Member Call Center Sample Clauses

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,
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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, 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.

Related to Member Call Center

  • Call Center Services Answer telephone inquiries during mutually agreed upon hours each day on which the Fund is open for trading. In the event that the Fund plans to be open on a business day when the New York Stock Exchange is to be closed, the Fund shall provide the Transfer Agent with reasonable advance notice and the parties shall discuss the call center resources available for such day. The Transfer Agent shall answer and respond to inquiries from existing Shareholders, prospective Shareholders of the Fund and broker-dealers on behalf of such Shareholders in accordance with the instructions provided by the Fund to the Transfer Agent for purpose of fulfilling its duties under this Agreement, including, accepting transaction requests on behalf of the Fund.

  • Shift Rotation Routine shift rotation is not an approach to staffing endorsed by the Employer. Except for emergency situations where it may be necessary to provide safe patient care, shift rotation will not be utilized without mutual consent. If such an occasion should ever occur, volunteers will be sought first. If no one volunteers, the Employer will rotate shifts on an inverse seniority basis until the staff vacancies are filled.

  • How Non-network Providers Are Paid If you receive care from a non-network provider, you are responsible for paying all charges for the services you received. You may submit a claim for reimbursement of the payments you made. For the limited circumstances listed below, your copayment and deductible will apply at the network level of benefits: • emergency care (emergency room, urgent care and ambulance services); • we specifically approve the use of a non-network provider for covered healthcare services, see Network Authorization in Section 5 for details; • covered healthcare services are rendered by a non-network provider at a network For those circumstances where we cover services from a non-network provider, we reimburse you or the non-network provider, less any copayments and deductibles, up to the lesser of: • our allowance; • the non-network provider’s charge; or • the benefit limit. You are responsible for the deductible, if one applies, and the copayment, as well as any amount over the benefit limit that applies to the service you received. You are liable for the difference between the amount that the non-network provider bills and the payment we make for covered healthcare services. Generally, we send reimbursement to you, but we reserve the right to reimburse a non-network provider directly. We reimburse non-network provider services using the same guidelines we use to pay network providers. Generally, our payment for non-network provider services will not be more than the amount we pay for network provider services. If an allowance for a specific covered healthcare service cannot be determined by reference to a fee schedule, reimbursement will be based upon a calculation that reasonably represents the amount paid to network providers. For emergency services, we reimburse non- network providers, in accordance with R.I. Gen. Laws § 27-18-76, the greater of our allowance, our usual guidelines for paying non-network providers, or the amount that would be paid under Medicare, less any copayments or deductibles. Payments we make to you are personal. You cannot transfer or assign any of your right to receive payments under this agreement to another person or organization, unless the R.I. General Law §27-20-49 (Dental Insurance assignment of benefits) applies. For information about network authorization requests to seek covered healthcare services from a non-network provider when the covered healthcare service cannot be provided by a network provider, please see Network Authorization in Section 5.

  • WASHINGTON’S STATEWIDE PAYEE DESK Contractor represents and warrants that Contractor is registered with Washington’s Statewide Payee Desk, which registration is a condition to payment.

  • One-Way Interconnection Trunks 2.3.1 Where the Parties use One-Way Interconnection Trunks for the delivery of traffic from Onvoy to Frontier, Onvoy, at Onvoy’s own expense, shall: 2.3.1.1 provide its own facilities for delivery of the traffic to the technically feasible Point(s) of Interconnection on Frontier’s network in a LATA; and/or 2.3.1.2 obtain transport for delivery of the traffic to the technically feasible Point(s) of Interconnection on Frontier’s network in a LATA (a) from a third party, or, (b) if Frontier offers such transport pursuant to a Frontier access Tariff, from Frontier. 2.3.2 For each Tandem or End Office One-Way Interconnection Trunk group for delivery of traffic from Onvoy to Frontier with a utilization level of less than sixty percent (60%) for final trunk groups and eighty-five percent (85%) for high usage trunk groups, unless the Parties agree otherwise, Onvoy will promptly submit ASRs to disconnect a sufficient number of Interconnection Trunks to attain a utilization level of approximately sixty percent (60%) for all final trunk groups and eighty-five percent (85%) for all high usage trunk groups. In the event Onvoy fails to submit an ASR to disconnect One-Way Interconnection Trunks as required by this Section, Frontier may disconnect the excess Interconnection Trunks or bill (and Onvoy shall pay) for the excess Interconnection Trunks at the rates set forth in the Pricing Attachment. 2.3.3 Where the Parties use One-Way Interconnection Trunks for the delivery of traffic from Frontier to Onvoy, Frontier, at Frontier’s own expense, shall provide its own facilities for delivery of the traffic to the technically feasible Point(s) of Interconnection on Frontier’s network in a LATA.

  • NON-NETWORK PROVIDER is a provider that has not entered into a contract with us or any other Blue Cross and Blue Shield plan. For pediatric dental care services, non-network provider is a dentist that has not entered into a contract with us or does not participate in the Dental Coast to Coast Network. For pediatric vision hardware services, a non-network provider is a provider that has not entered into a contract with EyeMed, our vision care service manager.

  • Scope of Interconnection Service 1.3.1 The NYISO will provide Energy Resource Interconnection Service and Capacity Resource Interconnection Service to Interconnection Customer at the Point of Interconnection. 1.3.2 This Agreement does not constitute an agreement to purchase or deliver the Interconnection Customer’s power. The purchase or delivery of power and other services that the Interconnection Customer may require will be covered under separate agreements, if any, or applicable provisions of NYISO’s or Connecting Transmission Owner’s tariffs. The Interconnection Customer will be responsible for separately making all necessary arrangements (including scheduling) for delivery of electricity in accordance with the applicable provisions of the ISO OATT and Connecting Transmission Owner’s tariff. The execution of this Agreement does not constitute a request for, nor agreement to, provide Energy, any Ancillary Services or Installed Capacity under the NYISO Services Tariff or any Connecting Transmission Owner’s tariff. If Interconnection Customer wishes to supply or purchase Energy, Installed Capacity or Ancillary Services, then Interconnection Customer will make application to do so in accordance with the NYISO Services Tariff or Connecting Transmission Owner’s tariff.

  • Two-Way Interconnection Trunks 2.4.1 Where the Parties use Two-Way Interconnection Trunks for the exchange of traffic between Verizon and Ymax, Ymax, at its own expense, shall: 2.4.1.1 provide its own facilities to the technically feasible Point(s) of Interconnection on Verizon’s network in a LATA; and/or 2.4.1.2 obtain transport to the technically feasible Point(s) of Interconnection on Verizon’s network in a LATA (a) from a third party, or, (b) if Verizon offers such transport pursuant to this Agreement or an applicable Verizon Tariff, from Verizon. 2.4.2 Where the Parties use Two-Way Interconnection Trunks for the exchange of traffic between Verizon and Ymax, Verizon, at its own expense, shall provide its own facilities to the technically feasible Point(s) of Interconnection on Verizon’s network in a LATA. 2.4.3 Prior to establishing any Two-Way Interconnection Trunks, Ymax shall meet with Verizon to conduct a joint planning meeting (“Joint Planning Meeting”). At that Joint Planning Meeting, each Party shall provide to the other Party originating Centium Call Seconds (Hundred Call Seconds) information, and the Parties shall mutually agree on the appropriate initial number of End Office and Tandem Two-Way Interconnection Trunks and the interface specifications at the technically feasible Point(s) of Interconnection on Verizon’s network in a LATA at which the Parties interconnect for the exchange of traffic. Where the Parties have agreed to convert existing One-Way Interconnection Trunks to Two-Way Interconnection Trunks, at the Joint Planning Meeting, the Parties shall also mutually agree on the conversion process and project intervals for conversion of such One- Way Interconnection Trunks to Two-Way Interconnection Trunks. 2.4.4 On a semi-annual basis, Ymax shall submit a good faith forecast to Verizon of the number of End Office and Tandem Two-Way Interconnection Trunks that Ymax anticipates Verizon will need to provide during the ensuing two (2) year period for the exchange of traffic between Ymax and Verizon. Ymax’s trunk forecasts shall conform to the Verizon CLEC trunk forecasting guidelines as in effect at that time. 2.4.5 The Parties shall meet (telephonically or in person) from time to time, as needed, to review data on End Office and Tandem Two-Way Interconnection Trunks to determine the need for new trunk groups and to plan any necessary changes in the number of Two-Way Interconnection Trunks. 2.4.6 Two-Way Interconnection Trunks shall have SS7 Common Channel Signaling. The Parties agree to utilize B8ZS and Extended Super Frame (ESF) DS1 facilities, where available. 2.4.7 With respect to End Office Two-Way Interconnection Trunks, both Parties shall use an economic Centium Call Seconds (Hundred Call Seconds) equal to five (5). Either Party may disconnect End Office Two-Way Interconnection Trunks that, based on reasonable engineering criteria and capacity constraints, are not warranted by the actual traffic volume experienced. 2.4.8 Two-Way Interconnection Trunk groups that connect to a Verizon access Tandem shall be engineered using a design blocking objective of Xxxx-Xxxxxxxxx B.005 during the average time consistent busy hour. Two-Way Interconnection Trunk groups that connect to a Verizon local Tandem shall be engineered using a design blocking objective of Xxxx- Xxxxxxxxx B.01 during the average time consistent busy hour. Verizon and Xxxx shall engineer Two-Way Interconnection Trunks using BOC Notes on the LEC Networks SR-TSV-002275. 2.4.9 The performance standard for final Two-Way Interconnection Trunk groups shall be that no such Interconnection Trunk group will exceed its design blocking objective (B.005 or B.01, as applicable) for three (3) consecutive calendar traffic study months. 2.4.10 Ymax shall determine and order the number of Two-Way Interconnection Trunks that are required to meet the applicable design blocking objective for all traffic carried on each Two-Way Interconnection Trunk group. Ymax shall order Two-Way Interconnection Trunks by submitting ASRs to Verizon setting forth the number of Two-Way Interconnection Trunks to be installed and the requested installation dates within Verizon’s effective standard intervals or negotiated intervals, as appropriate. Ymax shall complete ASRs in accordance with OBF Guidelines as in effect from time to time. 2.4.11 Verizon may (but shall not be obligated to) monitor Two-Way Interconnection Trunk groups using service results for the applicable design blocking objective. If Verizon observes blocking in excess of the applicable design objective on any Tandem Two-Way Interconnection Trunk group and Ymax has not notified Verizon that it has corrected such blocking, Verizon may submit to Ymax a Trunk Group Service Request directing Ymax to remedy the blocking. Upon receipt of a Trunk Group Service Request, Ymax will complete an ASR to establish or augment the End Office Two-Way Interconnection Trunk group(s), or, if mutually agreed, to augment the Tandem Two-Way Interconnection Trunk group with excessive blocking and submit the ASR to Verizon within five (5) Business Days. 2.4.12 The Parties will review all Tandem Two-Way Interconnection Trunk groups that reach a utilization level of seventy percent (70%), or greater, to determine whether those groups should be augmented. Ymax will promptly augment all Tandem Two-Way Interconnection Trunk groups that reach a utilization level of eighty percent (80%) by submitting ASRs for additional trunks sufficient to attain a utilization level of approximately seventy percent (70%), unless the Parties agree that additional trunking is not required. For each Tandem Two-Way Interconnection Trunk group with a utilization level of less than sixty percent (60%), unless the Parties agree otherwise, Ymax will promptly submit ASRs to disconnect a sufficient number of Interconnection Trunks to attain a utilization level of approximately sixty percent (60%) for each respective group, unless the Parties agree that the Two-Way Interconnection Trunks should not be disconnected. In the event Ymax fails to submit an ASR for Two-Way Interconnection Trunks in conformance with this Section, Verizon may disconnect the excess Interconnection Trunks or bill (and Ymax shall pay) for the excess Interconnection Trunks at the applicable Verizon rates. 2.4.13 Because Verizon will not be in control of when and how many Two- Way Interconnection Trunks are established between its network and Ymax’s network, Verizon’s performance in connection with these Two- Way Interconnection Trunk groups shall not be subject to any performance measurements and remedies under this Agreement, and, except as otherwise required by Applicable Law, under any FCC or Commission approved carrier-to-carrier performance assurance guidelines or plan. 2.4.14 Ymax will route its traffic to Verizon over the End Office and Tandem Two-Way Interconnection Trunks in accordance with SR-TAP-000191, including but not limited to those standards requiring that a call from Ymax to a Verizon End Office will first be routed to the End Office Interconnection Trunk group between Ymax and the Verizon End Office.

  • Verizon Retail Telecommunications Service Any Telecommunications Service that Verizon provides at retail to subscribers that are not Telecommunications Carriers. The term “Verizon Retail Telecommunications Service” does not include any Exchange Access service (as defined in Section 3(16) of the Act, 47 U.S.C. § 153(16)) provided by Verizon.

  • Verizon OSS Services Access to Verizon Operations Support Systems functions. The term “Verizon OSS Services” includes, but is not limited to: (a) Verizon’s provision of ECI Usage Information to ECI pursuant to Section 8.3 of this Attachment; and, (b) “Verizon OSS Information”, as defined in Section 8.1.4 of this Attachment.

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