2010-06-07_(2).pdf - 19318.8K - BridgeportCT.gov

CIGNA HealthCare Performance Guarantee Agreement
Customer Bridgeport City BOE
Effective Date July 1 2010
Account Number s involved in Performance Guarantee s 3213172
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CIGNA
EXHIBIT B2
SERVICE
I
Additional Definitions
1 1 Account Level The performance
commitment is measured with respect to
Employer s claims processed during the
Guarantee Period
12 Average Speed to Answer The sum ofthe
total elapsed time between the momentwhen
atelephone call is queued to the Call
Center s and the time the call is responded
to
13 Call Center Member service center of
Connecticut General that receives and
responds to Plan Participant telephone calls
14 Claim Refers to claims received by
Connecticut General underthe Plan s Ifthe
term claim is used without a capital c it
refers to claims received by Connecticut
General whether under the
Employer s
Plan s orunder other plans
1 5 Connecticut General s Standard Quality
Assurance Audit Methodology The
objective ofaudit claim quality is to measure
claim accuracy by identifying claim payment
or
processing errors that are based on data
available to the claim processor at the
time day the claim was
paid that caused
incorrect payment or correspondence that has
a customer impact and thatresults in
correctional work by Connecticut General
1 6 Customer Service Representative CSA
A person responding to callers at a Call
Center
1 7 1nmirY An answered call received at a Call
Center about the services Connecticut
General provides to the Plan s
beginning ofthe plan year to prepare for Plan
administration
1 9 Maintenance ID Cards Means ID Cards
issued during the Guarantee Period for
changes in member address changes in
enrollment etc Maintenance ID Cards does
not include the initial issuance ofID cards at
the beginning ofthe Plan year
1 10 Office Level The performance commitment
is measured using a random sample of all the
claims processed at the Service Center s on
the same claim engine that processes
Employer s Claims And for all Vision Plan
performance guarantees Office Level shall
mean that the performance commitment is
measured using arandom sample ofall vision
claims processed across the entire book of
vision business
11 Processed A Claimclaim shall be
considered proc ssed when Connecticut
General has made a determination as to
whetherthe billed services are covered and if
covered determined the amount of
reimbursement
1 12 Service Center A claim processing office of
Connecticut General that processes Claims
1 13 Special Account Queue A defined group of
customer service associates that handle a
specific block ofbusiness with similar ASA
and abandonment rate
requirements The
SAQ refers to a specific call queue to which
an account
belongs For measurement
purposes results aJre derived by compiling
statistics for all accounts within that particular
queue
2 Performance Metrics
1 8 Maintenance Eligibility Means additions
2 1 Claim Time to Process TTP
deletions and changes in eligibility that are
processed during the Guarantee Period
Maintenance Eligibility does not include any
eligibility loads that are done at or before the
2 1 1 Time to Process Measurement Time to
Process will be calculated by counting the
number ofBusiness Days or calendar days
as
appropriate from the day that a Claim is
OS 28 2010
20 I 0 Performance Guarantee
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