Illustrative — not actual patient/client data. Synthetic example for demonstration only.
Assessed Entity
Acme Health Plan
Medicare Advantage · Assessment Period: Q3 2026
Assessment Summary
12
Delegates Assessed
Across 4 function categories
91.3%
SLA Compliance Rate
Weighted across all delegates
DGS v1.0
Standard Applied
Full 6-domain framework
Overall Delegation Health
Delegation Health Score
Composite score across 12 delegates, 6 DGS domains. Range: 0-100. Score of 78 indicates functional delegation governance with targeted remediation areas. Two delegates require corrective action plans.
Per-Delegate Status
| Delegate |
Function |
Status |
Score |
SLA |
| Delegate A — Claims TPA |
Claims Processing |
Green |
92 |
97.1% |
| Delegate B — UM Vendor |
Utilization Management |
Green |
88 |
94.8% |
| Delegate C — Credentialing Org |
Credentialing |
Green |
85 |
96.2% |
| Delegate D — Pharmacy Benefit |
Pharmacy |
Green |
90 |
95.5% |
| Delegate E — Behavioral Health |
BH/SUD Management |
Yellow |
71 |
88.3% |
| Delegate F — Dental Vendor |
Dental Administration |
Green |
83 |
93.7% |
| Delegate G — Vision Vendor |
Vision Administration |
Green |
81 |
92.0% |
| Delegate H — Appeals Vendor |
Grievances & Appeals |
Yellow |
68 |
85.1% |
| Delegate I — Care Management |
Care Coordination |
Green |
79 |
91.4% |
| Delegate J — Network TPA |
Network Management |
Green |
84 |
93.2% |
| Delegate K — Data Analytics |
Quality Reporting |
Red |
54 |
76.8% |
| Delegate L — Member Services |
Member Engagement |
Green |
80 |
90.6% |
Audit Findings
HIGH
Delegate K (Quality Reporting): HEDIS data submission timelines missed in 2 of 3 quarters. Star rating impact projected for 2 measures. Corrective action plan required within 30 days.
MEDIUM
Delegate H (Appeals): Grievance resolution exceeded 30-day CMS threshold in 14.9% of cases. Trending improvement from prior quarter (18.2%). Continued monitoring.
MEDIUM
Delegate E (BH/SUD): Authorization turnaround times exceeded contractual SLA for non-urgent requests. Root cause identified as staffing shortfall. Remediation in progress.
LOW
Delegate C (Credentialing): Three providers re-credentialed 8-12 days past the 36-month cycle. No impact on network adequacy. Process improvement documented.
LOW
Delegate A (Claims): Claim adjustment rate of 2.9% within normal range but trending upward from 2.1%. Monitoring threshold set at 3.5%.
Next Scheduled Review
Next Full Assessment
January 15, 2027
Assessment Summary
Acme Health Plan's delegation governance was assessed against DGS v1.0 across 12 delegates and 6 domains. The overall delegation health score of 78 reflects a functional governance structure with two areas requiring focused remediation. Delegate K (Quality Reporting) received a Red status due to repeated HEDIS submission delays with projected Star rating impact; a corrective action plan is required within 30 days. Delegate H (Appeals) and Delegate E (BH/SUD) are in Yellow status with documented improvement plans in progress. Nine delegates maintained Green status with SLA compliance above 90%. The next full assessment is scheduled for January 2027, with interim monitoring of Yellow and Red delegates on a monthly cadence.
Basis of Assessment
This certificate documents a self-assessment conducted under the Delegation Governance Standard (DGS v1.0), a free published standard maintained by Cadence, LLC. Findings reflect the assessing plan's own attestations, based on documentation review, SLA monitoring, and structured interview. This certificate does not constitute legal or regulatory compliance advice. The Delegation Governance Standard is a published framework of Cadence, LLC.
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