CDRL_M010_Mgmt_Rpt_Amend_0001.pdf

DD FORM 1423-1, FEB 2001

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TDP ________ TM _______ OTHER

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

G. PREPARED BY H. DATE I. APPROVED BY J. DATE

Page of Pages

Untitled

Frequency: Monthly Reporting Period Start Date: Start of Service Delivery Due Date: 15 calendar days after end of reporting period SUBSEQUENT SUBMISSION: Start of Service Delivery

PII/PHI: No FILE FORMAT: Microsoft Excel

CONTENT DETAILS: The Management Report shall provide information detailing performance versus standards of this contract.

Provide the following for claims inventory separated by CONUS and OCONUS:

# of receipts; # processed to completion; # pending at the end of the month; #/% claims processed to completion by business days; Total # claims processed to completion; # of adjusted claims (original claim from prior period); % claims paid accurately; % of claim errors corrected;

Provide the following for telephone activity separated by CONUS and OCONUS:

Total # of all telephone calls received; total # telephone calls serviced by Customer Service Rep; total # telephone calls from Providers; total # telephone calls serviced by Automated Response Unit;

Provide the following by CONUS/OCONUS combined:

% telephone calls answered by Automated Response Unit within 20 seconds; % telephone calls transferred to customer service rep within 30 seconds of caller selection; % telephone blockage rate; % telephone inquiries completed during initial call and completed within 3 business days

Provide the following totals separated by CONUS/OCONUS and % CONUS/OCONUS combined:

#/% priority correspondence 0-7, 8-20, >20 bus days, total #/% routine correspondence 0-10, 11-25, >25 bus days, total

Provide the following for grievance inventory separated by CONUS/OCONUS:

# grievance beginning inventory, # receipts, # processed to completion, # pending end of month, # processed 0-30, #/% 31-60 calendar days (% combined for CONUS/OCONUS), total # closed, # interim letters issued.

Enrollment and disenrollment activity separated by CONUS and OCONUS; E-1- E-4 group and Other rank group, and plan type for # individual plans and enrollees in individual plans, and # family plans and enrollees in family plans

TOPD activity broken out by:

# providers identified by the Government # providers identified by the Government that signed agreements Total # providers that signed agreements (identified by the Government and the contractor)

When CLINs X010 and/or X011 are exercised for Attachment J-12 the contractor shall also report by locale: % of orthodontic plan reviews completed timely; total # of orthodontic plan reviews completed # of NARFs issued; # of TOPD contacted and specify whether the contact was an onsite visit, telephonically, or via email