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
RCIGNA
received by Connecticut General to and
including the day the Claim is processed
The day thatthe Claim is receivedwill not
be included in this calculation
2 Claim Qualitv
2 1 Financial Accuracy
2 2 1 1 Financial Accuracy Measurement
Financial Accuracy Performance
Commitment will be determined by
applying Connecticut General s Standard
Quality Assurance Audit Methodology to a
statistically valid sample ofClaims
Account Level or claims Office Level
processed during the Guarantee Period
Financial Accuracy represents the sum of
the absolute value oftotal dollars overpaid
and the total dollars underpaid subtracted
from the total dollars paid divided by the
total dollars paid expressed as a percent
Overpayments and underpayments are
determined from auditing a statistically
valid sample ofclaims paid during the
period
2 2 Claim Processing Accuracy Overall
Accuracy
2 2 2 1 Claim Processing Accuracv Overall
Accuracy Measurement
Claim
Processing Accuracy Overall Accuracy
Performance Commitment will be
determined by applying Connecticut
General s Standard Quality Assurance
AuditMethodology to a statistically valid
sample ofClaims Account Level or
claims Office Level processed during the
Guarantee Period
Claim Processing Accuracy Overall
Accuracy represents the total number of
claims processed without any errors both
financial and non financial errors divided
by the total claims processed expressed as
a percent The calculation ofclaims paid
with error is determined from auditing a
statistically valid sample of claims paid
during the period
23 Inquiry
23 1 Average Speed of Answer ASA
23 IIASA Measurement The ASA will be
determined by measuring the sum ofthe
total elapsed time between the moment
when a telephone call is queued to the Call
Center s and the time the call is responded
to for all answered calls to the Call
Center s and then dividing that number
by the total number of telephone calls
answered in the Call Center s during the
Guarantee Period
The calculation ofASA is either based on
all Inquiries Account Level or on all calls
received by the Call Center s that are
serviced in the Special Account Queue
232 Call Abandonment Rate
23 2 1 Call Abandonnlent Rate Measurement
The Call Abandonment Rate will be
calculated as the total number ofcalls
received during the Guarantee Period that
result in the caller terminating the call after
it is queued to a CSA divided by the total
number oftelephone calls received by the
Call Center s during the Guarantee Period
expressed as a percent
The calculation ofCall Abandonment Rate
is based on all Inquiries Account Level or
on all calls received by the Call Center s
during the Guarantee Period that are
serviced in the Special Account Queue
23 3 First Call Resolution
233 1 First Call Resolution Measurement An
Inquiry will be considered closed on first
inquiry when Connecticut General gives it
a closed status on the Inquiry Tracking
System s andno Inquiries involving the
same matter are received during the 45 day
period prior to the Inquiry or during
the 45
day period following the Inquiry
The First Call Resolution rate will be
calculated by dividing the number of
Inquiries thatwere closed on first inquiry
during the Guarantee Period by the total
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