Is Your Customer Service Ready? Top 5 Lessons Learned in 2015 Rolling into 2016

It’s only a few months until we ring in a new year.  Time flies, but there is still enough time to ensure we put our best foot forward as we begin 2016.  Here are the top 5 lessons learned in 2015 as we roll into 2016 to ensure Customer Service is ready for the New Year:

1. What were your member’s pain points in 2015?  Reviewing grievances and appeals and Complaints Tracking Module cases (CTMs) has many purposes.  High on that list is to improve the impacted process, but of course it goes beyond that.  Sometimes we forget to close the loop and review and educate Customer Service staff on managing the pain points and how to work through difficult topics with our members.  Better prepared Customer Service means better educated and knowledgeable members.
2. Are all tools and support materials updated for 2016?  There is a close-out for issues and claims from 2015, so for a period of time, Customer Service will heavily rely on two sets of information.  A clear understanding of what is in place for 2016 and how to find the correct information is critical to preventing confusion for Customer Service and members.
3. Have you tested your compliance with the various required timeliness standards?  Can all Customer Service staff secure a translator within 7 minutes?  Do they all know to stay on the line with the member and the translator once the translator is secured?  Have you tested your TTY lines to ensure they reach a live agent during all hours of operation, 8 am — 8 pm?  We are all monitoring average speed to answer and disconnect rates, but translator and TTY availability is harder to monitor, and every year the Centers for Medicare & Medicaid Services (CMS) finds plans failing to adequately manage non-English language and TTY calls.
4. Can your Customer Service staff recognize complaints about coverage for drugs as coverage determinations?  In a recent CMS enforcement notification, the first item called out in the health plan sanction letter was the plan improperly classified coverage requests as grievances or customer service inquiries.  The coverage determination request process should begin at the time of the original call.  It is critical Customer Service staff can recognize and correctly process these calls.  Have you pulled your Customer Service call logs to see if these are being correctly identified and routed appropriately?  That’s what CMS will do in an audit―don’t let them discover it first.
5. Have you set up a process to ensure all letters and communications sent to members are also available to Customer Service?  Everyone hates being blindsided by an issue or new information.  At most plans, this is an everyday occurrence in Customer Service.  Have you set up a common repository for all member material to be stored, and copies of the member materials placed there, before the information is mailed?  An informed Customer Service Department shows cohesiveness and gives members confidence in your program.

Customer Service is the heart of a health plan.  Ensuring your Customer Service staff is top-notch and has the tools to perform at the highest level for every call is critical to your plan’s success.   Gorman Health Group’s experienced Operations team can work with you to set up knowledgeable, well-trained Customer Service and Operations departments.   We’ve been in your shoes and know your struggles and how to solve them.

Before we ring in the New Year, let’s double check that our members will have everything they need from your Customer Service Department to start the year right!

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