Fiscal Employer Agent (Fea): 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: (7-1-26) IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 835 Page 173 a. Provide staff with customer service training with an emphasis on consumer-direction. (7-1-26) b. Ensure staff are trained and have the skills to assist participants with enrollment and to help them understand their account statements. (7-1-26) c. Ensure that FEA personnel are available during regular business hours. (7-1-26) d. Provide translation and interpreter services. (7-1-26) e. Provide prompt and consistent response to verbal and written communication. Specifically: (7-1-26) i. All calls and voice mails must be responded to within one (1) business day; and (7-1-26) ii. All written and electronic correspondence must be responded to within five (5) business days. (7-1-26) 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. (7-1-26) g. Maintain a toll-free fax line that is available at any time, exclusively for participants and their employees. (7-1-26) h. Maintain an e-mail address. (7-1-26) 02. Complaint Resolution and Tracking System. The provider is responsible for receiving, responding to, and tracking all complaints from any source under this agreement and corrective actions. A complaint is defined as a verbal or written expression of dissatisfaction about FEA services. The provider must: (7-1-26) a. Respond to all written and electronic correspondence within five business (5) days. (7-1-26) b. Respond to all calls and voicemails within one (1) business day. (7-1-26) c. Maintain an electronic tracking system and log of complaints and resolutions accessible for Department review through the SFTP site. (7-1-26) d. Log and track complaints received from the Department pertaining to FEA services. (7-1-26) e. Compile a quarterly summary report analyzing complaints to determine the quality of services to participants and to identify any corrective action necessary. (7-1-26) f. Implement corrective action within one (1) business day of the complaint response. (7-1-26) g. Post the complaint to the SFTP site within one (1) business day. Failure to comply will result in a fifty dollar ($50) penalty payable to Medicaid within ninety (90) days of incident. (7-1-26)