Chat Quality Audit

GEHA Scorecard — Chat Channel

Interaction Details
Transaction ID
Audit Source
Product Line
Member ID
UMR CCR
Plan Type
Site
Interaction Date
1. Member/Provider Experience
Max: 20 points
20 / 20

Professional greeting used

Pts
/ 3

Actively engaged throughout chat

Pts
/ 4

Expressed empathy through written response

Pts
/ 3

Willingness to help conveyed

Pts
/ 3

Professional and courteous language

Pts
/ 3

Used member's name in chat

Pts
/ 1

Used please and thank you

Pts
/ 2

Correct grammar, spelling, and punctuation

Pts
/ 1
Section Notes
2. First Chat Resolution
Max: 20 points
20 / 20

Addressed all questions, issues and concerns

Pts
/ 5

Included complete details specific to inquiry

Pts
/ 5

Completed all actions needed for resolution

Pts
/ 3

Set expectations/timeframes when applicable

Pts
/ 1

Proactively offered options/solutions/next steps

Pts
/ 2

Educated with relevant information

Pts
/ 2

Asked probing questions (what/why/when/how)

Pts
/ 2
Section Notes
3. Accuracy
Max: 20 points
20 / 20

Accurate — Benefits

Pts
/ 4

Accurate — Eligibility

Pts
/ 4

Accurate — Network Status

Pts
/ 4

Accurate — Prior Auth Requirement

Pts
/ 4

Accurate — Medicare Coordination

Pts
/ 2

Accurate — Claim/Pre-Determination

Pts
/ 2
Section Notes
4. Policy and Procedures
Max: 15 points
15 / 15

Documentation

Pts
/ 4

Check-in within 3 minutes of last response

Pts
/ 2

Controlled chat direction, kept chat on track

Pts
/ 2

Transfer/escalation procedures followed

Pts
/ 2

Professional chat greeting

Pts
/ 2

Additional Assistance Offered

Pts
/ 2

Responded within SLA timeframe

Pts
/ 1
Section Notes
5. Advocacy
Max: 15 points
15 / 15

Mention the G.E.H.A website

Pts
/ 5

Member Advocacy provided

Pts
/ 5

Offered additional resources if applicable

Pts
/ 5
Section Notes
6. Security and Compliance
Max: 10 points
10 / 10

Verified member identity appropriately

Pts
/ 6

Provider FTIN/NPI verified

Pts
/ 2

Reviewed ARF on file when applicable

Pts
/ 2
Section Notes
Oversight / QA Summary
Accuracy Issues Noted
Advocacy Demonstrated
FCR Achieved
Documentation Complete
Policy Adhered To
Moved Closer to Resolution
Feedback & Trend Identification
Error Category
Trend
GEHA Feedback
Opportunities for Improvement
Total Score: 100 / 100
Exceptional