All contractors must have a Quality Assurance program in place to ensure  the quality of responses to provider telephone inquiries.  The Quality Call Monitoring (QCM) tool assists contractors in evaluating the elements that comprise an accurate, complete and professional response.  Contractors shall use the data supplied by the QCM tool to identify, and act upon, areas of needed improvement, both for the Provider Contact Center (PCC) as a whole, as well as individual PCC staff. Contractors are required to adhere to specific QCM performance standards as shown below. 

1. Of all calls monitored for the quarter, the number of CSRs scoring as "Pass" for Adherence to the Privacy Act shall be no less than 90%. 

2. Of all calls monitored for the quarter, the percent of CSRs scoring as "Achieves Expectation" or higher shall be no less than 90% for Customer Skills Assessment. 

3. Of all calls monitored for the quarter, the percent of CSRs scoring as "Achieves Expectation" or higher shall be no less than 90% for Knowledge Skills Assessment. 

Copies of the QCM scorecard, Scoring Chart, User Guide, and Handbook are available in the QCMSCORES website below. 

The guidelines above are for legacy Title XVIII contractors.  Medicare Administrative Contractor (MAC) standards are 93%  for all three QCM metrics

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Page Last Modified: 08/21/2008 12:00:10 PM
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