The contractor shall support CMS with the QAM process, used to determine the accuracy, completeness, professionalism, and adherence to the Privacy Act of CSR responses to telephone inquiries at Medicare PCCs. To perform QAM, the independent monitoring contractor is required to access and maintain a secure connection (via CMSNet) to the MAC quality monitoring systems, thus enabling access to the MAC audio call recordings while viewing the video file of the CSR screen navigation. Each MAC owns and maintains its own system. These systems vary, but in general, they are from one of the leading industry vendors in the marketplace (i.e., Call Copy, NICE, Qfiniti, and Verint). The contractor shall work with CMS and the MACs to ensure that the MAC systems permit proper access.
In addition, QAM requires the Contractor to provide a team of Quality Monitors (QM) with expertise in quality assurance, Medicare policy, and the ability to interpret visual recorded CSR screen navigation (i.e. FISS, MCS, HIMR, CWF, HETS, and VMS), claims, and various systems while listening to the audio of inbound provider calls received in MAC PCCs nationwide.