would the DGS be receptive to

forming a committee of professionals with expertise in this field to determine the

8/30/2012 8:56 AM 11

best and most cost effective approach to implementing a comprehensive medical

bill review, panel development, and network discount program for SWIF?

This question is irrelevant to the preparation of a proposal in response to this RFP

and, therefore, no further response is required.

35. Please provide a definition of “Image Failure” within the context of requirements

set forth in Section IV-6.1.

Image failure is defined as: (1) documents that failed to meet the TIFF resolution

of 200 dpi; (2) documents that passed the Offeror's QC process but are found to be

illegible when viewed by SWIF staff; or (3) documents that were incorrectly

indexed (wrong claim number, incorrect or invalid document date, incorrect or

invalid medical document flag or incorrect or invalid document type).

36. The RFP states “documents must be indexed with the correct claim number,

document date, medical document flag, and document type”. What level of

functionality are you seeking as far as being able to retrieve data electronically,

specifically as it relates to document date, medical document flag, and document

type?

SWIF seeks functionality to enable document retrieval within the SWIF system,

therefore, the document claim number, document date, medical document flag and

document type are needed.

37. Are the liquidated damages in the third consecutive month 20% as written, or was

this a typo and was it meant to be 30% (noted as 10% first month, 20% second

consecutive month, 20% third consecutive month)?

The liquidated damages described in Section IV-6.3 and IV-6.4 are correct as

written – 10% for the first month, 20% for the second consecutive month and 20%

for the third consecutive month.

38. 10 days is understood to be calendar days, not business days? Assuming a system

whereby processed bills are pended to the adjuster electronically for approval, ten

days would be from receipt to pending status?

“10 days” means 10 calendar days from receipt to pending status.

39. Please define the auditing process to be conducted by the Control Unit and how

specifically accuracy, appropriateness, and reasonableness will be defined.

The SWIF Control Unit will review bills to ensure that the amount to be paid is

accurate, that the services to be paid for are appropriate for the claimed injury and

there is a causal relationship between the treatment billed and the claim made.

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40. What are the credentials of the individuals who will be conducting the audit

process?

The SWIF Control Unit is comprised of SWIF Medical Supervisors and Reviewers.

41. Will the Offeror be informed of the specific bills included in the sampling?

If as a result of an audit SWIF seeks liquidated damages, SWIF will identify the

audited bills that are the basis for the liquidated damages sought. Liquidated

damages will be calculated as described in section IV-6 of the RFP.

42. What percentage is considered to constitute a statistically valid sample?

The percentage that constitutes a statistically valid sampling depends on the

universe of bills being audited, as well as other factors such as the confidence level,

the interval level and the prescribed error rates.

43. What grievance procedure will be placed in effect if the Offeror does not agree

with the findings of the auditor?

A Successful Offeror may consider filing a claim under the Commonwealth

Procurement Code, 62 Pa. C.S.A. 1712.1.

44. Does the “Repriced Amt” reflect application of fee schedule reductions only, or is

SWIF currently utilizing a PPO or other type of cost containment other than fee

schedule, to include the IBC network? Please respond for all years of data.

For all years of data contained in Appendix F the “Repriced Amt” reflects only the

application of the Workers’ Compensation Fee Schedule. SWIF does not currently

utilize a PPO.

45. What process is currently being followed in the management of trauma bills?

Currently, SWIF nurses negotiate trauma bill rates. Per section IV-5.2 b, page 25,

of the RFP, SWIF expects a successful vendor to negotiate trauma bill rates. See

Appendix M which provides data regarding SWIF’s negotiation of trauma bills.

46. What percentage of insureds currently have a panel in place?

SWIF does not maintain data regarding the use of panels by its policyholders.

47. Are existing panels linked to a specific network?

SWIF does not maintain data regarding the use of panels by its policyholders. If

there are SWIF policyholders that have established panels, those panels are not

linked to a network maintained or sponsored by SWIF.

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48. With regard to the Estimated Annual Value of Medical Bills Paid, (WCA Fee

Schedule) figure of $105,000,000, please confirm whether this refers to the

estimated Provider Fees after application of fee schedule reductions only. If this is

not the case, please alternately define.

The Estimated Annual Value of Medical Bills Paid refers to the estimated Provider

Fees after the application of the Workers’ Compensation Fee Schedule and the

negotiation of trauma bills by SWIF’s nurses only. The $105,000,000 is the

estimated amount that a successful offeror’s panel/PPO/discount and trauma bill

negotiation services can impact.

49. Is [the Estimated Annual Value of Medical Bills Paid] an estimate or an

established baseline?

The Estimated Annual Value of Medical Bills Paid is an estimate. It is not a

baseline; it is not a guarantee.

50. How will [the Estimated Annual Value of Medical Bills Paid] be adjusted based

on either positive or negative variations in volume?

The Estimated Annual Value of Medical Bills Paid is an estimate that was

developed from recent data for purposes of the Cost Submittal Sheet. A successful

offeror will be compensated based on the value of savings achieved below the

incurred annual value of medical bills paid after the application of the Workers’

Compensation Fee Schedule. The risk of fluctuations in the volume of bills and the

amount of bills is the offeror’s.

51. Will the Offeror be compensated in any manner for savings generated less than or

equal to the Guarantee amount?

No. A successful offeror will only be compensated for savings generated above the

Guarantee amount.

52. If the Offeror does not utilize a Small Disadvantaged Business, Socially

Disadvantaged Business or an enterprise zone small business, must the Offeror

file a Disadvantaged Business Submittal?

An offeror must file a Disadvantaged Business Submittal even if the offeror does

not utilize a Small Disadvantaged Business, Socially Disadvantaged Business or an

enterprise zone small business in its proposal.

53. Can the Issuing Office provide an example of a Program Evaluation and Review

Technique (PERT) or similar type format that is acceptable in showing the time

related to each event in the implementation and evaluation plan?

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A sample PERT chart and description of its components can be found at:

http://whatis.techtarget.com/definition/0,,sid9_gci331391_top1,00.html. Please

refer to the Work Statement section of the RFP (pages 20-39) for the specific tasks

that should included in implementation and evaluation plan.

54. Since SWIF expects the “successful Offeror to use its own bill review and

processing technology” (IV-5.3), can a prime contractor that is a PPO outsource

the medical bill review services to a subcontractor or joint venture partner that

provides medical bill review services?

Yes. The Commonwealth encourages the formation of joint ventures and/or

subcontractor relationships to address the services requested in the RFP.

55. In II-9, the Cost Submittal indicates “no invoice shall be sent to SWIF until the

Offeror exceeds the guaranteed savings level set forth on the Cost Submittal

sheet”. If the Offeror meets but does not exceed the “guaranteed savings level”,

would the Offeror send the invoice to SWIF?

No. A Successful Offeror will only be compensated for savings generated above the

guarantee amount.

56. In II-9, SWIF indicates it “will pay nothing for these services if SWIF does not

realize the guaranteed savings level”. Does the guaranteed savings level serve as

an absolute monthly threshold? Can the guaranteed savings level be considered an

average monthly savings level? For example, suppose savings in one month are

below the guaranteed savings level and in the subsequent month savings are

above the guaranteed level of savings. Would SWIF consider averaging the two

months and basing payment on the average guaranteed savings level?

The guaranteed savings level is an annual threshold. SWIF will begin

compensating a successful offeror after the annual threshold is exceeded.

57. Why is the “Repriced Amount” in Appendix F $86,007,665 and the amount paid

and the “Medical Paid” in Appendix D $104,756,426? It is stated that the

information in Appendix F excludes trauma bills, but $18.7 Million in Trauma

charges seems excessive based on SWIF’s volume.

The difference between the “Repriced Amount” in Appendix F ($86,007,665) and

the “Medical Paid” in Appendix D ($104,756,426) is the amount incurred in

trauma bills after negotiation by SWIF’s nurses. Per section IV-5.2 b, page 25, of

the RFP, SWIF expects a successful vendor to negotiate trauma bill rates. See

Appendix M which provides data regarding SWIF’s negotiation of trauma bills.

58. What savings is included in the 2005 Savings? Are duplicates that were identified

included in the savings? Is data from SWIF’s outsource vendors included in the

total?

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The “Amt Saved” in Appendix F is the difference between the amount originally

billed and the amount billed after the application of the Workers’ Compensation

Fee Schedule. The data in Appendix F does not include duplicates. Data from

outsource vendors is included in the Appendix F data.

59. The price sheet asks for only one (1) year. What pricing adjustments are

allowable in years two (2) and three (3)?

The Commonwealth seeks a single unit price for Part A and Part B bills for the

term of the contract.

60. We anticipate savings to increase from year one (1) to year three (3). Is the same

savings percentage required for all three (3) years?

Yes.

61. In Appendix F, 2005 medical paid is listed on two (2) different pages as eighty six

million dollars ($86,000,000.00) and one hundred and four million dollars

($104,000,000.00). (Please explain.)

The difference between the “Repriced Amount” in Appendix F ($86,007,665) and

the “Medical Paid” in Appendix D ($104,756,426) is the amount incurred in

trauma bills after negotiation by SWIF’s nurses. Per section IV-5.2 b, page 25, of

the RFP, SWIF expects a successful vendor to negotiate trauma bill rates. See

Appendix M which provides data regarding SWIF’s negotiation of trauma bills.

62. The price sheet requires the Offeror to guarantee a level of Preferred Provider

Organization (PPO) savings. If the Offeror does not meet the guarantee are

repricing fees at risk?

Repricing fees will be paid on a monthly basis independent of any guaranteed

savings payments. Repricing fees are at risk only to the extent that a successful

offeror is paid pro rata savings but then fails to achieve the guaranteed annual

savings level – see Response to Questions 103 and 107.

63. Are savings from the Correct Coding Initiative considered in the savings

percentage?

No. The savings percentage considers only the difference between what SWIF

would have paid under the Workers’ Compensation Fee Schedule and the amount

SWIF pays as a result of the successful offeror’s Panel/PPO/Discount services and

negotiated trauma savings beyond the 10% baseline -- see Response to Questions

76, 99 and 102.

64. Is there a requirement for a specific DBE, WBE percentage participation in this

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contract?

There is no requirement for a specific percentage of DBE, WBE participation in

this contract. DBW, WBE participation will be one of five scored criteria as

described on pages 17-19 of the RFP.

65. Will SWIF provide the Offeror with a zip code listing for its insureds?

SWIF will provide a successful offeror with the zip codes of its insureds.

66. How will the Offeror know if a claim is accepted or denied?

The successful offeror will be able to get active claim and claim denial information

through system interface described in Section IV-5.3 e of the RFP.

67. In Appendix F, does the bill count and billed amount include duplicates?

No.

68. Can SWIF provide a breakdown of Hospital Inpatient costs by county?

No.

69. Can SWIF provide the percentage or dollar amount of Hospital Inpatient

costs that are trauma or burn-unit related?

No.

70. Does SWIF expect the Offeror to file utilization reviews (UR’s) with the Bureau?

No. SWIF expects to develop a process with the successful offeror by which the

successful offeror will identify claims that may need URs. SWIF will review such

claims and file any URs with the Workers’ Compensation Bureau.

71. Who is currently providing the services outlined in the Project Scope (pg 21 of

39)?

No one currently provides the Panel/PPO/Discount services referenced in the RFP

(i.e. Section IV-1.2 a, b).

72. What percentage of savings and PPO-related fees is the current vendor/provider

charging?

No one currently provides the Panel/PPO/Discount services referenced in the RFP

(i.e. Section IV-1.2 a, b).

8/30/2012 8:56 AM 17

73. In addition to Pennsylvania, what other venues are or could be involved and what

are these venues?

Pennsylvania is the only venue involved. No other venues are or could be involved

under this RFP.

74. Are there any limitations to partnering arrangements by an “Offeror”?

The Commonwealth encourages the formation of joint ventures and/or

subcontractor relationships to address the services requested in the RFP.

75. Can the onerous and cumbersome task of creating a provider map be removed?

Section IV-5.2 b 2 of the RFP (page 26) seeks “a list of all PPO providers within

each Pennsylvania county and a map showing the locations of its providers in

Pennsylvania.” It is not necessary to locate each individual provider on the

requested map. Referencing the number of providers in each county on a map and

separately listing by county each provider by name, specialty, address, phone

number and board certification is acceptable.

76. How and how often is the percentage of savings and according compensation

calculated? Weekly? Monthly? Does this percentage of savings include all

reductions generated by Offeror? Does SWIF have a formula for these

calculations?

The percentage of savings and related compensation will be calculated on an

annual basis. This percentage of savings includes all savings below the Workers’

Compensation Fee Schedule that are generated by the successful offer. The

savings for Panel/PPO/Discount services will be measured as the difference

between what SWIF would have paid under the Workers’ Compensation Fee

Schedule and the amount SWIF pays as a result of the successful offeror’s

Panel/PPO/Discount services.

For trauma bills the savings will be measured as the difference between a baseline

savings of 10%, which is what SWIF assumes it would have saved if it continued to

negotiate trauma bills itself, and the savings to SWIF above the 10% baseline that

result from the successful offeror’s trauma bill negotiations. See Appendix M

which provides data regarding SWIF’s negotiation of trauma bills.

77. Regarding liquidated damages is there a demand notice and opportunity to cure

before being assessed? Does the Offeror have the right to right to challenge any

large penalties in the Board of Claims?

Notice and an opportunity to cure is provided for in Section IV-6.4 of the RFP. A

Successful Offeror may consider challenging any liquidated damages imposed by

filing a claim under the Commonwealth Procurement Code, 62 Pa. C.S.A. 1712.1.

8/30/2012 8:56 AM 18

78. According to section IV-4.3 all involved parties must sign a confidentiality

agreement prescribed by SWIF. Does this statement need to be signed by all

employees/related parties for the bid or for the beginning of the contract?

Confidentiality agreements must be filed after the contract is awarded.

79. What is meant by County PPO penetration rates? How should these figures be

expressed as percentages of the total network? Raw number? Providers to

population? Or another format?

The penetration rate information sought by Section IV-5.2 b 3 is an offeror’s

penetration rate for existing clients.

80. Are the executive addresses required for section IV-8 (f) home or work addresses?

Work addresses are required by section IV-8 f.

81. Does the potential exist to split the contract into a PPO provider and a Medical

Bill Re-pricing provider? If yes, does the possibility exist that the contract for re-

pricing and PPO be awarded to different entities?

The contract will be issued to a single entity. The Commonwealth encourages the

formation of joint ventures and/or subcontractor relationships to address the

services requested in the RFP.

82. Is it possible to bid on only one portion of services described in RFP Number

CN00020848 (e.g., to bid only on either the Preferred Provider Organization or

the Comprehensive Medical bill Review services portion of the RFP)?

The contract will be issued to a single entity. The Commonwealth encourages the

formation of joint ventures and/or subcontractor relationships to address the

services requested in the RFP.

83. The RFP specifies that the Offeror shall submit 10 paper copies of the proposal to

the Issuing Office and two complete and exact copies of the technical proposal on

CD-ROM in Microsoft Office or Microsoft Office compatible format. Is it

acceptable to provide the 2 copies on CD-ROM in Acrobat “pdf” format?

All documents on the C-ROM must be in MS Office or MS Office compatible

format. The CD-ROM can contain multiple MS Office compatible documents.

Scanned Adobe PDF files will not be accepted on the CD-ROM.

84. After medical invoices and records have been imaged for download to SWIF,

what requirements/arrangements or timeframes have been established for

subsequent disposition of the hard copy paper records received by the Offeror?

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SWIF requires that a Successful Offeror retain a hard copy of medical records and

imaged documents for 14-days after the medical records and invoices have been

imaged.

85. IV-5.3 Medical Bill Review; c. 4) indicates “Describe how the Offeror defends or

assists clients in defending the statistical methodology for establishing UCR’s.”

(Page 31). Please provide the Issuing Office’s definition of “UCR’s” in the

context of this RFP. The Pennsylvania Bureau of Workers’ Compensation

defines (UCR) Usual, Customary, and Reasonable as the amount the provider

charges.

The definition for UCR in the context of this RFP is the same as the Bureau of

Workers’ Compensation’s definition.

86. Is the intention of this RFP that the medical bill repricing be performed within the

PowerComp system, or is it performed utilizing the Offeror’s systems and

software, with processed results of the medical bill review subsequently

downloaded to SWIF’s PowerComp system and software?

Medical bill repricing must be performed using the successful offeror’s systems and

software. Processed results of the medical bill review will subsequently be

downloaded to the PowerComp® system and software used by SWIF.

87. During the first 21 days following a work-related injury, it is possible that a claim

denial may be issued. How will the Offeror be notified of claim denials? Will the

Offeror be provided access to SWIF’s PowerComp claim system to determine

claim status when reviewing medical bills?

The successful offeror will be able to get active claim and claim denial information

through system interface describe in Section IV-5.3 e , page 32, of the RFP.

88. If during the first 21 days of a work-related injury claim, repricing is being

performed to stay within the 10 day processing timeframe required by the RFP,

and the claim is later denied, will the Offeror be held financially responsible for

the PPO discounts taken during this time period, or will SWIF accept

responsibility?

In cases where acceptance has not been determined, a successful offeror should

pend payment of the medical bill until a final determination is rendered, at which

time the 10-day clock begins. A bill should not be processed for payment by SWIF

unless the claim has been accepted by SWIF. If a successful offeror mistakenly

processes a bill for payment before the claim is accepted, any discounts earned on

the bill will not be counted toward the guarantee savings amount.

8/30/2012 8:56 AM 20

89. Most PPO network provider contracts require payment to the provider within a

specified timeframe (generally 30 days from the carrier’s receipt of the provider

invoice), or the PPO discount no longer applies. What is SWIF’s proposed

payment schedule (e.g., the length of time from receipt of the completed reviewed

medical bills from the Offeror, until payment is issued to the provider)?

Payment to providers is expected to follow the regulations of the Pennsylvania

Workers’ Compensation Act.

90. We have a staff of RNs and certified bill coders who are experienced in bill

review for relatedness and proper bill coding. Will we have access to SWIF’s

claim system to verify that charges are related to the work injury? Will we be

permitted to make those decisions regarding relatedness and causation, or will

those be made by SWIF’s nursing staff, as is currently the case?

A successful offeror will have access to SWIF’s claim information through the

interface. A successful offeror is expected to determine whether services reported

on bills are “related to the work injury suffered by the claimant; whether the

services are properly coded and appropriate to the injury; determine whether billed

amounts are correct; and ensure that duplicate bills for the same service and

service date are not paid.” (See Section IV-1.2 d of the RFP, pages 20-21.)

91. While processing medical bills, a bill may be denied for various reasons (i.e., not

related to the work injury, denial due to CCI edits with bundling and unbundling,

no documentation supplied by the medical provider, etc.) This information can be

supplied on a system-generated EOR (Explanation of Reimbursement). Will the

Offeror be permitted to add system-generated remarks/comments to SWIF EORs?

No.

92. The link in the RFP directing bidders to the Standard Contract is no longer valid.

A search for standard procurement form 274 brings up the following two options:

1) STD-274, Standard Contract Terms & Conditions for

Services, 05/07/04

2) STD-274 (SAP), Standard Contract Terms & Conditions

– SAP, 05/07/04

Which is the correct contract to be used for this RFP?

STD-274 (SAP), Standard Contract Terms & Conditions – SAP, 05/07/04 is the correct

Terms and Conditions for this RFP and can be found at Appendix A to the RFP

(http://www.dgs.state.pa.us/dgs/lib/dgs/forms/comod/procurementforms/std274_sap.doc).

93. Eileen Wunsch, Chief, Health Care Services Review Division, Bureau of WC, has

actively publicized what she states as the Department of Labor and Industry’s

8/30/2012 8:56 AM 21

policy that PPOs that are not Coordinated Care Organizations (and we believe

there are no CCOs active in Pennsylvania currently) have no legal status in

Pennsylvania, and their contracts with their participating providers will not be

recognized or enforced by the Department. It is our understanding that she has

urged providers to ignore their contractual obligations to PPOs when submitting

bills for payment. Further, she has cited 34 Pa. Code Sec. 127.203(a) in support

of her position that employers and insurers may not authorize PPOs or other third

parties to receive bills on their behalf, even though this regulation appears

designed to protect payers rather than to restrict their methods of operation.

(Illinois statutes have similar language, but Illinois regulators expressly permit

providers to submit bills to insurers or their agents.) Will SWIF require PPOs it

contracts with to be certified as CCOs, and will SWIF require providers to submit

bills directly to employers?

A PPO is not required to be a Coordinated Care Organization. Providers will not

be required to submit their bills to employers. Providers will be required to submit

their bills to the successful offeror. SWIF recognizes that occasionally bills will be

submitted to SWIF instead of to the successful offeror. When this happens, SWIF

will forward the bills to the successful offeror. (See Section IV-5.3 of the RFP.)

94. On page 10 of the RFP, it is asked that offeror describe their experience

“providing and maintaining a web-based system to support the services requested

in this RFP”. Which specific services are being required via web-based

applications?

This refers to the listing of PPO’s as described in Sections IV-5.2 b 2, IV-5.3 b 5

and IV-5.2 c 3.

95. Criteria for Selection: The RFP describes the priority ranking of various criteria.

Could you provide the specific point values or scoring methodology for these

various options?

No.

96. The Calendar of Events end with the date the proposal is due. Is there any

information regarding the timeframes regarding proposal evaluation, selection and

program implementation?

The Commonwealth will endeavor to evaluate RFP responses as quickly as possible

and intends to award a contract for the services sought by the RFP without delay.

97. Page 24 refers to the “orderly transition of services to coincide with the expiration

of the current emergency procurements”. Could you provide more detail as the

specific services included in the current emergency procurements and the dates

they expire?

8/30/2012 8:56 AM 22

The scope of work sought by the RFP exceeds the services being provided pursuant

to current emergency procurements. Potential Offerors should refer to the RFP

and formal question responses in preparing their RFP responses. The

Commonwealth anticipates awarding a contract for the services sought by the RFP

as soon as possible. The current emergency procurements expire on October 31,

2006.

98. Page 26 item 3 asks for penetration rates of each county in PA. Penetration rates

are a function of a distinct population and who that population is using. It is not a

prospective measure, nor can it be calculated without a patient population. As

such, are you asking for the penetration rates of existing clients?

The penetration rate information sought by Section IV-5.2 b 3 is an offeror’s

penetration rate for existing clients.

99. Sections IV-7.1, 7.2 and 7.3 refer to “guaranteed savings amounts”. Could you

define what these are and their impact on cost proposals for this contract?

The “guaranteed savings amounts” referred to in Sections IV-7.1, 7.2 and 7.3 is the

guaranteed savings percentage sought on the Cost Submittal sheet – see line 38.

This percentage of savings includes all savings below the Workers’ Compensation

Fee Schedule that are generated by the successful offer. The savings for

Panel/PPO/Discount services will be measured as the difference between what

SWIF would have paid under the Workers’ Compensation Fee Schedule and the

amount SWIF pays as a result of the successful offeror’s Panel/PPO/Discount

services.

For trauma bills the savings will be measured as the difference between a baseline

savings of 10%, which is the amount SWIF assumes it would have saved if it

continued to negotiate trauma bills itself, and the savings to SWIF above the 10%

baseline that result from the successful offeror’s trauma bill negotiations. See

Appendix M which provides data regarding SWIF’s negotiation of trauma bills.

100. The term of the contract is defined as three years with two additional one

year options, with costs to be maintained at or below those in effect in year three.

A key component of the costs is the percentage of savings component. Obviously,

the revenue required to cover the costs of this program will be translated into the a

savings percentage as required by this contract. This savings percentage will be

determined based on current PA WC fee schedules: a significant change to the fee

schedule could result in changes to savings. Will revised costs be allowed in the

event of changes to state fee schedules?

No.

101. What interface will be available to the awarded vendor to determine

medical bill relatedness to the claim?

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Policy and claim data described in Appendix H will be provided through the

interface.

ADDITIONAL QUESTIONS RECEIVED ON 08/09/2006 & RESPONSES

102. Is there any payment for negotiation of trauma bills or negotiation of non

network Services?

The negotiation of trauma bills and the negotiation of non-network services will be

compensated by a flat fee and a portion of generated savings.

For non-networked services the savings will be measured as the difference between

what SWIF assumes it would have paid under the Workers’ Compensation Fee

Schedule and the amount SWIF pays as a result of the successful offeror’s

discounts from non-network providers. The flat fee paid for bill review and

processing of discounted bills will be at the per bill rate for Part A bills and at the

per line rate for Part B bills.

For trauma bills the savings will be measured as the difference between a baseline

savings of 10%, which is the amount SWIF assumes it would have saved if it

continued to negotiate trauma bills itself, and the savings to SWIF above the 10%

baseline that result from the successful offeror’s trauma bill negotiations. See

Appendix M which provides data regarding SWIF’s negotiation of trauma bills.

The flat fee paid for review and processing of trauma bills will be per bill at the

Part A bill rate.

103. As noted, the reimbursement to the offeror for savings above the guarantee

will not be paid until the annual guarantee is exceeded. This seems over

burdensome on the offeror as they will incur expenses related to PPO, trauma

negotiations and pre review without reimbursement up and until the annual

guaranteed savings is exceeded. In fact, this practice may serve to increase per

line charges as offerors seek to cover out of pocket expenses. Will the

Commonwealth be willing to pro rate the guaranteed savings on a monthly basis,

so that any savings exceeded in the month will be paid to the offeror and any

savings less than the guarantee would be reimbursed to the Commonwealth?

The payment for guaranteed savings in the RFP, Section II-9 2. b, is revised as

follows:

2. b. SWIF will pay for these services on a monthly basis. These

services shall be invoiced to SWIF each month. The invoice must set

forth the amount SWIF would have paid under the Workers’

Compensation Fee Schedule, the amount SWIF pays as a result of the

successful offeror’s use of panel providers, PPO providers, and health

care provider discounts, the amount saved above the trauma bill baseline

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of 10%, the percentage of savings guaranteed to SWIF in the successful

offeror’s Cost Submittal Sheet and the percentage of savings achieved

that month. SWIF will reimburse a successful offeror a pro rata

amount of the offeror’s share of savings each month the successful

offeror produces savings exceeding the guaranteed amount. SWIF will

pay nothing for these services for any month the guaranteed savings

amount is not exceeded. If SWIF pays some monthly savings, but the

annual guarantee is not met at the end of any year, SWIF will retain bill

review and processing fees until the overpaid savings are recovered or

invoice the offeror for the amount owed. Otherwise, bill review and

reprocessing fees will be paid independently of SWIF’s reimbursement

to a successful offeror for savings generated. The amount of savings

claimed will be subject to audit.

104. Can you elaborate on how the Backerd EDI and Image File will be used

by SWIF? For example; Where in the workflow will the adjuster be able to view

the image of the bill and the repriced data?

A successful offeror’s interface with SWIF will provide the means for the adjuster

to access the imaged documentation on SWIF’s Onbase system. The repriced data

will be available through the interface with the Powercomp® system used by SWIF.

105. Is $105,000,000 on Cost Saving Form “net” medical dollars after bill

review savings? In other words, is the $105,000,000, the amount that the PPO

can access / impact? Re: Question 48

The Estimated Annual Value of Medical Bills Paid refers to the estimated Provider

Fees after the application of the Workers’ Compensation Fee Schedule and the

negotiation of trauma bills by SWIF’s nurses only. The $105,000,000 is the

estimated amount that a successful offeror’s panel/PPO/discount and trauma bill

negotiation services can impact.

106. Of the 250,000 bills, how many are out of state and what other states?

SWIF does not maintain data regarding the number of out of state bills and where

the out of state bills originate.

107. The Guarantee Program requires reconsideration. If the vendor must wait

until total savings guaranteed are achieved before reimbursement of dollar one,

then that does not seem fair or reasonable. We recommend interim

reimbursement on a monthly basis. Will SWIF consider Interim Reimbursement

on a monthly basis which assess monthly guarantee monthly?

The payment for guaranteed savings in the RFP, Section II-9 2. b, is revised as

follows:

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2. b. SWIF will pay for these services on a monthly basis. These

services shall be invoiced to SWIF each month. The invoice must set

forth the amount SWIF would have paid under the Workers’

Compensation Fee Schedule, the amount SWIF pays as a result of the

successful offeror’s use of panel providers, PPO providers, and health

care provider discounts, the amount saved above the trauma bill baseline

of 10%, the percentage of savings guaranteed to SWIF in the successful

offeror’s Cost Submittal Sheet and the percentage of savings achieved

that month. SWIF will reimburse a successful offeror a pro rata

amount of the offeror’s share of savings each month the successful

offeror produces savings exceeding the guaranteed amount. SWIF will

pay nothing for these services for any month the guaranteed savings

amount is not exceeded. If SWIF pays some monthly savings, but the

annual guarantee is not met at the end of any contract year, SWIF will

retain bill review and processing fees until the overpaid savings are

recovered or invoice the offeror for the amount owed. Otherwise, bill

review and reprocessing fees will be paid independently of SWIF’s

reimbursement to a successful offeror for savings generated. The

amount of savings claimed will be subject to audit.

108. Would DGS consider reassessing the answer to question 63 and include

savings from medical bill review and correct coding?

The Commonwealth believes the proposed reimbursement structure for this RFP is

reasonable.

109. Regarding question 62; Is there any penalty for not meeting the guarantee,

other than not getting paid?

The guaranteed savings amount contained in an offeror’s proposal is considered

material and important and will be relied upon during the proposal evaluation

process. After the contract is awarded to a successful offeror, SWIF will monitor

the guaranteed savings on a monthly basis. If a successful offeror fails to deliver

the savings guaranteed in its proposal after a reasonable amount of time, SWIF

may find the offeror in default of its obligations and the offeror could face

termination of the contract and debarment by the Commonwealth.

110. With regard to the manual bill review process that a vendor must perform

to provide SWIF with significant savings below the fee schedule. How will SWIF

compensate the offeror? NOTE: These are not standard repricing charges and are

not associated with the WCC edits.

The only payment which will be made for medical bill review services will be the

fixed fee payments. Savings realized by panel providers will be part of the

guaranteed savings calculation.

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111. Do the Department of General Services (DGS) / SWIF understand that the

potential for medical bill review savings over and above the WCC edits for SWIF

are just as substantial as PPO savings?

The Commonwealth believes the proposed reimbursement structure for this RFP is

reasonable.

112. If SWIF does not incentivize an offeror to achieve savings [over and

above the WCC edits], does DGS recognize that offerors will not be incentivized

to provide these savings?

The Commonwealth believes the proposed reimbursement structure for this RFP is

reasonable.

113. Does the Department of General Services know that the PA Bureau of WC

provides annual Medical Bill Review Training to repricing companies and they

strongly recommend that insurance carriers utilize vendors who provide these

services?

This question is irrelevant to the preparation of a proposal in response to this RFP

and, therefore, no further response is required.

114. To my knowledge all of The Bureau of Minority and Women Business

Opportunities (BMWBO) that would be interested in bidding this pay an access

fee to a National PPO to access their network discounts for their clients. Does the

Department of General Service recognize that any BMWBO would be financially

harmed by the “no pay if you do not meet the guarantee” reimbursement

methodology as they must pay the PPO company for those savings.

The Commonwealth has revised its payment structure for the savings portion of the

RFP. Please see the Response to Questions 103 and 107. A successful offeror will

be reimbursed a pro rata amount of its share of savings each month it achieves

savings in excess of its proposed guarantee amount.

115. SWIF, in the RFP, has indicated their total combined savings for 2005

were at the 48% level; 2004 at the 45% level; and 2003 at the 46% level. These

saving levels are difficult for any operation to achieve due to the fact that there

were no PPO discounts utilized in the savings process. Will SWIF produce

audited financials that will verify their stated annual savings levels?

The data provided in Appendix F is the data maintained by SWIF regarding the

repricing and recoding of bills to the Workers’ Compensation Fee Schedule and

has been audited by the Pennsylvania Auditor General. SWIF expects a successful

offeror to use its experience in the marketplace to calculate savings below the

Workers’ Compensation Fee Schedule with a reasonable degree of certainty.

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116. Will Offerors be able to conduct an audit of SWIF’s indicated savings, in

conjunction with Offerors’ guarantee?

Per the requirements of the RFP a successful offerors will be responsible for both

repricing/recoding bills to the Workers’ Compensation Fee Schedule (WCFS) and

generating discounts below the WCFS. Thus, a successful offeror will have all of

the data relating to savings and will not need to audit SWIF.

If a successful offeror believes that SWIF did not correctly pay it, it may consider

filing a claim under the Commonwealth Procurement Code, 62 Pa C.S.A. 1712.1.

SWIF expects a successful offeror to use its experience in the marketplace to

calculate savings below the Workers’ Compensation Fee Schedule with a

reasonable degree of certainty.

117. If discrepancies are found in SWIF’s stated annual savings, will Offeror be

able to modify it’s saving guarantee?

SWIF expects a successful offeror to use its experience in the marketplace to

calculate savings below the Workers’ Compensation Fee Schedule with a

reasonable degree of certainty.

If a successful offeror believes that SWIF did not correctly pay it, it may consider

filing a claim under the Commonwealth Procurement Code, 62 Pa C.S.A. 1712.1.

118. It appears that the Cost Proposal Sheet is not calculating correctly at Line

48, "Excess Savings of $5 Million - $10 Million". Should the calculation in Line

48 be Line 41 minus Line 44 if positive otherwise Zero?

The amount in Line 48 was not being calculated correctly on the original Cost

Proposal Sheet. This has been corrected. Please use the corrected Cost Sheet,

which has been posted on the DGS website.

119. Section I-12 Proposals of the RFP states “In addition to the paper copies

of the proposal, Offerors shall submit two complete and exact copies of the

technical proposal on CD-ROM in Microsoft Office or Microsoft-compatible

format.” Does the CD version of the RFP have to be contained in a single Office-

compatible document? If so, does the document have to be a Microsoft Word

document? If the CD can contain multiple Office-compatible documents, can

they be different types (Word, Excel, Visio, Powerpoint, etc…)? Can the CD

contain scanned Adobe PDF files if documents submitted as part of the RFP

currently only exist as a PDF file? Examples of this would be printed marketing

materials.

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All documents on the C-ROM must be in MS Office or MS Office compatible

format. The CD-ROM can contain multiple MS Office compatible documents.

Scanned Adobe PDF files will not be accepted on the CD-ROM.

120. Section IV – 7.3 Discounts of the RFP states “After achieving the

guaranteed savings amount, the Offeror must also provide a monthly invoice that

sets forth the savings that have been achieved because of the use of health care

providers that have agreed to extend discounts to SWIF claimants. This amount

will be subject to audit. The Offeror must describe the records it will maintain

which will enable SWIF to verify, by audit, the amount of monthly savings

reported.” How are differences between the Offeror’s savings report and SWIF’s

audit of those reports handled? Does the Offeror have the right to inspect any

SWIF internal data used by SWIF to audit a submitted discount savings report?

Will any duplicate payments to providers made by SWIF that are determined to

not be the fault of the Offeror be excluded from the audit?

SWIF will audit the reports provided by a successful offeror. Duplicate payments

should be eliminated at bill entry by a successful offeror. If it is discovered that

duplicate payments have been made through no fault of the successful offeror,

these payments will not be included in the audit. If as a result of an audit SWIF

identifies savings that it believes were incorrectly included in the savings report,

SWIF will identify those instances to the successful offeror and reduce any savings

payments by the incorrectly included amounts. If a successful offeror believes that

SWIF did not correctly pay it, it may consider filing a claim under the

Commonwealth Procurement Code, 62 Pa. C.S.A. 1712.2.

121. To insure that the offeror's savings guarantee in the price proposal is

reasonable and attainable, will SWIF require that fees derived from repricing

work be put at risk against the guaranteed savings amount? If the total guarantee

is not realized by SWIF over the initial three year term of the contract, the offeror

will be required to return some or all of its repricing fees to make up the shortfall.

Repricing fees will be paid on a monthly basis independent of the guaranteed

savings payments. Repricing fees are at risk only to the extent that a successful

offeror is paid a pro rata amount of its savings but then fails to achieve the

guaranteed annual savings level – see Response to Question 103 and 107.

122. The availability of 1099 provider data will enable prospective vendors to

more confidently and aggressively bid guaranteed PPO network savings amounts

in their proposal response to this RFP. Can a 1099 report that includes total

dollars paid to providers, by service type (Radiology, in-patient hospital, physical

therapy, etc.) the providers full demographics (name, address and zip code) and

Tax ID number be provided for the most recent 12 month or 90 day period?

The Commonwealth has included extensive data regarding SWIF’s bills and

payments with this RFP. The Commonwealth expects that the data provided along

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with an offeror’s experience in the marketplace will allow all potential offerors to

calculate savings below the Workers’ Compensation Fee Schedule with a

reasonable degree of certainty.

* * *

NOTE: The total amount paid in Appendix D does not match the sum of the amounts

paid on Appendix F and Appendix M. The difference is due to the fact that the

databases from which the data for the appendices was pulled track refunds and

duplicate payments differently. Also, SWIF implemented a system conversion in the

middle of 2005, which affected how data was captured and retained through the years

in certain databases. For purposes of responding to this RFP, please refer to the

Estimated Annual Value of Medical Bills Paid ($105,000,000) as the estimated amount

that a successful offeror’s panel/PPO/discount and trauma bill negotiation services

can impact.