Toll-Free Help Line a. The Health Plan shall operate a toll-free telephone help line. Such help line shall respond to all areas of Enrollee inquiry.
b. If the Health Plan has authorization requirements for prescribed drug services and is subject to the Xxxxxxxxx Settlement Agreement (HSA), the Health Plan may allow the telephone help line staff to act as Xxxxxxxxx Ombudsman, pursuant to the terms of the HSA, so long as the Health Plan maintains a Xxxxxxxxx Ombudsman Log. The Health Plan may maintain the Xxxxxxxxx Ombudsman Log as part of the Health Plan’s telephone help line log, so long as the Health Plan can access the Xxxxxxxxx Ombudsman Log information separately for reporting purposes. The log shall contain information as described in Section V.D.13, Prescribed Drug Services.
c. The Health Plan shall have telephone call policies and procedures that shall include requirements for staffing, personnel, hours of operation, call response times, maximum hold times, and maximum abandonment rates, monitoring of calls via recording or other means, and compliance with standards.
d. The telephone helpline shall handle calls from non-English speaking Enrollees, as well as calls from Enrollees who are hearing impaired.
e. The telephone help line shall be fully staffed between the hours of 8:00 a.m. and 7:00 p.m., EDT or EST, as appropriate, Monday through Friday, excluding State holidays. The telephone help line staff shall be trained to respond to Enrollee questions in all areas, including but not limited to, Covered Services, the Provider network, and non-emergency transportation.
f. The Health Plan shall develop performance standards and monitor telephone help line performance by recording calls and employing other monitoring activities. Such standards shall be submitted and approved by the Agency. At a minimum, the standards shall require that, measured on a monthly basis:
(1) One hundred percent (100%) of all calls are answered within four (4) rings (these calls may be placed in a queue);
(2) The wait time in the queue shall not exceed three (3) minutes;
(3) The Blocked Call rate does not exceed one percent (1%); and
(4) The rate of Abandoned Calls does not exceed five percent (5%).
g. The Health Plan shall have an automated system available between the hours of 8:00 p.m. and 7:00 a.m., EDT or EST, as appropriate, Monday through Friday and at all hours on weekends and holidays. This automated system must provide callers with operating instructions on what to do in case of an eme...
Toll-Free Help Line. From the Class Notice Date and thereafter until at least five (5) Business Days after the last payment under this settlement is made or the settlement is terminated, the Claims Administrator shall establish and maintain a toll-free help line for Settlement Class Members to call with settlement-related inquiries, with the option to leave a message and request a call back, with such calls being returned within three (3) business days, and answering the questions of Settlement Class Members, to the extent possible, who call with or otherwise communicate such inquiries. The Claims Administrator also will provide copies of the forms of the Long Form Notice and Claim Form approved by the Court, as well as this Settlement Agreement, upon request.
Toll-Free Help Line a. The PSN shall operate a toll-free telephone help line. Such help line shall respond to all areas of Enrollee inquiry.
b. If the PSN has authorization requirements for prescribed drug services and is subject to the Xxxxxxxxx Settlement Agreement (HSA), the PSN may allow the telephone help line staff to act as Xxxxxxxxx Xxxxxxxxx, pursuant to the terms of the HSA, so long as the PSN maintains a Xxxxxxxxx Ombudsman Log. The PSN may maintain the Xxxxxxxxx Ombudsman Log as part of the PSN’s telephone help line log, so long as the PSN can access the Xxxxxxxxx Ombudsman Log information separately for reporting purposes. The log shall contain information as described in Section V.D.14, Prescribed Drug Services, of this Contract.
