Common use of Member Services Clause in Contracts

Member Services. a. Instructions on how to contact the Member Services Call Center and a description of the functions of Member Services; b. A description of availability of and instructions on how to access clinical personnel who act within the scope of their licensure to practice medical and behavioral health-related profession twenty-four (24) hours, seven (7) days per week; c. A description of availability of and instructions on how to utilize the twenty- four (24) hours, seven (7) days per week nurse advice line; d. A description of EPSDT screenings and services and instructions advising Members about how to access such services; e. A description of all available covered services, including inpatient services, behavioral health/substance use disorder, Non-Emergency Transportation, dental, maternity, pharmacy, and preventive services, services available to children in xxxxxx care, if applicable, and an explanation of any service limitations, referral and Prior Authorization requirements. This description should include that the Member may receive a minimum of a three (3)-day emergency supply for prior authorized drugs until authorization is completed; f. Information about the features of Care Management, the responsibilities of the Contractor for coordination of Member care, and the Member’s role in the Care Management process; g. Procedures for notifying Members of the termination or change in any benefits, services, or locations; h. A description of the enhanced services the Contractor offers, if applicable; i. A description of the Contractor’s confidentiality policies; j. An explanation of any service limitations or exclusions from coverage; including limitations that may apply to services obtained from Out-of-network Providers; k. A notice stating that the Member shall be liable only for those services subject to Prior Authorization and not authorized by the Contractor and non-covered services; l. Circumstances under which an eligible Member may disenroll or be involuntarily disenrolled from the Contractor and/or MississippiCAN Program;