Abandonment Rate Measurements must be State-specific or for only the service center handling the State account. of less than 3%. Time over which standard is measured: Quarter. Performance Measurement Report Card (Report Card to be submitted by the Offeror). Frequency of report: Quarterly each percentage point, or fraction thereof, over 3%. Processing of Enrollment Eligibility Update Information received on a daily basis Plan will process electronic interchange of State enrollment information by 5:00 PM of the business day after receipt. Time over which standard is measured: Quarter Report Card - Vendor to maintain log for review by the State's contract auditor. Frequency of report: Quarterly 0.20% of fees for each calendar day, or portion thereof, of delay Contractor attendance at Open Enrollment meetings. Attendance by plan representatives trained on State of Maryland plan benefits at 100% of meetings scheduled by the State, for 100% of the meeting's duration. Representative must arrive 30 minutes before start of scheduled event. Display must be organized and include appropriate covering of table. Representatives must have adequate communication materials available to meet member demand. Representative must have detailed plan knowledge, interact with members, and exhibit professional Sign-in sheets at meetings. Frequency of report: Annually 0.05% of fees for each scheduled meeting date that vendor fails to arrive on time and/or does not meet the required standards.
appearance and behavior. Time over which standard is measured: Annual Delivery of Quarterly Plan Performance Measurement Report Card to the State and to the State’s Consultant. Delivery to the State by 6:00 pm on the following dates**: Documentation of receipt by the State, the State’s Consultant, and External Auditor. Frequency of report: Quarterly 0.25% of fees for each week, or fraction thereof, the data report is not received or is incomplete. First Quarter (Jan – Mar) Due: May 1 Second Quarter (Apr – Jun) Due: August 1 Third Quarter (Jul – Sep) Due: November 1 Fourth Quarter (Oct – Dec) Due: February 1 Delivery of Annual Settlement, Utilization and Forfeiture Report Delivery of required annual settlement report by 4:30 pm local time on the second day of March for the plan year ending the previous December 31. Date-stamp of receipt by the State and verification of completeness of required documentation. Frequency of report: Annually If performance is less than the standards: 1% of annual administrative fees The Contractor shall report on payment activity twice a year, at six-month intervals. The report shall include but not limited to the following: - Excel Format - Separate worksheet by Calendar Year (i.e.: CY16, CY17, CY18, etc.) - Receipt date of EBD invoice/memo (Transmittal type includes but not limited to email, Certified Mail, USPS Mail, etc.) -Date payment Report to be submitted by the 10th of the following month for the previous six months. First report would be due July 10 and Second report would be due January 10. .25% per day per late report
submitted to EBD -Date EBD cashed check -Payment Reason -Payment sent to EBD PO Box (Yes/No) -Payment submitted on time (Yes/No). If no, must explain in comments section and submit any supporting documentation at the time the report is due. Claims Standards: Financial Accuracy The ratio of reimbursements paid accurately to all reimbursements. This is determined by calculating the extrapolated weighted average dollar error in the sample and applying this to the population of processed claims, whether all substantiation requirements are met is considered. 99% of claim dollars processed accurately Measured by the State's independent auditor as part of the annual claims audit. Criteria as defined by the State's independent auditor. Measured to two (2) decimal places. 97%-98.99% accuracy: 1% of annual administrative fees; Less than 97%: 2% of annual administrative fees Claims Standards: Payment Accuracy The ratio of the total number of reimbursements without either payment or processing errors to all reimbursements processed during the audit time period. This is determined by calculating the 97% of claims w/ benefit payments are processed accurately Measured by the State's independent auditor as part of the annual claims audit. Criteria as defined by the State's independent auditor. Measured to two (2) decimal places. Less than 97%: 2% of annual administrative fees
extrapolated weighted average number of reimbursements without payment or processing errors in the sample and applying this to the entire population of reimbursements. Claims Adjudication 97% of claims will be processed in 10 days Measured by the State's independent auditor as part of the annual claims audit. Criteria as defined by the State's independent auditor. Measured to two (2) decimal places. Less than 97%: 2% of annual administrative fees Implementation All administrative functions completed for a successful Open Enrollment and plan implementation as of the effective date of the contract. Overall rating of 4.5 or greater on a scale of 1 to 5 must be received One time measurement after the first quarter of the initial plan year by State of Maryland DBM staff using implementation evaluation, with liquidated damages to be made annually 5% of total administrative fees for the first quarter. Website Availability For open enrollment, website will be updated and complete, tested and verified as acceptable by the State no later than 10/1/2015. Website uptime of 99%. As determined by the State. Self-report of uptime, reported quarterly. 2% of administrative fee per standard not met. All remittances owed to the State, including but not limited to shared Payment to be made no later than thirty (30) calendar days after the Proof of payments submitted via a separate check payment with 1% of remittance for each day late. An Additional 0.05% of remittance if the
costs related to Open Enrollment materials and Customer Service satisfaction surveys, will be paid to the State of Maryland, DBM. Contractor's receipt of invoice or notice of recoveries. attached invoice. All payments shall be submitted to: The Department of Budget and Management, Employee Benefits Division, P.O. Box 1516, Baltimore, Maryland, 21201 payments are not sent to the P.O. Box designated by the State. For any recoveries as a result of fraud or an audit, the Contractor shall pay the State any portion due it via a separate check payment and provide documented substantiation. Payments to the State of Maryland Department of Budget and Management shall be made no later than thirty (30) calendar days after the Contractor's receipt of invoice for Fraud or Audit recoveries. Proof of payments submitted via a separate check payment with attached invoice. All payments shall be submitted to: The Department of Budget and Management, Employee Benefits Division, P.O. Box 1516, Baltimore, Maryland, 21201 1% of recovery for each day late. An Additional 0.05% of remittance if the payments are not sent to the P.O. Box designated by the State. HIPAA Breach Discovery Notifications The Contractor shall notify the Contract Manager and/or Designee immediately and no later than ten (10) Business Days after the breach is discovered by the Contractor. Proof of notification including breach date and date of State notification. $1,000 per day late. Subcontractor Change Notifications Prior to any change in subcontractors, the Contractor must request and obtain the State’s approval. The approval must be obtained 30 days prior to the date the Subcontractor provides services. The State should also be notified with a minimum of 30 Proof of request for subcontractor change and approval dates. $1,000 per day late.