Performance Measurement Standards. (i) General - The Performance Measurement Table sets forth the categories of Performance Measurement Standards and their associated measurements. In performing its services under this Agreement, Contractor shall use commercially reasonable efforts to meet or exceed the Performance Measurement Standards. (ii) Root Cause Analysis/Corrective Action - If Contractor fails to meet any Performance Measurement Standard in any calendar month (whether or not the failure is excused), Contractor shall promptly (a) investigate and report on the root cause of the problem; (b) develop a corrective action plan (where applicable); (c) to the extent within Contractor’s control, remedy the cause of the performance failure and resume meeting the affected Performance Measurement Standards; (d) implement and notify the Exchange of measures taken by Contractor to prevent recurrences if the performance failure is otherwise likely to recur; and (e) make written recommendations to the Exchange for improvements in procedures. (iii) Performance Guarantee Exceptions; Contractor shall not be responsible for any failure to meet a Performance Guarantee if and to the extent that the failure is excused pursuant to Section 12.07 of the Agreement (Force Majeure) or the parties agree that the lack of compliance is due to the Exchange’s failure to properly or timely perform (or cause to be properly or timely performed) any responsibility, duty, or other obligation under this Agreement, provided that Contractor timely notifies the Exchange of the problem and uses commercially reasonable efforts to perform and meet the Performance Measurement Standards notwithstanding the Exchange’s failure to perform or delay in performing. If Contractor wishes to avail itself of one of these exceptions, Contractor shall indicate in the applicable performance report delivered in the second month following the failure to meet such Performance Measurement Standard: (a) the identity of the Performance Measurement Standard that is subject to the exception, and (b) the circumstances that gave rise to the exception in sufficient detail to permit the Exchange to evaluate whether Contractor’s claim of exception is valid. Notwithstanding anything to the contrary herein, in no event shall any failure to meet a Customer Satisfaction Performance Guarantee fall within an exception. The Exchange will also comply with the Performance Measurement Standards set forth herein to the extent that such measurements are applicable to Exchange’s operations. In the event that Exchange fails to meet a Performance Measurement Standard with respect to its operations for any applicable period, the additional fees that may be assessed by the Exchange under this Attachment will not be imposed on Contractor with respect to Contractor’s failure to meet the same Performance Measurement Standard. (iv) Agreed Adjustments/Service Level Relief - In addition, the Parties may agree on Performance Measurement Standard relief or adjustments to Performance Measurement Standards from time to time, including, the inclusion of new and/or temporary Performance Measurement Standards. (v) Performance Measurement Defaults - If the Exchange elects to assess sanctions for failure to meet Performance Measurement Standards, it will so notify Contractor in writing following the Exchange’s receipt of the Monthly Performance Report setting forth the performance level attained by Contractor for the calendar quarter to which the sanctions relate. If Contractor does not believe it is appropriate for the Exchange to assess sanctions for a particular calendar quarter or calendar year (as applicable), it shall so notify the Exchange in writing within thirty (30) days after receipt of the Exchange’s notice of assessment and, in such event, the Exchange will meet with Contractor to consider, in good faith, Contractor’s explanation of why it does not believe the assessment of sanctions to be appropriate; provided, however, that it is understood and agreed that the Exchange, acting in good faith, will make the final determination of whether or not to assess the sanctions. (vi) Service Level Credits - For certain of the performance standards set forth in the Performance Guarantee table, Contractor will have the opportunity to earn service level credit (“Service Level Credits”) for performance that exceeds the Performance Measurement Standards. The Service Level Credits shall be used to offset (i.e., reduce) any sanctions that are imposed during any Contract Year. (vii) Performance Guarantee Tables - The Performance Measurement Standards are set forth in the Chart 1. Covered California Performance Standards below: Call Answer Timeliness for Covered California Expectation: 80% of calls answered 30 seconds. 5% of total performance penalty at risk. Performance Level: <80%- 5% performance penalty. 80%-90%: no penalty. >90%: 5% performance credit. Processing ID Cards Expectation: 99% sent within 10 business days of receiving complete and accurate enrollment information from the Exchange and premium. 5% of total performance requirement expected. Performance Level: <50%: 5% penalty of total performance requirement. 50-98%: 2.5% penalty of total performance requirement. 99%: no penalty.
Appears in 1 contract
Samples: Qualified Health Plan Contract
Performance Measurement Standards. (i) General - The Performance Measurement Table sets forth the categories of Performance Measurement Standards and their associated measurements. In performing its services under this Agreement, Contractor shall use commercially reasonable efforts to meet or exceed the Performance Measurement Standards.
(ii) Root Cause Analysis/Corrective Action - If Contractor fails to meet any Performance Measurement Standard in any calendar month (whether or not the failure is excused), Contractor shall promptly (a) investigate and report on the root cause of the problem; (b) develop a corrective action plan (where applicable); (c) to the extent within Contractor’s control, remedy the cause of the performance failure and resume meeting the affected Performance Measurement Standards; (d) implement and notify the Exchange of measures taken by Contractor to prevent recurrences if the performance failure is otherwise likely to recur; and (e) make written recommendations to the Exchange for improvements in procedures.
(iii) Performance Guarantee Measurement Standard Exceptions; Contractor shall not be responsible for any failure to meet a Performance Guarantee Measurement Standard if and to the extent that the failure is excused pursuant to Section 12.07 of the Agreement (Force Majeure) or the parties agree that the lack of compliance is due to the Exchange’s failure to properly or timely perform (or cause to be properly or timely performed) any responsibility, duty, or other obligation under this Agreement, provided that Contractor timely notifies the Exchange of the problem and uses commercially reasonable efforts to perform and meet the Performance Measurement Standards notwithstanding the Exchange’s failure to perform or delay in performing. If Contractor wishes to avail itself of one of these exceptions, Contractor shall indicate in the applicable performance report delivered in the second month following the failure to meet such Performance Measurement Standard: (a) the identity of the Performance Measurement Standard that is subject to the exception, and (b) the circumstances that gave rise to the exception in sufficient detail to permit the Exchange to evaluate whether Contractor’s claim of exception is valid. Notwithstanding anything to the contrary herein, in no event shall any failure to meet a Customer Satisfaction Performance Guarantee Standard fall within an exception. The Exchange will also comply with the Performance Measurement Standards set forth herein to the extent that such measurements are applicable to Exchange’s operations. In the event that Exchange fails to meet a Performance Measurement Standard with respect to its operations for any applicable period, the additional fees that may be assessed by the Exchange under this Attachment will not be imposed on Contractor with respect to Contractor’s failure to meet the same Performance Measurement Standard.
(iv) Agreed Adjustments/Service Level Relief - In addition, the Parties may agree on Performance Measurement Standard relief or adjustments to Performance Measurement Standards from time to time, including, the inclusion of new and/or temporary Performance Measurement Standards.
(v) Performance Measurement Defaults - If the Exchange elects to assess sanctions for failure to meet Performance Measurement Standards, it will so notify Contractor in writing following the Exchange’s receipt of the Monthly Performance Report setting forth the performance level attained by Contractor for the calendar quarter to which the sanctions relate. If Contractor does not believe it is appropriate for the Exchange to assess sanctions for a particular calendar quarter or calendar year (as applicable), it shall so notify the Exchange in writing within thirty (30) days after receipt of the Exchange’s notice of assessment and, in such event, the Exchange will meet with Contractor to consider, in good faith, Contractor’s explanation of why it does not believe the assessment of sanctions to be appropriate; provided, however, that it is understood and agreed that the Exchange, acting in good faith, will make the final determination of whether or not to assess the sanctions.
(vi) Service Level Credits - For certain of the performance standards set forth in the Performance Guarantee table, Contractor will have the opportunity to earn service level credit (“Service Level Credits”) for performance that exceeds the Performance Measurement Standards. The Service Level Credits shall be used to offset (i.e., reduce) any sanctions that are imposed during any Contract Year.
(vii) Performance Guarantee Tables - The Performance Measurement Standards are set forth in the Chart 1. below table, Covered California Performance Standards below: and Reporting Requirements for Contractor:
1.1 Inbound Call Answer Timeliness for Covered California Expectation: 80% Volume Total number of calls answered 30 secondsreceived by the ACD. 5% X X Reporting Required Only. Volume will be used in calculation of total performance penalty at riskstandards 1.3 and 1.4
1.2 Abandoned Call Volume Number of calls offered to the service center by the ACD, but terminated by the person originating the call outside the Service Level. Performance Level: <80%- 5% performance penalty. 80%-90%: no penalty. >90%: 5% performance credit. Processing ID Cards Expectation: 99% sent within 10 business days of receiving complete and accurate enrollment information from the Exchange and premium. 5% of total performance requirement expected. Performance Level: <50%: 5% penalty of total performance requirement. 50-98%: 2.5% penalty of total performance requirement. 99%: no penalty.X X
Appears in 1 contract
Samples: Qualified Dental Plan Contract
Performance Measurement Standards. (i) General - The Performance Measurement Table sets forth the categories of Performance Measurement Standards and their associated measurements. In performing its services under this Agreement, Contractor shall use commercially reasonable efforts to meet or exceed the Performance Measurement Standards.
(ii) Root Cause Analysis/Corrective Action - If Contractor fails to meet any Performance Measurement Standard in any calendar month (whether or not the failure is excused), Contractor shall promptly (a) investigate and report on the root cause of the problem; (b) develop a corrective action plan (where applicable); (c) to the extent within Contractor’s control, remedy the cause of the performance failure and resume meeting the affected Performance Measurement Standards; (d) implement and notify the Exchange of measures taken by Contractor to prevent recurrences if the performance failure is otherwise likely to recur; and (e) make written recommendations to the Exchange for improvements in procedures.
(iii) Performance Guarantee Exceptions; Contractor shall not be responsible for any failure to meet a Performance Guarantee if and to the extent that the failure is excused pursuant to Section 12.07 of the Agreement (Force Majeure) or the parties agree that the lack of compliance is due to the Exchange’s failure to properly or timely perform (or cause to be properly or timely performed) any responsibility, duty, or other obligation under this Agreement, provided that Contractor timely notifies the Exchange of the problem and uses commercially reasonable efforts to perform and meet the Performance Measurement Standards notwithstanding the Exchange’s failure to perform or delay in performing. If Contractor wishes to avail itself of one of these exceptions, Contractor shall indicate in the applicable performance report delivered in the second month following the failure to meet such Performance Measurement Standard: (a) the identity of the Performance Measurement Standard that is subject to the exception, and (b) the circumstances that gave rise to the exception in sufficient detail to permit the Exchange to evaluate whether Contractor’s claim of exception is valid. Notwithstanding anything to the contrary herein, in no event shall any failure to meet a Customer Satisfaction Performance Guarantee fall within an exception. The Exchange will also comply with the Performance Measurement Standards set forth herein to the extent that such measurements are applicable to Exchange’s operations. In the event that Exchange fails to meet a Performance Measurement Standard with respect to its operations for any applicable period, the additional fees that may be assessed by the Exchange under this Attachment will not be imposed on Contractor with respect to Contractor’s failure to meet the same Performance Measurement Standard.
(iv) Agreed Adjustments/Service Level Relief - In addition, the Parties may agree on Performance Measurement Standard relief or adjustments to Performance Measurement Standards from time to time, including, the inclusion of new and/or temporary Performance Measurement Standards.
(v) Performance Measurement Defaults - If the Exchange elects to assess sanctions for failure to meet Performance Measurement Standards, it will so notify Contractor in writing following the Exchange’s receipt of the Monthly Performance Report setting forth the performance level attained by Contractor for the calendar quarter to which the sanctions relate. If Contractor does not believe it is appropriate for the Exchange to assess sanctions for a particular calendar quarter or calendar year (as applicable), it shall so notify the Exchange in writing within thirty (30) days after receipt of the Exchange’s notice of assessment and, in such event, the Exchange will meet with Contractor to consider, in good faith, Contractor’s explanation of why it does not believe the assessment of sanctions to be appropriate; provided, however, that it is understood and agreed that the Exchange, acting in good faith, will make the final determination of whether or not to assess the sanctions.
(vi) Service Level Credits - For certain of the performance standards set forth in the Performance Guarantee table, Contractor will have the opportunity to earn service level credit (“Service Level Credits”) for performance that exceeds the Performance Measurement Standards. The Service Level Credits shall be used to offset (i.e., reduce) any sanctions that are imposed during any Contract Year.
(vii) Performance Guarantee Tables - The Performance Measurement Standards are set forth in the Chart Charts 1, 2 and 3. Covered California Performance Standards below: Call Answer Timeliness for Covered California Expectation: 80% of calls answered 30 seconds. 5% of total performance penalty at risk. Performance Level: <80%- 5% performance penaltybelow expectation . 80%-90%: no penaltymeets expectation. >90%: 5% performance credit. exceeds expectation Processing ID Cards Expectation: 99% sent within 10 business days of receiving complete and accurate enrollment information from the Exchange and premiumpremium3.. Performance Level: <50%: below expectation . 550-98%: meets expectation 99%: exceeds expectations. Telephone Abandonment Rate for Covered California Expectation: No more than 3% of incoming calls in a calendar month. Performance Level: >3% abandoned-: below expectation. 2-3% abandoned: meets expectation <2% abandoned: exceeds expectation Initial Call Resolution Expectation: 85% of enrollee issues will be resolved within one (1) business day of receipt of the issue. Performance Level: <85%: below expectation 85-95%: meets expectation >95%: exceeds expectation Grievance Resolution Expectation: 95% of enrollee grievances resolved within 30 calendar days. Performance Level: <95% resolved within 30 calendar days: below expectation 95% or greater resolved within 30 calendar days: meets expectation 95% or greater resolved within 15 calendar days: exceeds expectation Enrollment and payment transactions 6 month pilot period: 10/1/13-3/31/14 Measurement period: 4/1/14-12/31/14 Expectation: The Exchange will receive the 999 file within one business day of receipt of the 834/820 file 85% of the time and within 3 bus days of receipt of the 834/820 file 99% of the time within any given month. Expectation and Performance Level and methodology to be determined after the pilot period (based on pilot period). Effectuation of enrollment upon receipt of payment 6 month pilot period: 10/1/13-3/31/14 Measurement period: 4/1/14-12/31/14 Expectation: The exchange will receive the 834 file within one business day of receipt of the member's initial payment file 85% of the time and within 3 bus days of receipt of the member's initial payment 99% of the time within any given month. Expectation and Performance Level and methodology to be determined after the pilot period (based on pilot period). Member payment 6 month pilot period: 10/1/13-3/31/14 Measurement period: 4/1/14-12/31/14 Expectation: The Exchange4 will receive the 820 file within one business day of receipt of the member's payment file 95% of the time and within 3 business days of receipt of the member's payment 99% of the time within any given month. Expectation and Performance Level and methodology to be determined after the pilot period (based on pilot period). Enrollment change upon non-receipt of member payment, 30 day notice and termination 6 month pilot period: 10/1/13-3/31/14 Measurement period: 4/1/14-12/31/14 Expectation: The Exchange will receive the 834 file within one business day of receipt of change of the members’ status 95% of the time and within 3 business days of receipt of change of the members’ status 99% of the time within any given month. Expectation and Performance Level and methodology to be determined after the pilot period (based on pilot period). Member Email or Written Inquiries Expectation: Correspondence 90% response to email or written inquiries within 15 working days of inquiry. Does not include written grievances or appeals. 10% of total performance requirement expected. Performance Level: <5070%: 5% penalty of total performance requirement. 50below expectation 70-9890%: 2.5below expectation 90% penalty of total performance requirement. 99%or greater: no penaltymeets expectation Greater than 90% in 2 days: exceeds expectation 4 Does not apply in the SHOP Exchange.
Appears in 1 contract
Samples: Stand Alone Dental Plan Contract
Performance Measurement Standards. (i) General - The Performance Measurement Standards Table sets forth the categories of Performance Measurement Standards and their associated measurements. In performing its services under this Agreement, Contractor shall use commercially reasonable efforts to meet or exceed the Performance Measurement Standards.
(ii) Root Cause Analysis/Corrective Action - If Contractor fails to meet any Performance Measurement Standard in any calendar month (whether or not the failure is excused), Contractor shall promptly (a) investigate and report on the root cause of the problem; (b) develop a corrective action plan (where applicable); (c) to the extent within Contractor’s control, remedy the cause of the performance failure and resume meeting the affected Performance Measurement Standards; (d) implement and notify the Exchange of measures taken by Contractor to prevent recurrences if the performance failure is otherwise likely to recur; and (e) make written recommendations to the Exchange for improvements in procedures.
(iii) Performance Guarantee Exceptions; Contractor shall not be responsible for any failure to meet a Performance Guarantee if and to the extent that the failure is excused pursuant to Section 12.07 of the Agreement (Force Majeure) or the parties agree that the lack of compliance is due to the Exchange’s failure to properly or timely perform (or cause to be properly or timely performed) any responsibility, duty, or other obligation under this Agreement, provided that Contractor timely notifies the Exchange of the problem and uses commercially reasonable efforts to perform and meet the Performance Measurement Standards notwithstanding the Exchange’s failure to perform or delay in performing. If Contractor wishes to avail itself of one of these exceptions, Contractor shall indicate in the applicable performance report delivered in the second month following the failure to meet such Performance Measurement Standard: (a) the identity of the Performance Measurement Standard that is subject to the exception, and (b) the circumstances that gave rise to the exception in sufficient detail to permit the Exchange to evaluate whether Contractor’s claim of exception is valid. Notwithstanding anything to the contrary herein, in no event shall any failure to meet a Customer Satisfaction Performance Guarantee fall within an exception. The Exchange will also comply with the Performance Measurement Standards set forth herein to the extent that such measurements are applicable to Exchange’s operations. In the event that Exchange fails to meet a Performance Measurement Standard with respect to its operations for any applicable period, the additional fees that may be assessed by the Exchange under this Attachment will not be imposed on Contractor with respect to Contractor’s failure to meet the same Performance Measurement Standard.
(iv) Agreed Adjustments/Service Level Relief - In addition, the Parties may agree on Performance Measurement Standard relief or adjustments to Performance Measurement Standards from time to time, including, the inclusion of new and/or temporary Performance Measurement Standards.
(v) Performance Measurement Defaults - If the Exchange elects to assess sanctions for failure to meet Performance Measurement Standards, it will so notify Contractor in writing following the Exchange’s receipt of the Monthly Performance Report setting forth the performance level attained by Contractor for the calendar quarter to which the sanctions relate. If Contractor does not believe it is appropriate for the Exchange to assess sanctions for a particular calendar quarter or calendar year (as applicable), it shall so notify the Exchange in writing within thirty (30) days after receipt of the Exchange’s notice of assessment and, in such event, the Exchange will meet with Contractor to consider, in good faith, Contractor’s explanation of why it does not believe the assessment of sanctions to be appropriate; provided, however, that it is understood and agreed that the Exchange, acting in good faith, will make the final determination of whether or not to assess the sanctions.
(vi) Service Level Credits - For certain of the performance standards set forth in the Performance Guarantee table, Contractor will have the opportunity to earn service level credit (“Service Level Credits”) for performance that exceeds the Performance Measurement Standards. The Service Level Credits shall be used to offset (i.e., reduce) any sanctions that are imposed during any Contract Year.
(vii) Performance Guarantee Tables - The Performance Measurement Standards are set forth in the below table, Covered California Performance Standards.Chart 1. Covered California Performance Standards below: Call Answer Timeliness 3. Performance Measurement Standards Reporting-Group 3- Quality, Network Management and Delivery System Reform
(a) All performance measures in Group 3 are for Covered California Expectation: 80measurement only in 2014 with no penalty or credit assessed in 2015. For measurement in years 2015 and thereafter, penalty or credit will be assessed in 2016 and thereafter. For performance measures in Group 1 – Customer Service and Group 2 – Operations, measurement in year 2014 of penalty or assessment s will count for 50% each of calls answered 30 seconds. 5% of the total performance penalty at risk. Performance Level: <80%- 5% performance penalty. 80%-90%: no penalty. >90%: 5% performance credit. Processing ID Cards Expectation: 99% sent within 10 business days of receiving complete assessment.
(b) Specific reporting requirements for HEDIS and accurate enrollment information CAHPS measures referenced in Attachment 14, Group 3 measures 3.1-3.4 are noted in Attachment 7, section 3.01
(c) Attachment 14, Group 3 measures 3.1- 3.4 related to HEDIS/CAHPS Quality Reporting System Measures for “Getting the Right Care” (3.1), “Access to Care” (3.2), “Staying Healthy/Prevention” (3.3) and “Plan Service” (3.4) are all derived from the Exchange and premium. 5% of total performance requirement expected. Performance Level: <50%: 5% penalty of total performance requirement. 50-98%: 2.5% penalty of total performance requirement. 99%: no penaltyHEDIS and/or CAHPS measures as noted in Appendix 1 to this attachment 14.
Appears in 1 contract
Samples: Performance Measurement Standards
