Call Center

Consolidated Service Center (CSC) to assist consumers seeking support in determining eligibility and enrollment in insurance affordability programs including private health and dental plans and Medicaid programs.
- Consolidated Service Center operations from the Go-Live Date through the Contract end date, including any option years, in compliance with all applicable State and federal laws in effect at the time the services are offered, including the Affordable Care Act and its regulations together with any regulations promulgated thereunder.
- Consolidated Service Center operations include but are not limited to: inbound call management, outbound calls, live chat service, Interactive Voice Response (IVR) provision and management, telephony systems provision and management, quality assurance management, training and development, workforce management and reporting. In addition, the Consolidated Service Center will assist Medicaid recipients with the enrollment into a Managed Care Organization (MCO), selection of a primary care provider (PCP), and completion of a health assessment questionnaire.
The following chart depicts monthly call volumes offered year over year from January 1, 2024 through June 30, 2026.
- Account Management Services include, but are not limited to, the following:
a. Serving as liaison between the MHBE and Contractor’s leadership and support teams;
b. Updating MHBE on an ongoing basis of all CSC issues, joint initiatives, and change requests;
c. Providing reports as specified in the mutually agreed upon format and on an ad hoc basis;
d. Ensuring deliverables are met in accordance with contractual and service level requirements;
e. In the event of systems-related occurrences that impact the Service Center, acting as the primary point of contact for all solution participants and ensuring the MHBE is involved in the event via a common communication bridge;
f. Acting as primary point of contact for the MHBE when service-impacting events occur and participating in issue resolution conference calls as needed;
g. Coordination of information flow from the MHBE to operations staff;
h. Coordination of urgent escalations, call reviews and corrective actions;
i. Participation in and response to SOC 2 audit requests, PII Breach reporting and general compliance.
- Customer Service Representative (CSR) Functions shall perform the following tasks:
a. Documenting all consumer interactions and work processes in State-provided Customer Relationship Management (CRM) solution and the MHC worker portal
b. Providing information about QHP, SADP and Medicaid/MCHP Managed Care Organizations (MCOs) offerings
c. Informing consumers how to make premium payments to carriers
d. Assisting Medicaid eligible consumers with selecting an MCO and choosing a Primary Care Provider (PCP), while following MDH MCO scripts precisely
e. Assisting Medicaid-eligible consumers in completing a Health Service Needs Information (HSNI) form
f. Responding to inquiries related to eligibility status, enrollment status, coverage dates and change in circumstances
g. Researching and resolving or escalating consumer issues and account discrepancies
h. Assisting and educating consumers on appeal and complaint processes; properly escalating when necessary
i. Assisting Medicaid-eligible consumers with Annual Right to Change (ARC) requests for MCO Enrollment
j. Assisting Medicaid eligible consumers with transfers between MCOs if disenrolled “For Cause” reasons.
k. Answering questions and assisting with problems related to 1095A and 1095B forms
l. Providing assistance with password resets (tech support)
m. Provide referrals to appropriate agencies including the Attorney General’s Health Education and Advocacy Unit, the MIA, and local departments of social services for applicants and enrollees with grievances, complaints, questions, or the need for other social services;
n. Responding to inquiries related to eligibility status, enrollment status, coverage dates and change in circumstances
o. Researching and resolving or escalating consumer issues and account discrepancies
p. Assisting and educating consumers on appeal and complaint processes; properly escalating when necessary
q. Assisting Medicaid-eligible consumers with Annual Right to Change (ARC) requests for MCO Enrollment
r. Assisting Medicaid eligible consumers with transfers between MCOs if disenrolled “For Cause” reasons.
s. problems related to 1095A and 1095B forms
t. Providing assistance with password resets (tech support).
u. Answering questions and assisting with
v. Provide referrals to appropriate agencies including the Attorney General’s Health Education and Advocacy Unit, the MIA, and local departments of social services for applicants and enrollees with grievances, complaints, questions, or the need for other social services;
w. Documenting all consumer interactions and work processes in State-provided Customer Relationship Management (CRM) solution and the MHC worker portal.
- Telephony System Requirements
a. Cloud Based Automated Call Distribution (ACD) - Telephony system will provide intelligent routing of customer contacts based on predefined thresholds, monitoring real-time consumer support center statistics such as but not limited to, agent skill, longest available agents, and wait time.
b. Interactive Voice Response (IVR) - the telephony solution shall provide call queuing and self-service at the edge of the network, allowing for redundancy so that calls can be routed to alternate consumer support centers in the event of a failure.
c. Weighted Skills-Based Routing: the telephony system shall consolidate contacts to a centralized queue and dynamically route to representatives according to pre-defined business rules and contact priority.
d. Call prioritization: the telephony system shall have the capability to tag/prioritize calls within the IVR/ACD to move “critical” calls ahead in the queue (e.g., account issue, etc.)
e. Auto answer: the telephony system shall allow for an automatic connection to incoming calls when an agent is in a ready state. This feature can be leveraged to improve speed to answer.
f. Courtesy callback: the telephony system shall provide a courtesy callback feature to reduce the time callers are waiting on hold or in a queue. The feature offers callers who meet predetermined criteria the option to be called back by the system instead of waiting on the phone for an agent. Callers who decide to be called back by the system leave their names and phone numbers.