Provider Customer Service Inquiry Triage Process
The Centers for Medicare & Medicaid Services (CMS) provides guidance to all Medicare contractors on the Inquiry Triage Process in the Internet Only Manual (IOM) Publication 100-09, Chapter 6, Section § 30.1. Medicare contractors are to organize telephone Customer Service Representatives (CSRs) into at least two levels to handle questions of varying complexity. Wisconsin Physicians Service (WPS) Medicare has three levels of staff ready and available to assist callers. These are the level one (tier one) CSR, level two (tier two) CSR, and the Provider Relations Research Specialist (PRRS), otherwise known as tier three.
When a provider calls the WPS Medicare provider contact center, the level one CSR is the first point of contact. The first level CSRs handle the majority of all calls WPS Medicare receives. If the level one CSR determines the call is more complex than they can handle or the inquiry needs additional research they will transfer the call to a queue for the level two CSRs. During busy times the level two CSR may take down the information for a callback to prevent the caller from having to wait on the line. CMS requires completion of all callbacks within ten business days of receipt.
The most complex questions are referred to PRRS, discussed in the CMS IOM, Publication 100-9, Chapter 6, Provider Customer Service Program, Section § 30.5. Per CMS direction, responses to PRRS follow the same guidelines as written inquiries, including quality and timeliness. The IOM states that PRRS staff shall provide clear, accurate, and complete responses within 45 business days for all cases referred by telephone CSRs or from the general written inquiries area.
We encourage all providers to first use self-service technologies before contacting the Provider Customer Service line. This includes the Interactive Voice Response (IVR), CMS Secure Net Access Portal (C-SNAP), the WPS Medicare Website at http://www.wpsmedicare.com/ and the CMS Website at http://www.cms.hhs.gov/ 
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Page Last Updated: Thursday, 18-Mar-2010 05:54:31 CDT
