Complaints Tracking Module

1. Complaints Tracking Module Colleen Carpenter, CMS

2. Complaints Tracking Module (CTM) Procedures for working CTM complaints Standard Operating Procedure SOP Time frames for Immediate need cases Urgent cases Congressional cases “Routine” cases

3. Trending CTM CTM indicators of Medicare Advantage or Prescription Drug Plan performance Early warning of potential operational problems Use in conjunction with MA/PDP plan’s internal call center complaint tracking

4. MAO/PDP Responsibility Thorough documentation of all steps taken to resolve complaint Don’t refer beneficiaries back to 1-800-MEDICARE Root Cause Analysis Analyze Internal Customer Service Corrective Action

5. CMS Monitoring Formal High Volume CTM Informal Internal Day to Day Monitoring Identify Trends Monitor performance

6. High Volume CTM Project Conducted at least once per year Includes plans with highest ratio of complaints over time Requires root cause analysis Identify business operations generating complaints Describe corrective action to reduce complaints Account Managers to monitor progress

7. Customer Service Data indicates that the majority of Medicare beneficiaries contact plan prior to filing a complaint with CMS Analyze customer service performance Ensure CSRs are not directing beneficiaries to 1-800-MEDICARE or CMS

8. Corrective Action Corrective action taken to correct the problems generating complaints Corrective actions should be monitored to ensure effectiveness Corrective actions should be adjusted if no improvement is noted

9. FTP CTM Cases Failure to pay disenrollments (FTP) Don’t assume Findings indicate that: Beneficiaries misinformed by MAO/PDP CSRs Beneficiaries did not receive premium notices MAO/PDP errors in posting payments Premiums paid through SSA deductions

10. Enrollment CTM Enrollment related CTMs are often related to incorrect handling at the MAO/PDP TRR handling Not tracking “out of service area” correctly Not processing enrollments timely CTM documentation should include the MAO/PDP’s efforts to correct enrollment prior to asking CMS for assistance

11. Marketing CTM Marketing CTMs should be thoroughly investigated Ensure that agent activity is closely monitored Beneficiary concern should be considered Actively monitor CTM year round

12. Access to Care CTM Immediate resolution required Ensure delegated entities are performing Analyze and resolve the issue that created the access issue

13. CTM Data Data used to monitor plan performance High volume of CTM over time indicates operational performance concerns Account Managers monitoring Provides valuable data for plan Compliance Officers

14. Summary Take CTMs seriously Use CTM to monitor performance Don’t assume CTMs are inevitable Work with your Account Manager when issues arise