Idaho Admin. Code r. 16.03.13.302

Current through September 2, 2024
Section 16.03.13.302 - FISCAL EMPLOYER AGENT DUTIES AND RESPONSIBILITIES: CUSTOMER SERVICE
01.Customer Service System. The provider must provide a customer service system to respond to all inquiries from participants, employees, agencies, and vendors. The provider must:
a. Provide staff with customer service training with an emphasis on consumer-direction.
b. Ensure staff are trained and have the skills to assist participants with enrollment and to help them understand their account statements.
c. Ensure that fiscal employer agent personnel are available during regular business hours.
d. Provide translation and interpreter services (i.e., American Sign Language and services for persons with limited English proficiency).
e. Provide prompt and consistent response to verbal and written communication. Specifically:
i. All calls and voice mails must be responded to within one (1) business day; and
ii. All written and electronic correspondence must be responded to within five (5) business days.
f. Maintain a toll-free phone line where callers speak to a live person during business hours and are provided the option to leave voice mail at any time, all day, every day.
g. Maintain a toll-free fax line that is available all day, every day, exclusively for participants and their employees.
02.Complaint Resolution and Tracking System. The provider is responsible for receiving, responding to, and tracking all complaints from any source under this agreement. A complaint is defined as a verbal or written expression of dissatisfaction about fiscal employer agent services. The provider must:
a. Respond to all written and electronic correspondence within five business (5) days.
b. Respond to all calls and voicemails within one (1) business day.
c. Maintain an electronic tracking system and log of complaints and resolutions. The electronic log of complaints and resolutions must be accessible for Department review through the SFTP site.
d. Log and track complaints received from the Department pertaining to fiscal employer agent services.
e. Compile a summary report and analyze complaints received on a quarterly basis to determine the quality of services to participants and to identify any corrective action necessary.
f. Post the complaint to the SFTP site within twenty-four (24) hours any day a complaint is received Monday through Friday. Saturday and Sunday complaints must be posted to the SFTP site by close of business the following Monday. Failure to comply will result in a fifty dollar ($50) penalty payable to Medicaid within ninety (90) days of incident.

Idaho Admin. Code r. 16.03.13.302

Effective July 1, 2024