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Dollar Aceura AR <br /> Definition ': Dollar accuracy rate of not less than the designated percent in any quarter. <br /> Measurement Percentage of claims dollars processed accurately 99% <br /> Criteria "" Statistically significant random sample of claims processed is reviewed to determine the percentage of claim <br /> dollars processed correctly out of the total claim dollars paid. <br /> Level Office Level <br /> Period " Annually <br /> Payment Period ° Annually <br /> Fees"at Risk : Total Dollars at Risk for this metric $3,900 <br /> Payment.Amount Of the Fees at Risk for this metric,percentage at risk for each gradient 20% <br /> Gradients !! 98.99%-98.50% <br /> 98.49%-98.00% <br /> 97.99%-97.50% <br /> 97.49%-97.00 <br /> Below 97.00% <br /> Procedural Accurac <br /> Definition`' Procedural accuracy rate of not less than the designated percent. <br /> Measurement Percentage of claims processed without procedural(i.e.non-financial)errors 97% <br /> Criteria . Statistically significant random sample of claims processed is reviewed to determine the percentage of claim <br /> dollars processed without procedural(i.e.non-financial)errors. <br /> Level " Office Level <br /> Period Annually <br /> Payment Period Annually <br /> Fees at Risk Total Dollars at Risk for this metric $3,900 <br /> Payment.Amount Of the Fees at Risk for this metric,percentage at risk for each gradient 20% <br /> Gradients 96.99%-96.50% <br /> 96.49%-96.00% <br /> 95.99%-95.50% <br /> 95.49%-95.00% <br /> Below 95.00% <br /> Phone service guarantees and standards apply to Participant calls made to the customer care center that primarily services <br /> Customer's Participants.If Customer elects a specialized phone service model the results may be blended with more than one call <br /> center and/or level.They do not include calls made to care management personnel and/or calls to the senior center for Medicare <br /> Participants,nor do they include calls for services/products other than medical,such as mental health/substance abuse,pharmacy <br /> (except when United is Customer's pharmacy benefit services administrator),dental,vision,Health Savings Account,etc. <br /> Average Speed eed to"Answer <br /> Definition Calls will sequence through United's phone system and be answered by customer service within the <br /> parameters set forth. <br /> Measurement Percentage of calls answered 100% <br /> Time answered in seconds,on average seconds 30 <br /> Criteria Standard tracking reports produced by the phone s stem for all calls <br /> Level Team that services Customer's account <br /> Period " Annually <br /> Pa' ent Period Annually <br /> Fees at Risk Total Dollars at Risk for this metric $3,900 <br /> Payriient Amount = Of the Fees at Risk for this metric,percentage at risk for each gradient 20% <br /> Gradients,= 32 seconds or less <br /> 34 seconds or less <br /> 36 seconds or less <br /> 38 seconds or less <br /> Greater than 38 seconds <br /> 25 <br />