Member Services Helpline and 24 Hour Nurse Line. The Contractor shall maintain a statewide dedicated toll-free member services helpline staffed with trained personnel knowledgeable about the Hoosier Care Connect program. Helpline staff shall be equipped to handle a variety of member inquiries. The member services helpline shall be staffed and accessible via live voice coverage, at minimum for twelve (12) hours per day, Monday through Friday, from 8 a.m. to 8 p.m.
Member Services Helpline and 24 Hour Nurse Line. The Contractor shall maintain a statewide toll-free telephone helpline staffed with trained personnel knowledgeable about the HIP program equipped to handle a variety of member inquiries, including the ability to address member questions, concerns, complaints and requests for PMP changes. The same helpline shall be available to HIP members, so that members may call one number to answer all the family’s questions. Member helpline staff shall be equipped to provide customer service to individuals assigned to the Contractor’s plan who have not yet made their first POWER Account contribution. The helpline staff must be based in Indiana and take at a minimum seventy percent (70%) of the Indiana Medicaid calls, except when emergency rollover is required. The State must be notified if such an emergency is taking place. A minimum of fifty percent (50%) of helpline staff must be employees of the prime Contractor. The Contractor shall staff the member services helpline to provide sufficient “live voice” access to its members during, at a minimum, a twelve (12)-hour business day, from 8 a.m. to 8 p.m. Eastern, Monday through Friday. The call center shall open 60 days prior to the Contractor’s go live date, with State approval. The Contractor shall provide a voice message system that informs callers of the 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. The member helpline may be closed on the following holidays: ▪ New Year’s Day; ▪ Xxxxxx Xxxxxx Xxxx, Xx. Day ▪ Memorial Day; ▪ Independence Day (July 4th); ▪ Labor Day; ▪ Thanksgiving; and ▪ Christmas. The Contractor may request that additional days, such as the day after Thanksgiving, be authorized for limited staff attendance. This request shall be submitted to FSSA at least thirty (30) calendar days in advance of the date being requested for limited staff attendance and shall be approved by FSSA. For all days with a closure, early closing or limited staff attendance, members shall have access to the 24-Hour Nurse Call Line as appropriate. Call center closures, limited staffing or early closures shall not burden a member’s access to care. The member services helpline shall offer language translation services for members whose primary language is not English and shall offer automated telephone menu options in English and Spanish. A member services messaging option shall be available ...
Member Services Helpline and 24 Hour Nurse Line. The Contractor shall maintain a statewide dedicated toll-free member services helpline staffed with trained personnel knowledgeable about the Hoosier Care Connect program. Helpline staff shall be equipped to handle a variety of member inquiries. The member services helpline shall be staffed and accessible via live voice coverage, at EXHIBIT 1.M SCOPE OF WORK minimum for twelve (12) hours per day, Monday through Friday, from 8 a.m. to 8 p.m. Eastern Standard Time. Beginning one (1) year after the Contract effective date, the Contractor may request FSSA approval to modify the hours of operation of the member services helpline based on call center traffic data. FSSA retains sole discretion for approval or denial of such requests. The Contractor shall provide a voice message system that informs callers of the 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 the following business day. The member services helpline may be closed on the following holidays: New Year’s Day; Xxxxxx Xxxxxx Xxxx, Xx. Day; Memorial Day; Independence Day (July 4th); Labor Day; Thanksgiving; and Christmas. For all days with a closure, members must have access to the twenty-four (24) hour nurse call line described below. Call center closures shall not burden a member’s access to care. The Contractor shall provide Telecommunications Device for the Deaf (TDD) services for hearing impaired members. Respondents shall also describe any additional technology to be leveraged to communicate with hearing impaired members. Additionally, the member services helpline must offer language translation services for members whose primary language is not English. Automated telephone menu options must be made available in English and Spanish. The Contractor must have the ability to warm transfer members to outside entities including the Enrollment Broker, DFR and provider offices. Additionally, the Contractor shall ensure the warm transfer of calls for members that require attention from a Contractor care manager. The Contractor shall ensure the care manager has access to all information necessary to resolve the member’s issues. Any messages left with care managers must be returned by the next business day. The Contractor must maintain a system for tracking and reporting the number and type of member calls and inquiries it receives during business and non-business hours. The Contractor mu...
