HomeMy WebLinkAboutRESPONSE - RFP - 7649 DENTAL ADMINISTRATOR (10)Category Description Target Measure Penalty
Claim Turnaround Time
Measured by Specific
Client
Timeliness of claim
processing
95% of claims will be
processed within 15 calendar
days
Assuming quarterly claim receipts equal to or greater than 500 claims, Delta
Dental will report the percent of claims processed within 15 calendar days.
Turnaround time commences on the date of the initial receipt of a claim form
with all necessary information and ends on the date of adjudication of the
claim. Measure is reported annually.
$1,250
Financial Payment
Accuracy*
Measured by Book of
Business
Claims dollars paid
accurately 99% of claims paid accurately
Financial accuracy is defined as total dollars that should be paid, minus the
sum of the absolute value of dollars overpaid and/or underpaid divided into
the total claims dollars that should be paid. Analysis is a random claim
sample measured by Delta Dental's block of business.
$1,250
Average Speed of Answer
(ASA)
Measured by Book of
Business
Timeliness of customer
service calls answered
All customer service calls
answered in less than 30
seconds
ASA is the length of time a caller waits on hold before a representative
answers their call. Calls received through Delta Dental's Integrated Voice
Response (IVR) are included.
$1,250
Abandonment Rate
Measured by Book of
Business
Number of customer
service calls abandoned
No more than 5% of calls that
end call after 30 seconds.
Percent of calls that end their call after 30 seconds. Calls received through
Delta Dental's Integrated Voice Response (IVR) are included. $1,250
City of Fort Collins
Claims Administration & Customer Service
Performance Guarantees
All measurements will be tracked on a quarterly basis while performance guarantee liability will be based upon annualized performance results
*DDCO's statistically valid sample of claims is 360 claims annually. Quarterly reports reflect preliminary results, with final results presented at year-end.