Attachment 7 - Quality Assurance Surveillance Plan.doc
DOC document 77 KB Posted
- Attached to
- Long Term Care Insurance Services Federal contract opportunity
- Solicitation number
- OPM049-08-R-0002
- Issued by
- Office of Personnel Management
About this file
Attachment 7 - Quality Assurance Surveillance Plan
View the file
Other files for this federal contract opportunity
Show all 32
On GovTribe
Work with this file on GovTribe
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
QUALITY ASSURANCE SURVEILLANCE PLAN (QASP)
Performance Standards Offerors must complete this QASP as part of their proposal. In your response to Section L, you will propose your profit as a percentage of annualized premium. You must propose a profit formula that puts a significant percentage of your profit at risk based on performance in the following areas. These performance standards represent the measures OPM considers appropriate to the performance evaluation of the services that OPM expects to receive from the Contractor. You may propose more stringent Target Values. We will use the information provided as part of our evaluation of your offer. Your proposed profit formula will be important to our evaluation. Submit this completed table with both your technical and price proposals.
Profit Formula: (Fully describe your proposal here) Factor #1: Customer Service Goals
| Performance Standard |
| Measuring Method* |
| Target Values** |
| Percent of Profit at Risk (to be proposed by Offeror) |
Call Center:
Calls answered within 20 seconds
| Call Center Reports |
| ≥ 85% |
Timely callbacks
| Call Center Reports |
| 90% in one business day and 99% in 2 business days |
Timely response to written/email inquiries (Excludes auto-replies)
| Call Center Reports |
| 90% in 5 business days and 99% in 10 business days |
| Percent of customers who rate overall satisfaction with customer service |
| Contractor survey, as approved by OPM |
| 90%+ rate overall satisfaction very satisfied or satisfied |
Percent of customer service representatives certified as long term care insurance specialists
| Contractor report |
| 95% of customer service representatives responsible for providing detailed plan/insurance information will hold professional certification as long term care insurance specialists within 9 months of assuming duties. |
Claims:
| Accuracy of payments |
| Contractor report |
Total claims audited must be statistically significant
98% of claims will be paid accurately the first time. Claim accuracy defined by these formulas:
Processing Accuracy:
Total # of accurate claims Total claims audited Financial Accuracy:
Total # with financial errors Total claims audited
AND
Total dollars paid correctly
Total benefits dollars paid
| Timeliness of payments |
| Contractor report |
| 98% within 5 business days of receipt of all necessary information to process claim |
Underwriting:
| Applications underwritten timely |
| Contractor report |
Initial Underwriting Decisions: 95% within 5 business days and 97% in 10 business days of complete information
| Reconsiderations handled timely |
| Contractor report |
Initial Reconsiderations: 95% within 10 business days and 97% within 15 business days of complete information
Second Level Reconsiderations: 97% within 10 business days of complete information
Claims and Care Coordination:
| Benefit determinations made timely |
| Contractor report |
| 95% within 5 business days of receipt of all information; 99% within 10 business days |
| Percent of customers who rate overall satisfaction with care coordination |
| Contractor survey |
The “customer” is defined as the person/patient for whom care coordination services are being rendered, or the person responsible for care coordination service receipt and implementation, on behalf of that person/patient.
95%+ rate overall satisfaction very satisfied or satisfied
Coordination with BENEFEDS:
Quarterly enrollment reconciliation completed timely
BENEFEDS Report
Complete master enrollment file must be sent to BENEFEDS within 2 business days of schedule agreed to by BENEFEDS and Contractor. Must provide discrepancies to BENEFEDS within 10 business days of receipt of file.
Enrollment files sent accurately and timely
BENEFEDS Report
95% of files sent without error and on time within 2 business days
Website:
| Website availability |
| Website Report |
| 99% uptime (percentage of time web servers remain connected to the internet as well as accessible and fully functional by FLTCIP customers). |
| Website satisfaction |
| Contractor survey |
| 95%+ rate overall satisfaction very satisfied or satisfied |
Factor #2: Responsiveness to OPM
| Performance Standard |
| Measuring Method* |
| Target Values** |
| Percent of Profit at Risk (to be proposed by Offeror) |
Contractor compliance with the Notice of Significant Events contract clause
Significant events reported to OPM within 10 business days after Contractor becomes aware of it.
Contractor report and OPM evaluation
OPM has the right to make a downward adjustment to this factor or withhold profit payments to protect the interests of enrollees upon learning of a significant event, regardless of whether Contractor notifies OPM on a timely basis.
Contractor compliance with the Correction of Deficiencies contract clause.
| Detailed plans for correction of deficiencies provided within 10 business days following OPM notification of deficiencies. |
| Measurement will be based on tracking documents for deficiency correction in a form prescribed by the Contracting Officer. |
OPM has the right to make a downward adjustment to this factor or withhold profit payments to protect the interests of enrollees pending submission or implementation of plans for correction of deficiencies.
| General working relationship |
| As measures of general working relationship, OPM will consider such elements as (but not be limited to) (1) the volume and validity of complaints received by OPM, (2) the timeliness and adequacy of requested reports, (3) responsiveness to OPM offices, enrollees, applicants, Federal agencies and Congress, etc., (4) timely receipt of incident reports and appropriate follow-up as required in C.2.(E).4, and successful use of Contractor-initiated innovations that enhance the FLTCIP |
| Measurement of negative performance will be based upon documentation provided by OPM to Contractor. Contractor may provide a written response to such documentation for OPM consideration. |
| Cost Control |
| Measures initiated by the Contractor that result in productivity improvements and other cost containment accomplishments that are of benefit to the FLTCIP. |
Contractor report; audited financial statements
Factor #3: Marketing/Education Effectiveness
| Performance Standard |
| Measuring Method* |
| Target Values** |
| Percent of Profit at Risk (to be proposed by Offeror) |
| Success in increasing employee positive awareness of FLTCIP |
| OPM survey |
Annual increase in employee awareness of FLTCIP
Factor #4: Administrative Expense Savings
| Performance Standard |
| Measuring Method* |
| Target Values** |
| Percent of Profit at Risk (to be proposed by Offeror) |
| Actual administrative expenses less than expected |
| Annual expense report vs. approved budget |
| ≤100% of budget |
* This is the method OPM will use to monitor performance and determine the extent to which performance has met the standard. Offerors are encouraged to propose a sound process for verifying the accuracy of performance data on a continuing or recurring basis. Regardless of the method or degree of monitoring, we reserve the right to audit all performance data to independently verify its accuracy.
** For each Target Value, your proposal must specify a profit reduction that will take effect if you fail to meet the Target Value and/or profit incentives for performance that exceeds the Target Value.
File details come from the government source that posted it. Updated .