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.
Appears in 17 contracts
Samples: Provider Agreement, Provider Agreement, Provider Agreement
