US · guidance
CMS Pub. 100-09, ch. 6, § 30.6.11.1
Telephone Response Quality Monitoring Program
MACs shall have a monitoring program in place to ensure the quality of telephone inquiry responses
on the provider inquiry line(s). Monitoring the accuracy, completeness, adherence to the Privacy Act,
and professionalism of telephone CSR-handled calls leads to improved customer satisfaction and
reduce the number of calls to the PCCs. MACs shall provide CMS with access to their quality
monitoring systems (such as NICE, QFiniti and Verint) and notify us by emailing the provider services
mailbox within 2 business days about any changes that will require us to update that access.
MACs shall use the information from their quality monitoring program to improve telephone inquiry
responses within the PCC, including individual PCC staff. MACs shall document their monitoring
efforts and corrective action plans as applicable and make them available to CMS upon request.
CMS will provide MACs with feedback about monitoring and information about the evaluation processes used
through the PCUG electronic mailing list and regularly scheduled meetings.
History
(Rev. 13683; Issued: 04-08-26; Effective: 05-08-26; Implementation: 05-08-26)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
9ef924b43638fbbaa7c9f687f1d0e4dc32a7e54b5b767530f45ca22dae832f62
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