Enrollee Service Telephone Responsiveness. The Contractor must operate a call center during normal business hours, seven (7) days a week, consistent with the Marketing Guideance for Massachusetts Medicare‑Medicaid Plans. ESRs must be available Monday through Friday, during normal business hours, consistent with the Marketing guidance for Medicare‑Medicaid Plans. The Contractor may use alternative call center technologies on Saturdays, Sundays, and Federal holidays except New Year’s Day. On New Year’s Day, the Contractor must operate a call center with ESRs available during normal business hours.
Enrollee Service Telephone Responsiveness. 2.10.2.1 The Contractor must operate a call center during normal business hours and never less than from 8:00 a.m. to 8:00 p.m. (CST), seven (7) days a week, consistent with the required Marketing Guidelines. ESRs must be available Monday through Friday, at least from 8:00 a.m. to 8:00
Enrollee Service Telephone Responsiveness. The Contractor must operate a call center during normal business hours and never less than from 8:00 a.m. to 8:00 p.m., 7 days a week, consistent with the required Marketing Guidelines. ESRs must be available Monday through Friday, at least from 8:00 a.m. to 8:00 p.m. The Contractor may use alternative call center technologies on Saturdays, Sundays, and Federal holidays. The Contractor’s ESRs must answer 90% of all Enrollee telephone calls within 30 seconds or less. The Contractor must limit average hold time to two (2) minutes, with the average hold time defined as the time spent on hold by the caller following the interactive voice response (IVR) system, touch tone response system, or recorded greeting and before reaching a live person. The Contractor must limit the disconnect rate of all incoming calls to five (5) percent. The Contractor must have a process to measure the time from which the telephone is answered to the point at which an Enrollee reaches an ESR capable of responding to the Enrollee's question in a manner that is sensitive to the Enrollee’s language and cultural needs.
Enrollee Service Telephone Responsiveness. 2.12.2.1. The Contractor must operate a call center during normal business hours seven (7) days a week, consistent with the required Medicare Marketing Guidelines and the Marketing Guidance for California Medicare-Medicaid Plans. The Enrollee must be able to speak with a live ESR, Monday through Friday, during normal business hours, consistent with the required Medicare Marketing Guidelines and the Marketing Guidance for California Medicare-Medicaid Plans. The Contractor may use alternative technologies on Saturdays, Sundays, and state and federal holidays (except New Year’s Day). The Contractor’s ESR’s must answer eighty percent (80%) of all Enrollee telephone calls within thirty (30) seconds or less. The Contractor must limit average hold time to two (2) minutes, with the average hold time defined as the time spent on hold by the caller following the interactive voice response (IVR) system, touch tone response system, or recorded greeting and before reaching a live person. The Contractor must limit the disconnect rate of all incoming calls to five percent (5%). The Contractor must have a process to measure the time from which the telephone is answered to the point at which an Enrollee reaches an ESR capable of responding to the Enrollee's question in a manner that is sensitive to the Enrollee’s language and cultural needs.
Enrollee Service Telephone Responsiveness. ESRs must be available during normal business hours on a daily basis. The Contractor must answer 90% of all Enrollee telephone calls within 20 seconds or less. The Contractor must have a process to measure the time from which the telephone is answered to the point at which an Enrollee reaches an ESR capable of responding to the Enrollee's question.
Enrollee Service Telephone Responsiveness. 2.12.2.1. There are five (5) call center requirements for the Contractor: 2.12.2.1.1. General customer service (8:00 am-8:00 pm, seven (7) days a week. Alternative technologies may be used on Saturdays, Sundays, and federal holidays);
Enrollee Service Telephone Responsiveness. 2.10.2.1 The Contractor must operate a call center in accordance with the requirements of 42 CFR §§ 422.111(h) and 423.128(d)(1) during normal business hours. Normal business hours are defined as 8:00 AM to 8:00 PM CT in all regions served by the Contractor. Notwithstanding 42 CFR §§ 422.111(h)(1)(i)(A)&(B) and 423.128(d)(1)(i)(A)(1)&(2), the Contractor must operate the call center seven (7) days a week, consistent with the Marketing Guidance for Illinois Medicare-Medicaid Plans. ESRs must be available Monday through Friday, consistent with the Marketing Guidance for Illinois Medicare- Medicaid Plans. The Contractor may use alternative call center technologies on Saturdays, Sundays, and federal holidays.
Enrollee Service Telephone Responsiveness. 2.9.2.1. The ICO must operate a call center during normal business hours and never less than from 8:00 a.m. to 8:00 p.m. (EST), seven (7) days a week, consistent with the required Marketing Guidelines.
Enrollee Service Telephone Responsiveness. The Contractor must operate a call center during normal business hours, 7 days a week, consistent with the required Medicare Marketing Guidelines and the Medicare-Medicaid marketing guidance. ESRs must be available Monday through Friday, during normal business hours, consistent with the required Medicare Marketing Guidelines, the Medicare-Medicaid marketing guidance, and the Massachusetts State-specific Marketing guidance. The Contractor may use alternative call center technologies on Saturdays, Sundays, and Federal holidays. The Contractor’s ESRs must answer 80% of all Enrollee telephone calls within 30 seconds or less. The Contractor must limit average hold time to two (2) minutes, with the average hold time defined as the time spent on hold by the caller following the interactive voice response (IVR) system, touch tone response system, or recorded greeting and before reaching a live person. The Contractor must limit the disconnect rate of all incoming calls to five (5) percent. The Contractor must have a process to measure the time from which the telephone is answered to the point at which an Enrollee reaches an ESR capable of responding to the Enrollee's question in a manner that is sensitive to the Enrollee’s language and cultural needs.
Enrollee Service Telephone Responsiveness. The Contractor must operate a call center during normal business hours, seven (7) days a week, consistent with the required Medicare Communications and Marketing Guidelines and the Medicare-Medicaid marketing guidance. ESRs must be available Monday through Friday, during normal business hours, consistent with the required Medicare Communications and Marketing Guidelines, and the Medicare-Medicaid marketing guidance. The Contractor may use alternative call center technologies on Saturdays, Sundays, and Federal holidays. Coverage Determinations and Appeals Call Center Requirements The Contractor must operate a toll-free call center with live customer service representatives available to respond to providers or Enrollees for information related to requests for coverage under Medicare or Medicaid, and Medicare and Medicaid Appeals (including requests for Medicare exceptions and prior authorizations). The Contractor is required to provide immediate access to requests for Medicare and Medicaid covered benefits and services, including Medicare coverage determinations and redeterminations, via its toll-free call centers. The call centers must operate during normal business hours as specified in the Medicare Communications and Marketing Guidelines, and the Medicare-Medicaid marketing guidance. The Contractor must accept requests for Medicare or Medicaid coverage, including Medicare coverage determinations /redeterminations, outside of normal business hours, but is not required to have live customer service representatives available to accept such requests outside normal business hours. Voicemail may be used outside of normal business hours provided the message: Indicates that the mailbox is secure; Lists the information that must be provided so the case can be worked (e.g., provider identification, beneficiary identification, type of request (coverage determination or Appeal), physician support for an exception request, and whether the member is making an expedited or standard request); For coverage determination calls (including exceptions requests), articulates and follows a process for resolution within twenty-four (24) hours of call for expedited requests and seventy-two (72) hours for standard requests; and For Appeals calls, information articulates the process information needed and provide for a resolution within seventy-two (72) hours for expedited Appeal requests and thirty (30) calendar days for standard Appeal requests.
