(RFP) for Recovery Audit Contractor (RAC) - Texas Health and ...

espondent to HHSC in the format specified by HHSC. Each invoice will be processed and paid
separately, and Fixed Fees will be paid to the respondent retrospectively.
The respondent must supply detailed information with the invoice(s) as directed by HHSC to
justify and support the Fixed Fees invoiced. As directed by HHSC, the respondent must also
provide supporting documentation in an electronic format, subject to approval by HHSC.
HHSC, at its sole discretion, may choose to process only a portion of a Fixed Fee invoice, if only
a portion of the invoice can be verified and validated by the information submitted. If HHSC
decides to process an invoice in this manner, an adjustment will be made by HHSC and only
that portion of the fixed fee invoice that can be verified and validated will be paid.
To be paid for the Fixed Fees previously denied or not processed by HHSC, the respondent
must submit supplemental invoice(s) along with any and all necessary corrections or additional
changes requested by HHSC.
HHSC will process and pay Fixed Fees billed on supplemental invoices in accordance with
Chapter 2251, Texas Government Code. Each invoice will be processed and paid separately.
6.3.3 Fixed Fee Rates
HHSC anticipates that, during the life of the Contract, implementation of federal and state
mandates and other state initiatives will require additions to the activities not normally performed
on a regular basis. The RAC’s compensation for other audit services related to fraud
investigations or program integrity efforts, other specific audits, and any other service provided
by the RAC that would not be appropriate to utilize a contingency fee to compensate the RAC
for those specific services rendered will be based on Fixed Fees. The Fixed Fees will be based
on individual Fixed Fee Rates included in the Contract and the level of effort to perform a
specific service not paid on a contingency basis. The Fixed Fees for these services will be
based on the explicit fixed hourly rates proposed by the respondent and the projected number of
hours to be worked on the specific audit or specific project by the respondent’s staff or the staff
of the respondent’s subcontractor. The pricing associated with these services will be negotiated
between the respondent and HHSC after HHSC determines that the respondent has submitted
all of the detailed information (including detailed supporting metrics deemed appropriate by
HHSC) necessary to formulate a total fixed fee for the requested services.
Respondents must specify All-Inclusive Hourly Labor Rates for the different type of staff that
would be potentially working on audit services related to fraud investigations, program integrity
efforts, other specific audits, and any other service provided by the RAC that that would be paid
on a fixed fee basis. A representative sample of the types of staff the respondent must provide
All-Inclusive Hourly Labor Rates for is as follows:
(1) Project Director
(2) Medical Director;
(3) Audit Manager;
(4) Audit staff;
(5) Medical Review/Utilization Manager;
(6) Nursing staff;
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