DCS Comprehensive Health Plan

Telephone Performance Standards

Statement/Purpose

The Department of Child Safety Comprehensive Health Plan (DCS CHP) has established service standards when handling member and provider telephone calls.

Definitions

Average Speed of Answer (ASA): The average on line wait time in seconds that the member/ provider waits from the moment the call is connected in the Contractor’s phone switch until the call is picked up by a Contractor’s representative or Interactive Voice Recognition System (IVR).

Daily First Contact Call Resolution Rate (DFCCR): The number of calls received in a 24-hour period for which no follow-up communication or internal phone transfer is needed, divided by the total number of calls received in the 24-hour period.

Department of Child Safety (DCS): The regulatory oversight body of the Managed Care Organization (MCO)

Mercy Care DCS CHP: The contracted Managed Care Organization (MCO).

Monthly Average Abandonment Rate (MAAR): The number of calls abandoned in a 24-hour period, divided by the total number of calls received in the same 24-hour period, summed for each day of the month and then divided by the number of days in the monthly reporting period.

Monthly Average Service Level (MASL): The total of the month’s calls answered within 45 seconds divided by the sum of the following: all calls answered in the month, all calls abandoned calls in the month and all calls receiving a busy signal in the month (if available).

Monthly First Call Contact Resolution Rate: The sum of the DFCCRs divided by the number of days in the reporting period.

Policy

DCS CHP maintains established telephone performance standards to ensure member and provider service satisfaction. Incoming calls to DCS CHP and the contracted MCO’s centralized customer service telephone lines are tracked and reviewed to ensure compliance with the established performance measures.

Procedure

Service Standards for DCS CHP and the Contracted MCO

DCS CHP has adopted the following telephone performance measures for incoming member and provider telephone calls as set forth by AHCCCS in ACOM 435:

• ASOA, 45 seconds or less

• MAAR, 5% or less

• MFCCR, 70% or better

• MASL, 75% or better

Continuous improvement techniques are implemented to identify opportunities to improve these measures even when standards are met.

Reporting Telephone Performance Standards

Periodic reports are generated and reviewed to ensure performance standards are met.

AHCCCS Telephone Performance Measures Template, Worksheet A, is used to document ASOA, MAAR, MFCCR, and MASL separately for Member and Provider call types. The Centralized Telephone Line Down Time Template, Worksheet B, is used to report down time for DCS CHP and the Contracted MCO’s centralized telephone lines. The template includes dates of the occurrence and the length of time the line was out of service.

AD HOC Telephone Performance Measures Reporting

Should DCS CHP not meet two or more of the adopted Telephone Performance Measures within one-month, additional reporting is submitted on a monthly basis until three consecutive months of compliance have been achieved. Upon approval from AHCCCS, DCS CHP resumes a quarterly reporting schedule.

Compliance and Oversight Monitoring

The contract between DCS and its contracted MCO defines operational performance requirements to be satisfied when providing healthcare services to members. DCS CHP conducts ongoing reviews of operational performance requirements. If it is determined that the contracted MCO is not meeting the terms of their contract, DCS CHP notifies the contracted MCO in writing of deficiencies. Performance Improvement Plans are forwarded to the contracted MCO and include corrective actions and dates by which corrective actions are to be completed.