2010-06-07_(2).pdf - 19318.8K - BridgeportCT.gov
2010-06-07_(2).pdf - 19318.8K - BridgeportCT.gov
2010-06-07_(2).pdf - 19318.8K - BridgeportCT.gov
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CIGNA HealthCare Performance Guarantee Agreement<br />
Customer Bridgeport City BOE<br />
Effective Date July 1 <strong>2010</strong><br />
Account Number s involved in Performance Guarantee s 3213172<br />
IIf<br />
CIGNA<br />
EXHIBIT A Performance Guarantees and Penalties<br />
Account Manalement<br />
Account Management Composite Score all categories of3 0 or better on theAccount Management Report Card based on four<br />
4 quarterly assessments Results measured at Account Level<br />
Fees AtRisk<br />
5 102 00<br />
Financial Accuracv<br />
Medical Financial Accuracy Measured forthe Term of the Agreement results willmeet or exceed 99 of total audited Claim<br />
dollars are correctly paid Results measured at Account Level<br />
Processinl Accuracv<br />
Medical Processing Accuracy Measured for the Term of the Agreement results will meet or exceed 95 of total audited<br />
claims correctly processed Claim Processing Accuracy is reported quarterly as it is based on aquarterly post payment stratified<br />
audit program Results measured at Account Level<br />
Fees AtRisk<br />
5 102 00<br />
Fees At Risk<br />
5 02 00<br />
TIP<br />
Medical Time To Process Measured for the Term of the Agreement results will meet or exceed 90 in 14 calendar days<br />
clean paper claims Results measured at Account Level<br />
Fees At Risk<br />
5 102 00<br />
Clinical ImDrovement<br />
Disease Management Improvement in Participant Compliance with Recommended Asthma Testing<br />
mpro lement in the<br />
percentage ofAsthma Participants with persistent asthma who are<br />
prescribed asthma medication that are acceptable as<br />
primary<br />
therapy for long term asthma during the Guarantee Period compared to the Baseline Period Results measured are Client<br />
Specific<br />
Disease Management Improvement in Participant Compliance with Recommended Cholesterol Testing Improvement in the<br />
percentage of CHD Participants and Diabetes Participants receiving an annual LDL screening during the Gwlrantee Period<br />
compared to theBaseline Period Results measured are Client Specific<br />
Financial<br />
Fees AtRisk<br />
5 of asthma Well<br />
A ware Fees<br />
5 of cardiac and<br />
diabetic Well Aware<br />
Fees<br />
Fees AtRisk<br />
Up to 20<br />
of Well<br />
Aware fees ifthe<br />
performance target is not<br />
met Payment will be the<br />
D M ROI A d I 0 fProgram partlclpants dunng h Guarantee P odh t at equaI<br />
lesser of20 Well<br />
A F th<br />
or morethan 2 of their Baseline Period medical expenses Results measured are Client Specific<br />
Isease anagement savmgs ID me expenses t en IS to<br />
d ffi warebetees or I erence ween thee<br />
target savings<br />
percentage and the<br />
savings percentage<br />
achieved<br />
Fees AtRisk<br />
Auto Elilibilitv<br />
<strong>2010</strong> Performance Guarantee<br />
Page 3<br />
Auto Eligibility Processing Measured for the Term of theAgreement results will meet or exceed 100 Days after the receipt of clean eligibility Results measured at Account Level<br />
files processed in 3<br />
5 102 00<br />
ID Card Maintenance<br />
Fees AtRisk<br />
lD Cards Maintenance 99 mailed within 10 business days after the release of not receipt of clean and accurat eligibility to<br />
the lDcard vendor Results measured at Account Level<br />
Elilibilitv DiscreDancv ReDortDelivery<br />
5 102 00<br />
Fees AtRisk<br />
Guarantee the City and the BOE will not be held responsible to make payments forcovered services paid on individuals who<br />
were not eligible Within 30 business days after the end of each calendar month following the implementation date you agree<br />
to provide the City and BOE with a report showing the results of such eligibility reviews and claim payment recovery<br />
5 102 00<br />
completed for that calendar month Client will be responsible for downloading and reviewing the discrepancy reports via<br />
CIGNAccess com Results measured at Account Level<br />
ADDeals<br />
Fees AtRisk<br />
Turn around time for claim appeals will be no greater than 30 days from the time the appeal is submitted to when a final<br />
decision is reached Results measured at Account Level<br />
5 102 00<br />
OS 28 20 0
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