Call Center Standards. The MCP shall provide assistance to members and providers through a toll-free call-in system.
a. Provider call center standards. i. 85% of calls answered within 120 seconds.
Call Center Standards. In addition to Sections 2.9.2 through 2.9.4 of the Three-Way, the MCOP shall:
a. Notify ODM of any hours of operation of the member services lines outside the required days and times as specified in Section 2.9.2 of the Three-Way.
b. Ensure access to medical advice, behavioral health crisis, and care management support services through centralized toll-free 24 hour, 7 days a week (24/7) call-in systems available nationwide. The 24/7 call-in systems listed in this section shall be staffed by appropriately qualified medical and behavioral health professionals whose scope of practice and licensure permits them to perform the required functions associated with the services. The MCOP shall ensure an appropriately qualified health professional is the caller’s first point of live contact to answer the call, triage the issue, and determine an immediate course of action (e.g., warm transfer to care manager or local behavioral health crisis services, provide intervention, and offer medical advice). The MCOP may not require members to contact their PCP or any other entity prior to contacting the 24/7 call in systems for advice or direction concerning emergency or after-hours services. Only one auto-prompt can be used to get the caller to the live contact.
Call Center Standards. The MCP must provide assistance to members through a member services toll-free call-in system pursuant to OAC rule 5160-26-08.2(A)(1). MCP member services staff must be available nationwide to provide assistance to members through the toll-free call-in system every Monday through Friday, at all times during the hours of 7:00 am to 7:00 pm Eastern Time, except for the following major holidays: • New Year’s Day • Xxxxxx Xxxxxx Xxxx’x Birthday • Memorial Day • Independence Day • Labor Day • Thanksgiving Day • Christmas Day 2 optional closure days: These days can be used independently or in combination with any of the major holiday closures, but cannot both be used within the same closure period. Before announcing any optional closure dates to members and/or staff, MCPs must receive ODM prior approval which verifies that the optional closure days meet the specified criteria. If a major holiday falls on a Saturday, the MCP member services line may be closed on the preceding Friday. If a major holiday falls on a Sunday, the member services line may be closed on the following Monday. MCP member services closure days must be specified in the MCP’s member handbook, member newsletter, or other some general issuance to the MCP’s members at least thirty (30) days in advance of the closure. The MCP must request prior approval from ODM of any extended hours of operation of the member services line that is outside the required days and time specified above. The MCP must also provide access to medical advice and direction through a centralized twenty-four-hour, seven day (24/7), toll-free call-in system, available nationwide, pursuant to OAC rule 5160-26-03.1(A)(6). The 24/7 call-in system must be staffed by appropriately trained medical personnel. For the purposes of meeting this requirement, trained medical professionals are defined as physicians, physician assistants, licensed practical nurses (LPNs), and registered nurses (RNs). The MCP must meet the current American Accreditation HealthCare Commission/URAC-designed Health Call Center Standards (HCC) for call center abandonment rate, blockage rate and average speed of answer. At least semi-annually, the MCP must self-report its monthly and semi-annual performance in these three areas for their member services and 24/7 hour toll-free call-in systems to ODM as specified. If an MCP has separate telephone lines for different Medicaid populations, the MCP must report performance for each individual line separately. MCPs mu...
Call Center Standards. The MCP must provide assistance to members through a member services toll-free call-in system pursuant to OAC rule 5101:3-26-08.2(A)(1). MCP member services staff must be available nationwide to provide assistance to members through the toll-free call-in system every Monday through Friday, at all times during the hours of 7:00 a.m to 7:00 p.m Eastern Time, except for the following major holidays: • New Year’s Day • Xxxxxx Xxxxxx Xxxx’x Birthday • Memorial Day • Independence Day • Labor Day • Thanksgiving Day • Christmas Day
Call Center Standards. The MCP must provide assistance to members through a member services toll-free call-in system pursuant to OAC rule 5160-26-08.2(A)(1). MCP member services staff must be available nationwide to provide assistance to members through the toll-free call-in system every Monday through Friday, at all times during the hours of 7:00 am to 7:00 pm
Call Center Standards. The MCP must provide assistance to members through a member services toll-free call-in system pursuant to OAC rule 5101:3-26-08.2(A)(1). MCP member services staff must be available nationwide to provide assistance to members through the toll-free call-in system every Monday through Friday, at all times during the hours of 7:00 am to 7:00 pm Eastern Time, except for the following major holidays: - New Year's Day - Xxxxxx Xxxxxx Xxxx'x Birthday - Memorial Day Appendix C Covered Families and Children (CFC) population Page 8 - Independence Day - Labor Day - Thanksgiving Day - Christmas Day
Call Center Standards. The MCOP shall follow call center standards requirements pursuant to Sections 2.9.2, 2.9.3 and 2.9.4 of the Three‐Way. In doing so, the MCOP shall:
a. Notify ODM of any hours of operation of the member services lines outside the required days and times as specified in Section 2.9.2 of the Three‐Way.
b. Ensure access to medical advice, behavioral health crisis, and care management support services through centralized toll‐free 24 hour, 7 days a week (24/7) call‐in systems available nationwide. The 24/7 call‐in systems listed in this section shall be staffed by appropriately qualified medical and behavioral health professionals whose scope of practice and licensure permits them to perform the required functions associated with the services. The MCOP shall ensure an appropriately qualified health professional is the caller’s first point of live contact to answer the call, triage the issue, and determine an immediate course of action (e.g., warm transfer to care manager or local behavioral health crisis services, provide intervention, and offer medical advice). The MCOP may not require members to contact their PCP or any other entity prior to contacting the 24/7 call in systems for advice or direction concerning emergency or after hours services. Only one auto‐ prompt can be used to get the caller to the live contact.
Call Center Standards. The MCP must provide assistance to enrollees through a member services toll-free call-in system pursuant to OAC rule 5101:3-26-08.2(A)(1). MCP member services staff must be available at all times to provide assistance to members through the toll-free call-in system every Monday through Friday, 8:30 a.m. to 4:30 p.m., except for major holidays as specified in the MCP's member handbook. The MCP must also provide access to medical advice and direction through a centralized twenty-four-hour toll-free call-in system pursuant to OAC rule 5101:3-26-03.1(A)(6). The twenty-four hour call-in system must be staffed by appropriately trained medical personnel. For the purposes of meeting this requirement, trained medical professionals are defined as physicians, physician assistants, licensed practical nurses, and registered nurses. MCPs must meet the current American Accreditation HealthCare Commission/URAC-designed Health Call Center Standards (HCC) for call center abandonment rate, blockage rate and average speed of answer. By the 10th of each month, MCPs must self-report their prior month performance in these three areas for their member services and twenty-four-hour toll-free call-in systems to ODJFS. ODJFS will inform the MCPs of any changes/updates to these URAC call center standards.
Call Center Standards. The MCOP must follow call center standards requirements pursuant to Sections 2.9.2, 2.9.3 and 2.9.4 of the Three‐Way. In doing so, the MCOP must:
a. Notify ODM of any hours of operation of the member services lines that are outside the required days and time as specified in Section 2.9.2 of the Three‐ Way.
b. Ensure access to medical advice, behavioral health crisis, and care management support services through centralized toll‐free 24 hour, 7 days a week (24/7) call‐ in systems that are available nationwide. The 24/7 call‐in systems listed in this section must be staffed by appropriately qualified medical and behavioral health professionals whose scope of practice and licensure permits them to perform the required functions associated with the services. The MCOP must ensure that an appropriately qualified health professional is the caller’s first point of live contact to answer the call, triage the issue, and determine an immediate course of action (e.g., warm transfer to care manager or local behavioral health crisis services, provide intervention, and offer medical advice). MCOPs may not require members to contact their PCP or any other entity prior to contacting the 24/7 call in systems for advice or direction concerning emergency or after hours services. Only one auto‐prompt can be used to get the caller to the live contact.
Call Center Standards. The MCP must provide assistance to members through a member services toll-free call-in system.
a. The telephone system must have services available to assist:
i. Hearing-impaired members; and
ii. Limited English Proficiency (LEP) members in the primary language of the member.
b. The member services program must assist MCP members, and as applicable, eligible individuals seeking information about MCP membership with the following:
i. Accessing Medicaid-covered services;
ii. Obtaining or understanding information on the MCP’s policies and procedures;
iii. Understanding the requirements and benefits of the plan;
iv. Resolution of concerns, questions, and problems;
v. Filing of grievances and appeals as specified in OAC rule 5160-26-08.4;
vi. Obtaining information on state hearing rights;
vii. Appealing to or filing directly with the U.S. Department of Health and Human Services Office of Civil Rights any complaints of discrimination on the basis of race, color, national origin, age, or disability in the receipt of health services;
viii. Appealing to or filing directly with the ODM Office of Civil Rights any complaints of discrimination on the basis of race, color, religion, gender, gender identity, sexual orientation, age, disability, national origin, military status, genetic information, ancestry, health status, or need for health services in the receipt of health services; and
ix. Accessing sign language, oral interpretation, and oral translation services. The MCP must ensure that these services are provided at no cost to the eligible individual or member. The MCP must designate a staff person to coordinate and document the provision of these services.
c. In the event the consumer contact record (CCR) does not identify a member-selected primary care provider (PCP) for each assistance group member, or if the member- selected PCP is not available, the MCP must:
i. Select a PCP for each member prior to the effective date of coverage based on the PCP assignment methodology prior-approved by ODM;
ii. Notify each member of the name of his or her PCP prior to the effective date of coverage and pursuant to the provisions of OAC rule 5160-26-02;
iii. Simultaneously notify each member with an MCP-selected PCP of the ability within the first month of initial MCP membership to change the MCP-selected PCP effective on the date of contact with the MCP; and
iv. Explain that PCP change requests after the initial month of MCP membership shall be processed according to the pr...
