Enrollee Services Department Maintain an Enrollee services department to assist Enrollees, Enrollees’ family members or guardians, and other interested parties in learning about and obtaining services under this Contract; Enrollee Services Department Standards Maintain employment standards and requirements (e.g. education, training, and experience) for Enrollee services department staff and provide a sufficient number of staff for the Enrollee services department; Enrollee Services Department Staff Ensure that Enrollee services department staff have access to: The Contractor’s Enrollee database; The Eligibility Verification System (EVS); and An electronic Provider directory that includes, but is not limited to, the information specified in Section 2.7.E. of this Contract; Enrollee Services Telephone Line Operate a toll-free Enrollee services telephone line a minimum of nine hours per day during normal business hours, Monday through Friday, which shall: Have at least 90% of calls answered by a trained customer service department representative (non-recorded voice), within 30 seconds or less as reported in accordance with Appendix A; Have less than a 5% abandoned call rate; Make oral interpretation services available free-of-charge to Members and Enrollees in all non-English languages spoken by Members and Enrollees; and; Maintain the availability of services, such as TTY services or comparable services for the deaf and hard of hearing; Information for Enrollees and Potential Enrollees Ensure that customer service department representatives shall, upon request, make available to Enrollees and Potential Enrollees in the Contractor’s Plan information concerning the following: The identity, locations, qualifications, and availability of Providers;
Enrollee Services Department Maintain an Enrollee services department to assist Enrollees, Enrollees’ family members or guardians, and other interested parties in learning about and obtaining services under this Contract; Enrollee Services Department Standards Maintain employment standards and requirements (e.g. education, training, and experience) for Enrollee services department staff and provide a sufficient number of staff for the Enrollee services department; Enrollee Services Department Staff Ensure that Enrollee services department staff have access to: The Contractor’s Enrollee database; The Eligibility Verification System (EVS); and An electronic Provider directory that includes, but is not limited to, the information specified in Section 2.7.E. of this Contract; Enrollee Services Telephone Line Operate a toll-free Enrollee services telephone line a minimum of nine hours per day during normal business hours, Monday through Friday, which shall: Have at least 90% of calls answered by a trained customer service department representative (non-recorded voice), within 30 seconds or less as reported in accordance with Appendix A; Have less than a 5% abandoned call rate; Make oral interpretation services available free-of-charge to Members and Enrollees in all non-English languages spoken by Members and Enrollees; and; Maintain the availability of services, such as TTY services or comparable services for the deaf and hard of hearing; Information for Enrollees and Potential Enrollees Ensure that customer service department representatives shall, upon request, make available to Enrollees and Potential Enrollees in the Contractor’s Plan information concerning the following: The identity, locations, qualifications, and availability of Providers;
accountable-care-partnership-plan-model-contract.docx