Auto Assignment. The assignment of an Enrollee to a PMG and a PCP, normally at the time the person is Auto-Enrolled in the GHP Program. Auto-Enrollment: The Enrollment of a Potential Enrollee in an MCO by ASES without any action by the Potential Enrollee. Blocked Call: A call that cannot be connected immediately because no circuit is available at the time the call arrives or because the telephone system is programmed to block calls from entering the queue when the queue is backed up beyond a defined threshold. Business Continuity and Disaster Recovery (“BC-DR”) Plan: A documented plan (process) to restore vital and critical Information/health care technology systems in the event of business interruption due to human, technical, or natural causes. The plan focuses mainly on technology systems, encompassing critical hardware, operating and application software, and tertiary elements required to support the operating environment. It must support the process requirement to restore vital business Data inside the defined business requirement, including an emergency mode operation plan as necessary. Business Days: Traditional workdays, including Monday, Tuesday, Wednesday, Thursday, and Friday. Puerto Rico Holidays, as defined in the Law for Compliance with the Fiscal Plan, Act No. 26 of April 29, 2017, or any other law enacted during the duration of this Contract regarding this subject, are excluded. Business Hours: 8:00 a.m. to 6:00 p.m. local Puerto Rico time on Business Days. Calendar Days: All seven (7) days of the week. Call Center: A telephone service facility equipped to handle a large number of inbound and outbound calls and perform all the functions described in this Contract via telephone. Centers for Medicare & Medicaid Services (“CMS”): The agency within the US Department of Health and Human Services with responsibility for the Medicare, Medicaid, and the Children’s Health Insurance Programs (“CHIP”). Children’s Health Insurance Program (“CHIP”): Puerto Rico’s Children’s Health Insurance Program established pursuant to Title XXI of the Social Security Act.
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Auto Assignment. The assignment of an Enrollee to a PMG and a PCP, normally at the time the person is Auto-Enrolled in the GHP Program. Auto-Enrollment: The Enrollment of a Potential Enrollee in an MCO by ASES without any action by the Potential Enrollee. Blocked Call: A call that cannot be connected immediately because no circuit is available at the time the call arrives or because the telephone system is programmed to block calls from entering the queue when the queue is backed up beyond a defined threshold. Business Continuity and Disaster Recovery (“BC-DR”) Plan: A documented plan (process) to restore vital and critical Information/health care technology systems in the event of business interruption due to human, technical, or natural causes. The plan focuses mainly on technology systems, encompassing critical hardware, operating and application software, and tertiary elements required to support the operating environment. It must support the process requirement to restore vital business Data inside the defined business requirement, including an emergency mode operation plan as necessary. Business Days: Traditional workdays, including Monday, Tuesday, Wednesday, Thursday, and Friday. Puerto Rico Holidays, as defined in the Law for Compliance with the Fiscal Plan, Act No. 26 of April 29, 2017, or any other law enacted during the duration of this Contract regarding this subject, or officially designated in writing by ASES and/or Medicaid, are excluded. Business Hours: 8:00 a.m. to 6:00 p.m. local Puerto Rico time on Business Days. Calendar Days: All seven (7) days of the week. Call Center: A telephone service facility equipped to handle a large number of inbound and outbound calls and perform all the functions described in this Contract via telephone. Centers for Medicare & Medicaid Services (“CMS”): The agency within the US Department of Health and Human Services with responsibility for the Medicare, Medicaid, and the Children’s Health Insurance Programs (“CHIP”). Children’s Health Insurance Program (“CHIP”): Puerto Rico’s Children’s Health Insurance Program established pursuant to Title XXI of the Social Security Act.
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