Member Call Center Sample Clauses
The Member Call Center clause establishes the requirement for providing a dedicated telephone support service for members. This typically involves setting up a call center that handles inquiries, complaints, and requests for assistance from members, often during specified hours and with trained staff. By formalizing the operation and standards of the call center, this clause ensures that members have reliable access to support, thereby improving service quality and addressing member needs efficiently.
Member Call Center. The CONTRACTOR shall maintain an organized, integrated Medicaid Managed Care Member services call-in center that provides a toll-free number, physically located in the United States, with dedicated staff to respond to member questions including, but not limited to, such topics as:
3.18.1. Information regarding Primary Care Provider (PCP) selection including registering the Medicaid Managed Care Member’s choice, 3.18.2. Explanation of CONTRACTOR Policies and Procedures,
Member Call Center. The CONTRACTOR shall maintain an organized, integrated Medicaid Managed Care Member services call-in center that provides a toll-free number, physically located in the United States, with dedicated staff to respond to member questions including, but not limited to, such topics as:
3.18.1. Information regarding Primary Care Provider (PCP) selection including registering the Medicaid Managed Care Member’s choice,
3.18.2. Explanation of CONTRACTOR Policies and Procedures,
3.18.3. Information regarding Prior Authorization requirements,
3.18.4. Information regarding Covered Services,
3.18.5. Information on Primary Care Providers (PCPs) or specialists,
3.18.6. Referral process to participating specialists,
3.18.7. Resolution of service and/or medical delivery problems,
3.18.8. Questions and/or referral requests resulting from the placement of the Member in the State’s Pharmacy Lock-in Program (SPLIP), and
3.18.9. Member Grievances.
Member Call Center. The CONTRACTOR shall maintain an organized, integrated Medicaid Managed Care Member services call-in center that provides a toll-free number, physically located in the United States, with dedicated staff to respond to member questions including, but not limited to, such topics as:
3.17.1 Information regarding Primary Care Provider (PCP) selection including registering the Medicaid Managed Care Member’s choice,
3.17.2 Explanation of CONTRACTOR Policies and Procedures,
3.17.3 Information regarding Prior Authorization requirements,
3.17.4 Information regarding Covered Services,
3.17.5 Information on Primary Care Providers (PCPs) or specialists,
3.17.6 Referral process to participating specialists,
3.17.7 Resolution of service and/or medical delivery problems,
3.17.8 Questions and/or referral requests resulting from the placement of the Member in the State’s Pharmacy Lock-in Program (SPLIP), and
3.17.9 Member Grievances.
3.17.10 Call Center Availability and Operation 3.17.11Toll-Free Number The toll-free number must be staffed between the hours of 8:00 a.m. through 6:00 p.m. Eastern Time, Monday through Friday, excluding state declared holidays. The toll-free line shall have an automated system, available twenty-four (24) hours a day, and seven (7) Days a week. This automated system must include the capability of providing callers with instructions on what to do in case of an emergency and the option to talk directly to a nurse or other clinician or leave a message, including instructions on how to leave a message and when that message will be returned.
Member Call Center. The CONTRACTOR shall maintain an organized, integrated Medicaid Managed Care Member services call-in center that provides a toll-free number, physically located in the United States equipped with caller identification, automatic call distribution equipment capable of handling the expected volume of calls, with dedicated staff to respond to member questions.
3.13.1 The Member Call Center should be able to respond to questions that include, but are not limited to, such topics as:
3.13.1.1 Information regarding Primary Care Provider (PCP) selection including registering the Medicaid Managed Care Member’s choice,
3.13.1.2 Explanation of CONTRACTOR Policies and Procedures,
3.13.1.3 Information regarding Prior Authorization requirements,
3.13.1.4 Information regarding Covered Services,
3.13.1. 5 Information on Primary Care Providers (PCPs) or specialists,
Member Call Center. The CONTRACTOR shall maintain an organized, integrated Medicaid Managed Care Member services call-in center that provides a toll-free number, physically located in the United States, with dedicated staff to respond to member questions including, but not limited to, such topics as:
3.19.1. Information regarding Primary Care Provider (PCP) selection including registering the Medicaid Managed Care Member’s choice,
3.19.2. Explanation of CONTRACTOR policies and procedures,
3.19.3. Information regarding prior authorization requirements,
3.19.4. Information regarding covered services,
3.19.5. Information on Primary Care Providers (PCPs) or specialists,
3.19.6. Referral process to participating specialists,
3.19.7. Resolution of service and/or medical delivery problems,
3.19.8. Questions and/or referral requests resulting from the placement of the Member in the Pharmacy Lock-in Program, and
3.19.9. Member Grievances.
3.19.10. Call Center Availability and Operation
3.19.11. Toll-Free Number The toll-free number must be staffed between the hours of 8:00 a.m. through 6:00 p.m. Eastern Time, Monday through Friday, excluding state declared holidays. The toll-free line shall have an automated system, available twenty-four (24) hours a day, and seven (7) days a week. This automated system must include the capability of providing callers with instructions on what to do in case of an emergency and the option to talk directly to a nurse or other clinician or leave a message, including instructions on how to leave a message and when that message will be returned.
Member Call Center.
1. Includes support of customer service calls and customer inquiries related to COBRA benefits.
2. Call center hours are 8 a.m. to 8 p.m., Eastern Standard Time Monday through Friday (Business Days only).
3. Call center operations team will be trained to have proper knowledge to be able to answer questions regarding the COBRA Administration.