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:
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: Information regarding Primary Care Provider (PCP) selection including registering the Medicaid Managed Care Member’s choice, Explanation of CONTRACTOR Policies and Procedures, Information regarding Prior Authorization requirements, Information regarding Covered Services, Information on Primary Care Providers (PCPs) or specialists, Referral process to participating specialists, Resolution of service and/or medical delivery problems, Questions and/or referral requests resulting from the placement of the Member in the State’s Pharmacy Lock-in Program (SPLIP), and Member Grievances. Call Center Availability and Operation 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. Telephone Lines The CONTRACTOR shall have sufficient telephone lines to answer incoming calls. Staffing The CONTRACTOR shall ensure sufficient staffing of the call center adjusted for peak call-volume time. The Department reserves the right to specify staffing ratio and/or other requirements, if performance standards are not met or it is determined that the call center staffing/processes are not sufficient to meet member needs as determined by the Department. Telephone Help Line Policies and Procedures The CONTRACTOR must develop telephone help line Policies and Procedures that address staffing, personnel, hours of operation, access and response standards, monitoring of calls via recording or other means, and compliance with standards. The CONTRACTOR shall make the Policies and Procedures available to the Department for review. Non-English Speaking Services CONTRACTOR shall ensure that translation services are available for all non-English-speaking callers. Automated Call Distribution (A...
Member Call Center. 1. Includes support of customer service calls and customer inquiries related to COBRA benefits.
