Member Hotline. The MCO must operate a toll-free hotline that Members can call 24 hours a day, seven (7) days a week. The Member Hotline must be staffed with personnel who are knowledgeable about its MCO Program(s) and Covered Services between the hours of 8:00 a.m. to 5:00 p.m. local time for the Service Area, Monday through Friday, excluding state-approved holidays. The State-approved holiday schedule is updated annually and can be found at xxxx://xxx.xx.xxxxx.xx.xx/compensation/holidays.html. The MCO must ensure that after hours, on weekends, and on holidays the Member Services Hotline is answered by an automated system with the capability to provide callers with operating hours and instructions on what to do in cases of emergency. All recordings must be in English, Spanish, and the languages of other Major Population Groups in the Service Area. A voice mailbox must be available after hours for callers to leave messages. The MCO's Member Services representatives must return calls received by the automated system from Members or their representatives on the next Business Day. If the Member Hotline does not have a voice-activated menu system, the MCO must have a menu system that will accommodate Members who cannot access the system through other physical means, such as pushing a button. The MCO must ensure that its Member Service representatives treat all callers with dignity and respect the callers' need for privacy. At a minimum, the MCO's Member Service representatives must be:
1. knowledgeable about Covered Services;
2. able to answer non-technical questions about the role of the PCP, as applicable;
Member Hotline. The HMO must operate a toll-free hotline that Members can call 24 hours a day, seven (7) days a week. The Member Hotline must be staffed with personnel who are knowledgeable about its HMO Program(s) and Covered Services, between the hours of 8:00 a.m. to 5:00 p.m. local time for the Service Area, Monday through Friday, excluding state-approved holidays. The HMO must ensure that after hours, on weekends, and on holidays the Member Services Hotline is answered by an automated system with the capability to provide callers with operating hours and instructions on what to do in cases of emergency. All recordings must be in English and in Spanish. A voice mailbox must be available after hours for callers to leave messages. The HMO’s Member Services representatives must return member calls received by the automated system on the next working day. If the Member Hotline does not have a voice-activated menu system, the HMO must have a menu system that will accommodate Members who cannot access the system through other physical means, such as pushing a button. The HMO must ensure that its Member Service representatives treat all callers with dignity and respect the callers’ need for privacy. At a minimum, the HMO’s Member Service representatives must be:
Member Hotline. (3 pages, plus 2 additional pages per additional MCO Program bid if the Respondent’s response differs by MCO Program; excluding hotline telephone reports) The Member Hotline requirements are described in Section 8.1.5.6. Describe the proposed Member Hotline function, including:
1. normal hours of operation;
2. number of Member Hotline staff, expressed in the number of full time employees (FTEs) per 1000 Members who are available 8:00 a.m. to 5:00 p.m., local time in the Service Area, Monday through Friday, excluding state-approved holidays;
3. routing of calls among Member Hotline staff to ensure timely and accurate response to Member inquiries;
4. responsibilities of Member Hotline staff, if any, in addition to responding to HHSC Member Hotline calls, (e.g., responding to non-HHSC Member calls and/or HHSC Provider Hotline or Behavioral Health Hotline calls);
5. after-hours procedures and available services, including those provided to non-English speaking Members in Major Population Groups;
6. the number and percentage of FTE Member Hotline staff who are bilingual in English and Spanish;
7. the number and percentage of FTE Member Hotline staff who are multi-lingual for any additional language, by language spoken;
8. for STAR+PLUS only, the number and percentage of FTE Member Hotline staff dedicated to the Service Coordination function;
9. Member Hotline telephone reports for the most recent four (4) quarters with data that show the monthly trends for call volume, monthly trends for average speed of answer (where answer is defined by reaching a live voice, not an automated call system) and monthly trends for the abandonment rate; and
10. Whether the Member Hotline has the capability to administer automated surveys to callers at the end of calls. A Respondent currently participating in any of HHSC’s MCO Programs must submit the information in #9 above for each Member Hotline operated, and identify any proposed changes to hotline functions. If the Respondent is not currently participating in any of HHSC’s MCO Programs, it should describe its experience and proposed approach in establishing and maintaining an accessible call center for Members that is comparable to the Member Hotline described in Section 8.1.5.6. Such a description must include the information listed in items 1 to 10 above. A Respondent proposing to participate in more than one (1) MCO Program should note that it is not required to operate separate STAR, STAR+PLUS, and CHIP Member Hotlines, i...
Member Hotline. HMO must maintain a toll-free Member telephone hotline 24 hours a day, seven days a week for Members to obtain assistance in accessing services under this contract. Telephone availability must be demonstrated through an abandonment rate of less than 10%.
Member Hotline. The HMO must operate a toll-free hotline that Members can call 24 hours a day, seven (7) days a week. The Member Hotline must be staffed with personnel who are knowledgeable about its HMO Program(s) and Covered Services, between the hours of 8:00 a.m. to 5:00 p.m. local time for the Service Area, Monday through Friday, excluding state-approved holidays. The HMO must ensure that after hours, on weekends, and on holidays the Member Services Hotline is answered by an automated system with the capability to provide callers with operating hours and instructions on what to do in cases of emergency. All recordings must be in English and in Spanish. A voice mailbox must be available after hours for callers to leave messages. The HMO’s Member Services representatives must return member calls received by the automated system on the next working day. If the Member Hotline does not have a voice-activated menu system, the HMO must have a menu system that will accommodate Members who cannot access the system through other physical means, such as pushing a button. The HMO must ensure that its Member Service representatives treat all callers with dignity and respect the callers’ need for privacy. At a minimum, the HMO’s Member Service representatives must be:
1. Knowledgeable about Covered Services;
2. Able to answer non-technical questions pertaining to the role of the PCP, as applicable;
3. Able to answer non-clinical questions pertaining to referrals or the process for receiving authorization for procedures or services;
4. Able to give information about Providers in a particular area;
5. Knowledgeable about Fraud, Abuse, and Waste and the requirements to report any conduct that, if substantiated, may constitute Fraud, Abuse, or Waste in the HMO Program;
6. Trained regarding Cultural Competency;
Member Hotline. 85 8.6 MEMBER COMPLAINT PROCESS.......................................................85 8.7 MEMBER NOTICE, APPEALS AND FAIR HEARINGS.......................................88 8.8 MEMBER ADVOCATES...............................................................89 8.9
Member Hotline. (3 pages, plus 2 additional pages per additional MCO Program bid if the Respondent’s response differs by MCO Program; excluding hotline telephone reports) The Member Hotline requirements are described in Section 8.1.5.6. Describe the proposed Member Hotline function, including:
Member Hotline. 73 8.6 MEMBER COMPLAINT PROCESS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 8.7 MEMBER NOTICE, APPEALS AND FAIR HEARINGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 8.8
Member Hotline. The MCO must establish a single toll-free telephone number to assist with questions that members may have about the MCO's providers or benefits. In accordance with 42 CFR 438.10(c), the MCO must satisfy each of the following requirements: - Provide a description of the oral interpretation services offered to members - Notify members of the availability of free oral interpretation services for all languages - Make free oral interpretation services available for all languages
Member Hotline. The DO shall establish a toll-free Member Service automated hotline that operates outside of the Member Call Center standard hours, Monday through Friday, and at all hours on weekends and holidays.
