Common use of Member Services Helpline Clause in Contracts

Member Services Helpline. DVHA shall continue to maintain a statewide toll-free telephone helpline staffed with trained personnel knowledgeable about the Vermont Medicaid program as well as basic information about the Contractor’s programs. DVHA’s member services helpline is intended to be equipped to handle a variety of basic, first-tier Member inquiries, including the ability to address Member questions, concerns, complaints and requests for PCP changes. Contractor shall be responsible for its own member services helpline to handle second-tier questions from Members (including issues that require specific expertise and authority by Contractor to resolve). Staff assigned to this function will be available to all Member incoming inquiries via “live voice” between 8 a.m. and 4:30 p.m. Eastern Standard Time, Monday through Friday. Contractor shall provide an after-hours voice message system that informs callers of Contractor’s business hours and offers an opportunity to leave a message after business hours. Calls received in the voice message system shall be returned within one (1) business day. During hours of operation, Contractor must be able to receive transfers from DVHA’s member services helpline, Agency of Human Services (AHS) staff and Members who wish to directly call Contractor. Contractor’s helpline may be closed on all holidays observed by the State of Vermont. Call center closures, limited staffing or early closures shall not burden a Member’s access to care. Contractor’s helpline shall offer language interpretation services for Members whose primary language is not English and shall provide teletypewriter (TTY) services for hard of hearing Members free of charge. Contractor’s Helpline staff shall be trained to ensure that Member questions and concerns are resolved as expeditiously as possible. Contractor shall maintain a system for tracking and reporting the number and type of Members’ calls and inquiries it receives during business hours and non-business hours. Contractor shall monitor its member services helpline service and report its telephone service level performance to DVHA in the timeframes and specifications described in the ACO Reporting Manual. Upon a Member’s attribution to the VMNG Program, Contractor shall inform the Member about DVHA’s member services helpline as well as Contractor’s helpline. Contractor must meet the following performance standards related to the responsiveness of staffed telephone lines: a. During open hours, seventy-five percent of all incoming calls that opt to talk to a live operator are answered by a live operator within 25 seconds of leaving Contractor’s Interactive Voice Response (IVR) system; b. Lost call abandonment rate after the call exits the IVR shall not exceed five percent; and

Member Services Helpline. DVHA shall continue to maintain a statewide toll-free telephone helpline staffed with trained personnel knowledgeable about the Vermont Medicaid program as well as basic information about the Contractor’s programs. DVHA’s member services helpline is intended to be equipped to handle a variety of basic, first-tier Member inquiries, including the ability to address Member questions, concerns, complaints and requests for PCP changes. Contractor shall be responsible for its own member services helpline to handle second-second- tier questions from Members (including issues that require specific expertise and authority by Contractor to resolve). Staff assigned to this function will be available to all Member incoming inquiries via “live voice” between 8 a.m. and 4:30 p.m. Eastern Standard Time, Monday through Friday. Contractor shall provide an after-hours voice message system that informs callers of Contractor’s business hours and offers an opportunity to leave a message after business hours. Calls received in the voice message system shall be returned within one (1) business day. During hours of operation, Contractor must be able to receive transfers from DVHA’s member services helpline, Agency of Human Services (AHS) staff and Members who wish to directly call Contractor. Contractor’s helpline may be closed on all holidays observed by the State of Vermont. Call center closures, limited staffing or early closures shall not burden a Member’s access to care. Contractor’s helpline shall offer language interpretation services for Members whose primary language is not English and shall provide teletypewriter (TTY) services for hard of hearing Members free of charge. Contractor’s Helpline staff shall be trained to ensure that Member questions and concerns are resolved as expeditiously as possible. Contractor shall maintain a system for tracking and reporting the number and type of Members’ calls and inquiries it receives during business hours and non-business hours. Contractor shall monitor its member services helpline service and report its telephone service level performance to DVHA in the timeframes and specifications described in the ACO Reporting Manual. Upon a Member’s attribution to the VMNG Program, Contractor shall inform the Member about DVHA’s member services helpline as well as Contractor’s helpline. Contractor must meet the following performance standards related to the responsiveness of staffed telephone lines: a. During open hours, seventy-five percent of all incoming calls that opt to talk to a live operator are answered by a live operator within 25 seconds of leaving Contractor’s Interactive Voice Response (IVR) system; b. Lost call abandonment rate after the call exits the IVR shall not exceed five percent; and

Member Services Helpline. DVHA shall continue to maintain a statewide toll-free telephone helpline staffed with trained personnel knowledgeable about the Vermont Medicaid program as well as basic information about the Contractor’s programs. DVHA’s member services helpline is intended to be equipped to handle a variety of basic, first-tier Member inquiries, including the ability to address Member questions, concerns, complaints and requests for PCP changes. Contractor shall be responsible for its own member services helpline to handle second-tier questions from Members (including issues that require specific expertise and authority by Contractor to resolve). Staff assigned to this function will must be available to all Member incoming inquiries via provide “live voice” access to Members during, at a minimum, the hours between 8 a.m. and 4:30 5 p.m. Eastern Standard Time, Monday through Friday. Contractor shall provide an after-hours voice message system that informs callers of Contractor’s business hours and offers an opportunity to leave a message after business hours. Calls received in the voice message system shall be returned within one (1) business day. During hours of operation, Contractor must be able to receive transfers from DVHA’s member services helpline, Agency of Human Services (AHS) staff and Members who wish to directly call Contractor. Contractor’s helpline may be closed on all holidays observed by the State of Vermont. Call center closures, limited staffing or early closures shall not burden a Member’s access to care. Contractor’s helpline shall offer language interpretation services for Members whose primary language is not English and shall provide teletypewriter (TTY) services for hard of hearing Members free of charge. Contractor’s Helpline staff shall be trained to ensure that Member questions and concerns are resolved as expeditiously as possible. Contractor shall maintain a system for tracking and reporting the number and type of Members’ calls and inquiries it receives during business hours and non-business hours. Contractor shall monitor its member services helpline service and report its telephone service level performance to DVHA in the timeframes and specifications described in the ACO Reporting Manual. Upon a Member’s attribution to the VMNG Program, Contractor shall inform the Member about DVHA’s member services helpline as well as Contractor’s helpline. Contractor must meet the following performance standards related to the responsiveness of staffed telephone lines: a. During open hours, seventy-five percent of all incoming calls that opt to talk to a live operator are answered by a live operator within 25 seconds of leaving Contractor’s Interactive Voice Response (IVR) system; b. Lost call abandonment rate after the call exits the IVR shall not exceed five percent; and