CTR078138_Performance_Guarantees.pdf

Arizona Department of Administration

State Procurement Office

100 N 15th Avenue

Phoenix, AZ 85007

INSTRUCTIONS TO OFFERORS:

2. Offeror may choose to increase the amount applied to each category but must meet the minimum.

3. Offeror shall describe how the results will be reported to verify compliance.

4. Penalties associated with required Performance Guarantees will be assessed as the Penalty Calculation and Assessment details..

5. At no time will monthly or quarterly measurements be re-averaged to alter results.

Implementation 2%

Account Management/Customer Service

3%

Reporting 1% Program Administration/Claim

Administration 2%

Total Minimum Percent at Risk 8%

Definitions:

Request for Proposal

Attachment 15 – Performance Guarantees

415-203-0465

Tracking and Reporting Method: the description of the report requested and the corresponding time frame that shows how the measure was met or missed.

Contact Name

Contact Phone Number

Authorized Signature

Offeror Name

Solicitation No. BPM006762 Health Savings Account and Flexible Spending Account Administration

Inspira Financial Health, Inc.

Kevin Duffy

Reporting Frequency: the frequency of reporting the Contractor’s results against the target. This is also the frequency with which penalties will be calculated (monthly guarantees are calculated as 1/12 of annual fees at risk, quarterly measures are 1/4 of annual fees at risk). At no time will quarterly or monthly measurements be re-averaged to alter results.

All measurements missed during the reporting frequency period will be assessed at the end of the year for that frequency period.

1. Under each category, Offeror shall assign at least the minimum percent of annual administrative fees at risk shown below for each section, designating a percentage for each performance standard.

Tracking and

Reporting Method

Reporting Frequency Target Administrative Fees at

Risk

Detailed explanation of how the Offeror will meet and report outcomes for the measurement

1. Implementation 5.00%

1.1 Vendor Implementatio n Log

One-time penalty measured ninety

(90) days following Go Live

Pass/Fail 1.00%

We will meet this performance measure through our project plan. This project plan will be a “living document” that will serve as a roadmap for the project.

1.2 Vendor Implementatio n Log

One-time penalty measured ninety

(90) days following Go Live

Pass/Fail 1.00%

We will meet this performance measure through our project plan. This project plan will be a “living document” that will serve as a roadmap for the project.

1.3 Vendor Implementatio n Log

One-time penalty measured ninety

(90) days following Go Live

Pass/Fail 1.00%

We will meet and report this performance measure through our current performance/service readiness metrics.

1.4 Vendor Implementatio n Log

One-time penalty measured ninety

(90) days following Go Live

Pass/Fail 2.00%

We will meet this performance measure through our project plan. This project plan will be a “living document” that will serve as a roadmap for the project.

2. Account Management/Customer Service 7.00%

2.1 Issue Log Monthly Pass/Fail 2.00%

We will meet this performance measure through our account management scorecard. This evaluation is performed at mutually agreed upon intervals on a team basis. Benchmark is an average score of 3.0 or better.

Issues raised by ADOA are resolved within one business day.

2.2 Vendor Report Monthly Pass/Fail 2.00%

We will meet this performance measure through our account management scorecard. This evaluation is performed at mutually agreed upon intervals on a team basis. Benchmark is an average score of 3.0 or better.

Return phone calls/emails within 24 hours (acknowledgement).

Performance Measure

Implementation: Contractor shall provide marketing materials within forty-five (45) calendar days prior to open enrollment.

Implementation: System set up including testing thirty (30) calendar days prior to implementation date.

Implementation: 100% Call Center System set up including testing ninety (90) calendar days prior to implementation date.

Implementation: 100% Website is set up and tested ninety

(90) calendar days prior to implementation date.

Account Management: The Account Management Team will respond to issues within one (1) business day.

Timely Correspondence: All written inquires/correspondence is responded within two (2) business days.

2.3 Vendor Report Monthly Pass/Fail 1.00%

Call abandonment rate: We guarantee that the average rate of telephone abandonment will not exceed 5.0%.

We measure telephone response time through monitoring equipment, which produces a report on the average abandonment rate. We determine the abandonment rate by taking the total number of calls transferred from the IVR but disconnected by the member before reaching an agent divided by the total number of calls transferred from the IVR into the phone site. We don’t include any calls that disconnect in less than 10 seconds. Instead, we treat them as misdirected calls.

Average Speed of Answer (ASA): We guarantee that customer service will have an ASA of 30 seconds or less.

We measure ASA through monitoring equipment, which creates an ASA report. ASA measures the speed customer service consultants answer calls after the auto attendant places them in queue. This doesn’t include time the caller spent navigating through any auto attendant menus or Interactive Voice Response (IVR) system calls. It includes total calls (answered and abandoned) offered to customer service consultants. We use the total number of seconds taken to answer all incoming calls divided by the total number of answered calls to

2.4 ADOA

Reporting Annually ≥95% 1.00%

We will meet this performance measure through our account management scorecard. This evaluation is performed at mutually agreed upon intervals on a team basis. Benchmark is an average score of 3.0 or better.

The purpose of the account management scorecard is to assess your overall satisfaction with assigned account manager. This includes the supporting account management areas. This evaluation must be completed annually. This allows us to measure the results then make the needed compensation adjustment (if any).

Quality Phone Services: All calls shall have less than three percent (3%) call abandonment rate and shall be answered within thirty (30) seconds or less.

Account Management Survey: Contractor shall obtain at least a ninety-five percent (95%) satisfaction rate on the annual account management survey conducted by ADOA.

2.5 ADOA

Reporting Annually ≥90% 1.00%

Member satisfaction is important to us. We are committed to actively listening to members and providing exceptional service throughout the year. Through our professional, knowledgeable and friendly service we will achieve this performance measure.

3. Reporting 3.00%

3.1 ADOA Audit

Review Monthly Pass/Fail 1.00%

We will meet this performance measure through our monthly reports that we deliver through the employer website or via email. Reports are produced daily, weekly, monthly, or annually.

3.2 ADOA Audit

Review Quarterly Pass/Fail 1.00%

We will meet this performance measure through our monthly reports that we deliver through the employer website or via email. Reports are produced daily, weekly, monthly, or annually.

3.3 ADOA Audit

Review Annually Pass/Fail 1.00%

We will meet this performance measure through our annual reports that we deliver through the employer website or via email. Reports are produced daily, weekly, monthly, or annually.

4. Program Administration/Claim Administration 5.00%

4.1 Vendor Report Monthly Pass/Fail 1.00%

We will meet this performance measure through our account management scorecard. This evaluation is performed at mutually agreed upon intervals on a team basis. Benchmark is an average score of 3.0 or better.

4.2 Vendor Report Monthly Pass/Fail 0.75%

We will process all dependent debit card and lost/stolen (replacement) card requests within five business days. Both of these are handled online (dependent cards) or through customer service (dependent cards and lost/stolen cards).

4.3

Monthly vendor report noting enrollment statistics.

Monthly Pass/Fail 0.75%

We will accept eligibility files within 24 hours, and process all files within two business days of receipt.

A file results email is sent every time a file has been processed. The email includes the file name, the statistics of the file (number of records, total dollar amount of deposits, etc.), and an error report macro (if there are errors or warnings present). This email is sent even if there are no errors. If an error report macro is included, it allows you to correct errors within the spreadsheet.

Member Satisfaction Survey: Contractor shall obtain as least a ninety percent (90%) satisfaction rate on the annual member satisfaction survey conducted by ADOA.

Monthly reports must be submitted within thirty (30) days following end of month.

Quarterly reports must be submitted within forty-five (45) days following end of quarter.

Annual report must be submitted within ninety (90) days following end of plan year.

Program Administration: Contractor will mail all appropriate plan materials (enrollment packets, debit cards, notification letters, etc.) to members within ten (10) calendar days of initial enrollment.

Program Administration: Contractor will process a participant request for debit cards within five (5) business days of receipt of request.

Eligibility File Load: Contractor shall load and reconcile daily eligibility files within twenty-four (24) hours of receipt.

4.4

Monthly vendor report noting fund disbursement statistics.

Monthly Pass/Fail 0.50%

We will process all payroll files within two business days of receipt.

A file results email is sent every time a file has been processed. The email includes the file name, the statistics of the file (number of records, total dollar amount of deposits, etc.), and an error report macro (if there are errors or warnings present). This email is sent even if there are no errors. If an error report macro is included, it allows you to correct errors within the spreadsheet. The file can then be placed on the secure file transfer protocol site for processing.

4.5 Vendor Report Monthly Pass/Fail 0.50%

Claim turnaround time during the guarantee period will not exceed two business days on average of the audited claims on a cumulative basis each quarter.

We measure turnaround time from the date the service center receives the claim to the date that our examiner verifies it. Weekends and holidays are not included in turnaround time.

4.6

Monthly vendor report noting processing accuracy and claims paid.

Monthly ≥98% 0.50%

The accuracy of the claim payment dollars will be 98.0% or higher in each quarter. We measure financial precision by the dollar amount of claims paid accurately divided by the total dollars paid.

We consider each underpayment and overpayment an error and don’t offset one by the other.

4.7 Vendor Report Monthly ≥98% 0.50%

The accuracy of the claim payment dollars will be 98.0% or higher in each quarter. We measure financial precision by the dollar amount of claims paid accurately divided by the total dollars paid.

We consider each underpayment and overpayment an error and don’t offset one by the other.

4.8 Vendor Report Monthly Pass/Fail 0.50%

Claims are processed within two business days of receipt, and we automatically generate an explanation of payment (EOP) with every adjudicated claim. The EOP is issued based on the production run date for the employer. In the event a claim cannot be approved, the EOP details the reason for denial. For partially denied claims, we reimburse the eligible amounts and report both the eligible and denied portions on the EOP.

Payroll File Load: Contractor shall load and reconcile bi-weekly payroll files within two (2) business days of receipt.

100% of all fully documented claims received will be processed within 2 business days.

98% of all claims will be accurately processed and paid.

Accuracy Rate = (Total Paid Charges in Population - Weighted Overpayment + Weighted Underpayments) / Total Paid Charges in Population

98% of all claims will be processed accurately. Accurate processing includes payment amount; communication to claimant or provider; data entry errors affecting current or future benefit determinations and management reports.

Overall Accuracy Rate= (Total # of claims in population- Weighted # of claims with any error) / Total # of claims in population

Contractor shall provide written notification to members within 5 business days of a submitted processed or denied claim.

Performance Guarantees