Delivery Process and Methods. The Cross Functional Translation Services will provide coordination across Towers and consistency of delivery related to the translation required at the tower level. Supplier responsibilities include: • Maintenance of the “Translation Source of Truth,” containing: • Health Net’s approved list of languages by line of business for translation • Regulation rule and section • Regulation verbatim • Compliance/SME contact • List of vital documents by LOB • Model disclaimer language • List of interpreter service resources to which members can be referred for translations not handled by Health Net (i.e., for non-approved translations) • Documentation of procedures to execute Translation Services in the Procedures Manual that are consistent with the “Translation Source of Truth” to include the following: • A list of required documents / languages that are proactively translated year over year and made available to business areas • Processes for the handling of translation requests that fall outside of departmental policy • Escalation process when input or decision is needed from Health Net and the Supplier’s Compliance Officer Final • Process for notifications sent to downstream departments whose materials may be impacted • Process to measure operational results at established checkpoints (i.e., quarterly or annually as needed) • Process to review and allocate cost of third party translation services across each tower as needed by Health Net to support internal charge back needs • Update procedures on recurring schedule and as needed to incorporate changes in policy and/or Health Net contractual commitments, • Ensure continuity of service for any modification to policy and procedures, including: • Pilot revised policy and procedures with a selected Tower • Review results with Tower Leads to determine the refinements and to confirm any modifications continue to meet Regulatory and Compliance guidelines as well as Health Net’s requirements • Deploy updated charge back approach, providing Health Net with the appropriate charges based upon usage for Translation Services • Conduct training on regular intervals for all resources working on Translation Services to ensure that the staff is adequately trained on procedures and policies, • Manage the third party translation service providers on behalf of Health Net as part of Third Party Managed Services until such time as the Supplier can transition the contract agreement directly with Supplier. Final The graphic below illu...
Delivery Process and Methods. Risk assessment processes will be established and adhered consistently across the towers and coordinated through a centralized Supplier function. The Supplier Risk Officer will: • Be the single point of contact for the Health Net Risk Officer as well as a leader providing oversight and direction for internal Supplier teams who are integral to the process. • Work with Supplier teams to identify current and emerging risks identified during performance of the Services. • Collect and collate risks as identified by Supplier and provides material risk to the Health Net Enterprise Risk Officer as input to the Enterprise Risk Management process. • Supports the entire life cycle of each material risk, including identification of emerging drivers of risks, maintenance of the risks inventory, assignment of owners responsible for creating and executing mitigation plans, monitoring and status reporting on mitigation activities, and ensuring proper focus to ensure risks are actively mitigated to the fullest extent possible. Supplier will leverage the inherent relationship that exists between the Issues and Error Resolution Services, Root Cause Analysis (“RCA”) and Enterprise Risk Management to provide a robust solution to risk management: • Where a tower level issue is determined to be material enough to cause an Enterprise risk, an RCA and corrective action plan will become part of the risk description and the mitigation strategy, • Where Issues and Errors are identified by either the Quality Assurance Process or the Audit Process and are material enough to cause an Enterprise risk an RCA performed will be performed and a corrective action plan will be developed. Supplier will work with Health Net to both manage the mitigation of the risks identified by Health Net as well as the agreed material risks raised by the Supplier. Supplier will include the following in its Solution: • Adopting Health Net’s Enterprise Risk Management framework to ensure that risks are being properly identified, assessed, monitored and reported at an enterprise level, • Mitigating and managing the risk exposures as part of the day to day operational processes at the tower level, • Identifying events (an important realistic threat that exploits a significant applicable vulnerability) with a potential negative impact on the goals or operations of the enterprise, including events that are market driven, regulatory, financial, legal, technological, involving third parties and operational aspects, •...
Delivery Process and Methods. Supplier will create a Compliance Office within the organizational structure that will be responsible for the following essential services: • Developing Compliance policies and procedures, • Monitoring to ensure guidelines and standards are being followed, • Initiating and manage compliance projects, • Reporting on status of compliance activities, Final • Self-identification (self-reporting and self-audits) and the subsequent implementation of corrective actions, • Participation on compliance committee. The Compliance Office will take direction from Health Net’s Compliance Office on the interpretation and impact on the Services or Health Net’s departments of new Laws or changes to existing, state, and federal regulations. In addition, under Health Net’s direction the Compliance Office will participate in external audits and interact with regulators from the DMHC, CMS, DMHCS, HHS, etc., or their designee. The Compliance Office, led by the Supplier Compliance Officer, will manage compliance related aspects for the ongoing performance of the Services. The Compliance Office will develop or adopt policies and procedures and audits to ensure that all Supplier areas are following the guidelines and standards documented and established by Health Net. This will include the following activities: • Implementing written policies, procedures and standards of conduct related to Health Net’s interpretation of Laws into Policy supported by Procedures, • Conducting Compliance education and training to the in-scope resources thereby enabling them to understand and conduct their duties consistent with Laws and Regulations, • Providing for effective communication with Supplier Personnel related to Health Net’s interpretations and policy decisions, • Enforcing Standards through well-publicized disciplinary guidelines linked to education and training, monitoring and audit functions. The Supplier will monitor Services to oversee and measure that Compliance guidelines and standards are being followed. From time to time, Regulatory Agencies or other interested parties may request reports or responses to their inquiries from Supplier. Such requests will need to be managed by the Suppliers Compliance Office under the direction of Health Net’s Compliance Office. Health Net’s Compliance Office will be the overall responsible party in responding to Regulatory requests with direct support from the Supplier Compliance Officer and Tower Leads ensuring that the associated supporting docume...
Delivery Process and Methods. Supplier will assess the marketplace using a scoring system to rate the capability and maturity of the Services as compared to existing capabilities of competitors within the marketplace as well as emerging capabilities and needs within the industry. The market place assessment will be evaluated against current capabilities as well as with the Road Map, Discretionary and Non-Discretionary project to determine material gaps that exist and the extent to which they are bridged by adopting the recommendations documented in the Innovation Plan. Supplier will engage Health Net in the development and evaluation of the Innovation Plan in order to align priorities and particular areas of interest as input to the plan. Innovation Services will include the following activities: • Monitoring and improving service delivery methods and identify weaknesses and opportunities for evolution and improvement to the service delivery methods while systematically implement those innovations, • Monitoring industry trends, including through independent research, and document and report on products and services with potential application for Health Net on a quarterly basis, • Developing an innovation plan that will be reviewed annually to include: Final • Identifying general and industry specific business, technical and medical trends and forecasts that inform both the Supplier and Health Net of new opportunities that could be used to improve medical, financial or experiential outcomes; • Identifying business challenges facing the Health Care Industry and Heath Net relative to Health Net’s stated business goals and objectives; • Categorizing disruptive technological or scientific advances and their expected timeframes for practical (e.g., economically feasible) application of future advances within the context of Health Net’s business and the Services; • Reporting on the current STARs, HEDIS and NCQA rating for the Services over the previous year and a plan for improving each rating during the upcoming year; • Identifying STARS goals for the upcoming year for each measure, initiatives to achieve the goals, and correlating metrics to track progress and inform that goals are on track; and • Maintaining a rolling two year forecast outlining specific improvements in techniques, methods, processes or technologies that Supplier will implement to deliver ongoing Innovation within the scope of the Services and a list of prioritized recommendations as to how Health Net could take advantage ...
Delivery Process and Methods. Supplier will process the Return Mail Services based upon the type of return mail and the action required that would enable the mail to be re-delivered to the recipient. Steps will also be taken to ensure records are updated properly for any future mailings and correspondence. Where possible the new address information, if known (and permitted by regulators), will be updated in the system of record for the Member, thus raising the potential for successful delivery. During the Term, Supplier may introduce improvements to the Return Mail Processing Services to enable portions of this Service to be performed offshore (subject to all Health Net offshoring restrictions). As part of Supplier’s Solution for the Return Mail Processing Services, the physical handling of return mail will remain onshore.
Delivery Process and Methods. Supplier will collect the checks/funds that are received at any facility at any time. Supplier will log the funds, package them for mailing and deposit and will direct them to the appropriate lock box via the United States Postal Service. As part of the monthly operating meetings, the log and total funds received will be reviewed with Health Net. For monthly funds received that are in excess of thresholds set and adjusted for seasonality, a Root Cause Analysis will be executed and the results including recommendations and implementation plans for corrections, where appropriate, provided in the following month’s report.
