Member Services Availability. The Contractor shall maintain an organized, integrated member/patient services function, to be operated during regular business hours, within the plan to assist members in selection of a primary care provider, provide explanation of the Contractor's policies and procedures, (re: access and availability of health services) provide additional information about the primary care providers and/or specialist(s), facilitate referrals to specialists, and assist in the resolution of service and/or medical delivery problems and member complaints. The Contractor shall agree to maintain a toll-free telephone number for Medicaid MHN program members’ inquiries. The toll-free telephone number shall be required to provide prior authorization/access and information of services during evenings and weekends.
Member Services Availability. The Contractor shall maintain an organized, integrated member/patient services function, operated during regular business hours, to assist members with PCP selection, to explain the Contractor's policies and procedures (re: access and availability of health services), to provide additional information about the PCPs and/or specialist(s), to facilitate referrals to participating specialists, and to assist in resolving service and/or medical delivery problems and member complaints. The Contractor shall agree to maintain a toll-free telephone number for members’ inquiries. The toll-free telephone number shall be required to provide prior authorization/access and information on services during evenings and weekends.
Member Services Availability. The CCN shall maintain an organized, integrated member/patient services function, to be operated during regular business hours, within the CCN to assist members in selection of a primary care provider, provide explanation of the CCN's policies and procedures, (re: access and availability of health services) provide additional information about the primary care providers, facilitate referrals to specialists, and assist in the resolution of service and/or medical delivery problems and member grievances. The CCN shall agree to maintain a toll-free telephone number for CCN members’ inquiries. The toll-free telephone number shall be required to provide prior authorization/access and information on services during evenings and weekends. Member Services and the Call Center must be physically located within the United States.
Member Services Availability. The Contractor shall maintain an organized, integrated Medicaid MCO Member services function operated during regular business hours to assist Medicaid MCO Members with PCP selection, to explain the Contractor's policies and procedures (access and availability of health services), to provide additional information about the PCPs and/or specialist(s), to facilitate referrals to participating specialists, and to assist in resolving service and/or medical delivery problems and Medicaid MCO Member complaints. The Contractor shall agree to maintain a toll-free telephone number for Medicaid MCO Program Members’ inquiries. The toll-free telephone number shall provide Prior Authorization/access and information on services during evenings and weekends.
