Common use of Electronic Version Clause in Contracts

Electronic Version. The Contractor shall maintain the electronic version of its formulary on its website in a machine readable file and format. Paper Version – Upon request, the Contractor shall provide each Enrollee or Potential Enrollee a paper version of its formulary. If directed by EOHHS and/or CMS, the Contractor shall report the information required in this Section 2.6.G using a template provided by EOHHS or CMS. Enrollee Services Enrollee Service Representatives (ESRs) The Contractor must employ ESRs trained to answer Enrollee inquiries and concerns from Enrollees and potential Enrollees. ESRs must be capable of speaking directly with, or arranging for someone else to speak with, Enrollees in their primary language, or through an alternative language device or telephone translation service. ESR Support Functions ESRs must: Be knowledgeable about MassHealth, Medicare, and all terms of the Contract, including the Covered Services listed in Appendix A; Be available to Enrollees to discuss and provide assistance with resolving Enrollee Grievances; and Enrollee Service Telephone Responsiveness ESRs must be available during normal business hours on a daily basis. The Contractor must answer 90% of all Enrollee telephone calls within 20 seconds, and be able to provide reports indicating compliance with this requirement upon request of EOHHS. The Contractor must have a process to measure the time from which the telephone is answered to the point at which an Enrollee reaches an ESR capable of responding to the Enrollee's question. Enrollee Grievances and Appeals The Contractor shall maintain written policies and procedures for the filing by Enrollees or Appeal Representatives, and the receipt, timely resolution, and documentation by the Contractor, of any and all Grievances and Internal Appeals which shall include, at a minimum, the following, in accordance with 42 CFR Part 438, Subpart F. (For purposes of this section, in cases where a minor is able, under law, to consent to a medical procedure, that minor can request an appeal of the denial of such treatment, or may appoint an Appeal Representative to represent himself or herself, without parental/guardian consent.)