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Title 5: Centrally Administered Programs Page 5 Iowa Department of Human Services Employees’ Manual Chapter E: Healthy and Well Kids in Iowa (hawk-i) General Administration Revised July 3, 2009 Responsibilities of the hawk-i Third-Party Administrator In general, the TPA will be responsible for the following: ♦ Operation of a customer service center. The customer service center will be the primary point of contact for most applicants, enrollees, and other persons inquiring about the program. The TPA shall: • Place a high priority in ensuring that the customer service center is adequately staffed with professional, bilingual (English- and Spanish- speaking), well-trained and courteous personnel who can respond quickly and accurately to callers, provide information, and gather demographic information about the caller when necessary. • Ensure that all customer service representatives identify themselves by name when answering calls, treat callers with dignity and respect, and ensure each caller’s right to privacy and confidentiality. ♦ Development and ongoing operation of an enrollment and financial accounting system for the hawk-i program. ♦ Maintenance of a Web-based application system. ♦ Development and maintenance of a Web-based renewal system. ♦ Collection and processing of applications. This includes, but is not limited to, applications received via the U.S. mail, internal Departmental mail, the Internet, facsimile (FAX), or intra-agency systems. ♦ Screening and referring applications to the Medicaid program. ♦ Determination of hawk-i eligibility. This includes, but is not limited to: • Obtaining documentation necessary to accurately determine eligibility, • Correspondence with the applicant, • Providing adequate and timely notice regarding eligibility decisions, and • Representing the Department at administrative hearings when an appeal challenging the decision of the TPA is filed. ♦ Collection of enrollee premiums, including notification of late payments. ♦ Preparing and providing financial statements to the Department. ♦ Processing disenrollments, including notification to members. ♦ Providing statistical reports to the Department. ♦ Providing enrollment and capitation files to participating health and dental plans.