Page 72 - Pharmacy Appeals 1/4/04 to 31/3/05

48 Performance analysis

Resolution

No. KPI description Area Target Met

To respond to a letter of claim involving a clinical/non-clinical Not
1 Claims Internal
matter within the pre-action protocol period met
To respond to a letter of claim within the timeframe agreed
2 Claims Internal Met
between the parties

Time to resolution from claims decision to agreement of Not
3 Claims Internal
damages met

The volume of cases that are repudiated initially with a
4 Claims Internal Met
subsequent payment agreed
Reduction in the volume of cases which enter formal court
5 Claims Internal Met
proceedings

The movement in the financial reserves placed on a claim is
6 Claims Internal Met
managed within a target range
7 Data accuracy Claims Internal Met

'First step' letters sent out within seven days of receiving the
8 Appeals 90% Met
appeal or dispute
Appeals or disputes where 14 or more days' notice of hearing
9 Appeals 100% Met
has been given

Appeals where decision maker agreed with recommendation
10 Appeals 80% Met
of case manager

11 Outcome of quality audits for appeals and dispute files Appeals 90% Met
Average number of weeks taken to resolve appeals and
12 Appeals 15 weeks Met
disputes - internal input only

Average number of weeks taken to resolve appeals and
13 Appeals 19 weeks Met
disputes-additional input
Average number of weeks taken to resolve appeals and Not
14 Appeals 25 weeks
disputes - oral hearing met

Average number of weeks taken to resolve disputes - current Not
15 Appeals 33 weeks
market rent valuation input required met