Letter to CMS - Medicaid Managed Care Policies - Agency for ...

Standard VI: Provider Services
CC-VII.I.4.c
CONTRACT
SECTION
8. Help Line
Performance
Standards
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
and 7:00 pm in the provider’s time
zone Monday through Friday,
excluding state holidays.
• The health plan’s call center
system has the capability to track
call center statistics.
• The health plan has telephone call
policies and procedures that
include requirements for:
Staffing.
Personnel.
Hours of operation.
Call response times.
Maximum hold times.
Maximum abandonment rates.
Monitoring of calls via recording
or other means.
Compliance with performance
standards.
The health plan develops performance
standards and monitor telephone help line
performance by recording calls and
employing other monitoring activities.
Such standards are approved by BMHC
before the health plan begins operation.
Performance standards include:
a. All calls are answered within 4 rings
(these calls may be placed in a
queue).
b. Wait time in the queue does not
exceed 3 minutes.
a. Yes
No
b. Yes
No
c. Yes
No
d. Yes
No
Met
Partially Met
Not Met
DOCUMENTS
REVIEWED
State of Florida Compliance Monitoring_Standard_VI_F2_07_11
Page 3
FINDINGS