Common use of Call Center Standards Clause in Contracts

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 • 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 ODJFS 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 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 5101:3-26-03.1(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, 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 24/7 toll-free call-in systems to ODJFS. ODJFS will inform the MCPs of any changes/updates to these URAC call center standards. MCPs are not permitted to delegate grievance/appeal functions [Ohio Administrative Code (OAC) rule 5101:3-26-08.4(A)(9)]. Therefore, the member services call center requirement may not be met through the execution of a Medicaid Delegation Subcontract Addendum or Medicaid Combined Services Subcontract Addendum. Appendix C Covered Families and Children (CFC) population

Call Center Standards. The MCP must provide assistance to members through a member services toll-free call-in system pursuant to OAC rule 5101:35160-26-08.2(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 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 ODJFS prior-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 (thirty30) 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 5101:35160-26-03.1(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 nursesnurses (LPNs), and registered nursesnurses (RNs). MCPs 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. By At least semi-annually, the 10th of each month, MCPs MCP must self-report their prior month its monthly and semi-annual performance in these three areas for their member services and 24/7 hour toll-free call-in systems to ODJFSODM as specified. ODJFS If an MCP has separate telephone lines for different Medicaid populations, the MCP must report performance for each individual line separately. MCPs must report their July through December performance to ODM by January 10 and their January through June performance by July 10. ODM reserves the right to require more frequent reporting by a MCP if it becomes aware of an egregious access issue or consecutive months of non- compliance with URAC standards. ODM will inform the MCPs of any changes/updates to these URAC call center standards. MCPs are not permitted to delegate grievance/appeal functions [Ohio Administrative Code (OAC) rule 5101:3-26-08.4(A)(9)]. Therefore, the The member services call center requirement may not be met through the execution of a Medicaid Delegation Subcontract Addendum or Medicaid Combined Services Subcontract Addendum, without prior approval by ODM. Appendix C Covered Families and Children (CFC) populationWith the exception of transportation vendors, MCPs are prohibited from publishing a delegated entity's general call center number.

Call Center Standards. The MCP must provide assistance to members through a member services toll-free call-in system pursuant to OAC rule 5101:35160-26-08.2(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 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 ODJFS prior-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 (thirty30) 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 5101:35160-26-03.1(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 nursesnurses (LPNs), and registered nursesnurses (RNs). MCPs 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. By At least semi-annually, the 10th of each month, MCPs MCP must self-report their prior month its monthly and semi-annual performance in these three areas for their member services and 24/7 hour toll-free call-in systems to ODJFSODM as specified. ODJFS If an MCP has separate telephone lines for different Medicaid populations, the MCP must report performance for each individual line separately. MCPs must report their July through December performance to ODM by January 10 and their January through June performance by July 10. ODM reserves the right to require more frequent reporting by a MCP if it becomes aware of an egregious access issue or consecutive months of non- compliance with URAC standards. ODM will inform the MCPs of any changes/updates to these URAC call center standards. MCPs are not permitted to delegate grievance/appeal functions [Ohio Administrative Code (OAC) rule 5101:3-26-08.4(A)(9)]. Therefore, the The member services call center requirement may not be met through the execution of a Medicaid Delegation Subcontract Addendum or Medicaid Combined Services Subcontract Addendum, without prior approval by ODM. Appendix C Covered Families and Children (CFC) populationWith the exception of transportation vendors, MCPs are prohibited from publishing a delegated entity's general call center number.

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 exceptfor 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 ODJFS 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 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 5101:3-26-03.1(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, 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 24/7 toll-free call-in systems to ODJFS. ODJFS will inform the MCPs of any changes/updates to these URAC call center standards. MCPs are not permitted to delegate grievance/appeal functions [Ohio Administrative Code (OAC) rule 5101:3-26-08.4(A)(9)]. Therefore, the member services call center requirement may not be met through the execution of a Medicaid Delegation Subcontract Addendum or Medicaid Combined Services Subcontract Addendum. Appendix C Covered Families and Children (CFC) population.

Call Center Standards. The MCP must provide assistance to members through a member services toll-free call-in system pursuant to OAC rule 5101:35160-26-08.2(A)(1). 08.2. a. 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 Day b. Two optional closure days: These days can be used independently or in combination with any of the major holiday closures 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 ODJFS prior-ODM prior approval which verifies that the optional closure days meet the specified criteria. . c. 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. d. 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 5101:35160-26-03.1(A)(6)03.1. 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 nursesnurses (LPNs), and registered nurses. MCPs nurses (RNs). e. The MCP must meet the current American Accreditation HealthCare Commission/URAC-URAC- designed Health Call Center Standards (HCC) for call center abandonment rate, blockage rate and average speed of answer. By At least semi-annually, the 10th of each month, MCPs MCP must self-report their prior month its monthly and semi-annual performance in these three areas for their member services and 24/7 hour toll-free call-in systems to ODJFSODM as specified. ODJFS will inform If an MCP has separate telephone lines for different Medicaid populations, the MCPs of any changes/updates to these URAC call center standardsMCP must report performance for each individual line separately. MCPs are not permitted must report their July through December performance to delegate grievance/appeal functions [Ohio Administrative Code (OAC) rule 5101:3-26-08.4(A)(9)]. Therefore, the member services call center requirement may not be met ODM by January 10 and their January through the execution of a Medicaid Delegation Subcontract Addendum or Medicaid Combined Services Subcontract Addendum. Appendix C Covered Families and Children (CFC) populationJune performance by July

Call Center Standards. The MCP must provide assistance to members through a member services toll-free call-in system pursuant to OAC rule 5101:35160-26-08.2(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 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 ODJFS prior-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 (thirty30) 30 days in advance of the closure. The MCP must request prior approval from ODM of anyextended 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 5101:35160-26-03.1(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 nursesnurses (LPNs), and registered nursesnurses (RNs). MCPs 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. By the 10th of each month, MCPs the MCP must self-report their its prior month performance in these three areas for their member services and 24/7 hour toll-free call-in systems to ODJFSODM. ODJFS If an MCP has separate telephone lines for different Medicaid populations, the MCP must report performance for each individual line separately. ODM will inform the MCPs of any changes/updates to these URAC call center standards. MCPs are not permitted to delegate grievance/appeal functions [Ohio Administrative Code (OAC) rule 5101:3-26-08.4(A)(9)]. Therefore, the The member services call center requirement may not be met through the execution of a Medicaid Delegation Subcontract Addendum or Medicaid Combined Services Subcontract Addendum. Appendix C Covered Families and Children (CFC) populationWith the exception of transportation vendors, MCPs are prohibited from publishing a delegated entity's general call center number.

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 's Day • Xxxxxx Xxxxxx Xxxx’x 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 Appendix C used within the same closure period. Before announcing any optional closure dates to members and/or staff, MCPs must receive ODJFS 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 's member handbook, member newsletter, or other some general issuance to the MCP’s 's members at least thirty (thirty30) 30 days in advance of the closure. The MCP must also provide access to medical advice and direction through a centralized twenty-four-hour, seven day (24/7) day, toll-free call-in system, available nationwide, pursuant to OAC rule 5101:3-26-03.1(A)(6). The 24/7 twenty-four (24)/7 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 24/7 twenty-four (24) hour toll-free call-in systems to ODJFS. ODJFS will inform the MCPs of any changes/updates to these URAC call center standards. MCPs are not permitted to delegate grievance/appeal functions [Ohio Administrative Code (OAC) rule 5101:3-26-08.4(A)(9)]. Therefore, the member services call center requirement may not be met through the execution of a Medicaid Delegation Subcontract Addendum or Medicaid Combined Services Subcontract Addendum. Appendix C Covered Families and Children (CFC) population.

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  Mxxxxx 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 ODJFS 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 (thirty30) 30 days in advance of the closure. The MCP must also provide access to medical advice and direction through a centralized twenty-four-hour, seven day (24/7) day, toll-free call-in system, available nationwide, pursuant to OAC rule 5101:3-26-03.1(A)(6). The 24/7 twenty-four (24)/7 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 24/7 twenty-four (24) hour toll-free call-in systems to ODJFS. ODJFS will inform the MCPs of any changes/updates to these URAC call center standards. MCPs are not permitted to delegate grievance/appeal functions [Ohio Administrative Code (OAC) rule 5101:3-26-08.4(A)(9)]. Therefore, the member services call center requirement may not be met through the execution of a Medicaid Delegation Subcontract Addendum or Medicaid Combined Services Subcontract Addendum. Appendix C Covered Families and Children (CFC) population.

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 • · 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 ODJFS 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 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 5101:3-26-03.1(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, 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 24/7 toll-free call-in systems to ODJFS. ODJFS will inform the MCPs of any changes/updates to these URAC call center standards. MCPs are not permitted to delegate grievance/appeal functions [Ohio Administrative Code AdministrativeCode (OAC) rule 5101:3-26-08.4(A)(9)]. Therefore, the member services call center requirement centerrequirement may not be met through the execution of a Medicaid Delegation Subcontract Addendum or Medicaid Combined Services Subcontract Addendum. Appendix C Covered Families and Children (CFC) population.

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 a.m to 7:00 pm p.m Eastern Time, except for the following major holidays: • New Year’s 's Day • Xxxxxx Xxxxxx Xxxx’x 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 ODJFS prior-approval which verifies that the optional closure days meet the specified criteria. Appendix C 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 's member handbook, member newsletter, or other some general issuance to the MCP’s 's members at least (thirty) 30 days in advance of the closure. 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 5101:3-26-03.1(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, 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 24/7 toll-free call-in systems to ODJFS. ODJFS will inform the MCPs of any changes/updates to these URAC call center standards. MCPs are not permitted to delegate grievance/appeal functions [Ohio Administrative Code (OAC) rule 5101:3-26-08.4(A)(9)]. Therefore, the member services call center requirement may not be met through the execution of a Medicaid Delegation Subcontract Addendum or Medicaid Combined Services Subcontract Addendum. Appendix C Covered Families and Children (CFC) population.