PH-MCO Internal Member Dedicated Hotline Sample Clauses

PH-MCO Internal Member Dedicated Hotline. The PH-MCO must maintain and staff a twenty-four (24) hour, seven (7) day-a-week toll-free dedicated hotline to respond to Members’ inquiries, issues and problems raised regarding services. The PH-MCO’s internal Member hotline staff are required to ask the callers whether or not they are satisfied with the response given to their call. All calls must be documented and if the caller is not satisfied, the PH-MCO must ensure that the call is referred to the appropriate individual within the PH-MCO for follow-up and/or resolution. This referral must take place within forty-eight (48) hours of the call. The PH-MCO must provide the Department with the capability to monitor the PH-MCO’s Member services and internal Member dedicated hotline from each of the PH-MCO’s offices. The Department will only monitor calls from HealthChoices Members or their representatives and will cease all monitoring activity as soon as it becomes apparent that the call is not related to a HealthChoices Member. The PH-MCO is not permitted to utilize electronic call answering methods, as a substitute for staff persons, to perform this service. The PH-MCO must ensure that its dedicated hotline meets the following Member services performance standards:  Provide for a dedicated phone line for its Members.  Provide for necessary translation and interpreter assistance for Members who speak a language other than English.  Be staffed by individuals trained in: – Cultural Competency; – addressing the needs of special populations; – the availability of and the functions of the SNU; – the services which the PH-MCO is required to make available to all Members; and – the availability of social services within the community.  Be staffed with representatives familiar with accessing medical transportation.  Be staffed with adequate service representatives to ensure an abandonment rate of less than or equal to five percent (5%) of the total calls.  Be staffed with adequate service representatives to ensure that at least 85% of all calls are answered within thirty (30) seconds.  Provide for TTY and/or Pennsylvania Telecommunication Relay Service availability for Members who are Deaf or hard of hearing.
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PH-MCO Internal Member Dedicated Hotline. The PH-MCO must maintain and staff a twenty-four (24) hour, seven
Sample 1Sample 2Sample 3See All (11)

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