Member Support Services Sample Clauses
The MEMBER SUPPORT SERVICES clause defines the obligations and scope of assistance that an organization provides to its members. Typically, this clause outlines the types of support available, such as technical help, customer service, or access to resources, and may specify the channels and hours of availability. Its core function is to ensure members have clear expectations regarding the support they can receive, thereby enhancing member satisfaction and reducing misunderstandings about service levels.
Member Support Services. 4.5.1 The PASSE must have a Member Support Services unit that has the capability to answer inquiries from potential members and enrolled members through writing, telephone, email, web-based transmission, or face-to-face communication.
4.5.2 The PASSE must develop and implement operational policies and procedures for Member Support Services that address, at a minimum, staff development and training, operations, use of technology and privacy concerns, and performance measures related to Member Support Services.
4.5.3 Member Support Services must include a toll-free Member Helpline for potential and enrolled members and participating and out-of-network providers. The Requirements for the Member Helpline include:
a. HIPAA-compliance;
b. Ability to accommodate all calls, including those requiring the use of interpreter services for the hearing impaired or for callers that have limited English proficiency, free of charge;
c. A call pick-up system that places the call in a queue;
d. If a hold time message is used while members are in the call queue, the message cannot include information about non-health related items (e.g., health insurance products, disability benefits, etc.), nor can it be used for marketing purposes. All hold time messages must be submitted to DHS for prior approval.
e. A sufficient number of adequately trained staff to operate the Call Center on Business Days from 8:00 am to 5:00 pm Central time, at a minimum;
f. Responsive, courteous staff that responds to calls and inquires accurately;
g. Call scripts to process common inquiries;
h. Performance standards, including: i. 95% of all calls must be answered within 3 rings or 15 seconds;
Member Support Services. 4.5.1 The PASSE must have a Member Support Services unit that has the capability to answer inquiries from Potential Members and Enrolled Members through writing, telephone, email, web-based transmission, or face-to-face communication.
Member Support Services. All MCOs shall maintain effective communications with Members or potential Members to include:
1. All MCOs shall respond to inquiries about: (i) transitioning of care; (ii) open enrollment; (iii) provider networks; (iv) Medicaid benefits and value added services; and (v) general questions relating to Centennial Care 2.0 or make referrals to the appropriate entity to get answers.
2. Current MCOs that are not selected as Centennial Care 2.0 MCOs shall:
(a) Inform members in writing at least sixty (60) calendar days prior to January 1, 2019 of the transitioning of services, and other specific information as requested by HSD; such communication shall be submitted to HSD for review and approval at least thirty (30) calendar days prior to issuance of the communication; and
(b) Develop “final” telephone, email, and website messages directing Members to sources of current information about Centennial Care
Member Support Services. For the Subscription Term ICIX shall provide assistance to Member by telephone, e-mail or online chat during normal business hours (6AM to 5 PM Pacific Time), in connection with any problem or advise that may arise out of using the Restricted Website, Materials or Services supplied by ICIX. Defects encountered by Member and confirmed by ICIX, will be corrected at no additional charge. This provision does not provide for the addition of new functionality to the Restricted Website, which may be considered desirable by the Member, or for improvement, as opposed to a correction on the Restricted Website. ICIX shall review all requests for improvements and new functionality, but ICIX shall have no obligation to provide any modifications to the Restricted Website.
Member Support Services. For the Subscription Term AZZULE shall provide assistance to Member by telephone or email during normal business hours (8AM to 5 PM Pacific Time), in connection with any problem or advise that may arise out of using the Membership Website, Materials or Services supplied by AZZULE. Defects encountered by Member and confirmed by AZZULE, will be corrected at no additional charge. This provision does not provide for the addition of new functionality to the Membership Website, which may be considered desirable by the Member, or for improvement, as opposed to a correction on the Membership Website. AZZULE shall review all requests for improvements and new functionality, but AZZULE shall have no obligation to provide any modifications to the Membership Website.
Member Support Services. WSCC shall maintain effective communications with Members to include:
1. Inquiries about: (i) transitioning of care; (ii) open enrollment; (iii) provider networks; (iv) Medicaid benefits and value-added services.
2. WSCC shall:
a) Inform Members in writing at least sixty (60) calendar days prior to July 1, 2024, of the transitioning of services, and other specific information as requested by HSD; such communication shall be submitted to HSD for review and approval no later than April 1, 2024.
b) All Member telephone lines shall remain open during business hours, for at least ninety (90) calendar days after the implementation of Turquoise Care.
c) Develop “final” telephone message for Members and Providers. The message shall include sources of sources of current information about Turquoise Care and the designated point of contact for provider claims. A draft of the final telephone message shall be sent to HSD for review and approval, no later than June 1, 2024. The final telephone message shall remain active until December 1, 2024. Develop final email and website messages directing Members to sources of current information about Turquoise Care. These final messages shall be sent to HSD for review and approval no later than May 1 1, 2024.These messages shall be effective June 1, 2024, and remain active until September 30, 2024.
Member Support Services