3. Prior All requests for Prior Authorization shall be acted upon Monthly Authorizations within 72 hours 5. Retail Financial accuracy rate of at least 99% for all pharmacy Monthly Claims claims processed at point-of-sale. Adjudication Accuracy 6. Payment Monthly The MMIS and PBM Vendor to quickly identify, correct and Accuracy report to DVHA any erroneous payments from the MMIS, and ensure that no overpayments or underpayments are made from State or Federal funds First call resolution rate will be 95% or greater. First contact Monthly 7. First Call Resolution completion applies when the first person the customer reaches either answers the question, resolves the problem, or dispatches service where appropriate. 8. Call 95% of all calls received will be answered within 30 Monthly Answering seconds Time 9. Call Not more than 3% of all calls will be abandoned Monthly Abandonment Rate 10. Federal Compliant with key Federal legislation (e.g. HIPAA, ADA, Monthly Compliance OSHA, etc.) in all activities 11. State Compliant with Vermont Law in all activities Monthly Compliance Compliant with all HIPAA requirements for privacy and Immediately 12. Privacy and Security security in all activities, breaches will be reported within 2 hours of becoming known by the Vendor 13. Data Breaches in data access will be reported within 30 minutes Immediately Breach of becoming known by the Vendor 16. Breach Breaches in data access regulations be made known to Monthly Notifications the State <Response> Service Level Requirements System Performance – Measures Instructions: Describe the approach to ensuring the Vendor processes and solution is able to meet the following Service Level Requirements. Include in this response the Vendor approach to measuring and reporting on these requirements, the process for remediating any
3. Prior Authorizations All requests for Prior Authorization shall be acted upon within 72 hours Monthly 5. Retail Claims Adjudication Accuracy Financial accuracy rate of at least 99% for all pharmacy claims processed at point-of-sale. Monthly 6. Payment Accuracy The MMIS and PBM Vendor to quickly identify, correct and report to DVHA any erroneous payments from the MMIS, and ensure that no overpayments or underpayments are made from State or Federal funds Monthly 7. First Call Resolution First call resolution rate will be 95% or greater. First contact completion applies when the first person the customer reaches either answers the question, resolves the problem, or dispatches service where appropriate. Monthly 8. Call Answering Time 95% of all calls received will be answered within 30 seconds Monthly 9. Call Abandonment Rate Not more than 3% of all calls will be abandoned Monthly 10. Federal Compliance Compliant with key Federal legislation (e.g. HIPAA, ADA, OSHA, etc.) in all activities Monthly 11. State Compliance Compliant with Vermont Law in all activities Monthly 12. Privacy and Security Compliant with all HIPAA requirements for privacy and security in all activities, breaches will be reported within 2 hours of becoming known by the Vendor Immediately 13. Data Breach Breaches in data access will be reported within 30 minutes of becoming known by the Vendor Immediately 16. Breach Notifications Breaches in data access regulations be made known to the State Monthly <Response> Service Level Requirements – System Performance Measures Instructions: Describe the approach to ensuring the Vendor processes and solution is able to meet the following Service Level Requirements. Include in this response the Vendor approach to measuring and reporting on these requirements, the process for remediating any
template-i-non-functional-requirements-approach.docx