TMPPM 2008 > Provider Information > Managed Care > PCCM

7.5.9.2 Client Support and Education

PCCM provides educational services to its clients. The most significant of these are three helplines:

•Client Helpline. The non-clinical Client Helpline at 1-888-302-6688 is the primary resource for clients seeking information or answers to questions. Clients may call the helpline to discuss concerns and file complaints regarding the operation and management of PCCM. The helpline operates from 7 a.m. to 7 p.m., Central Time, Monday through Friday. After hours, a recorded message instructs clients who need assistance with clinical, urgent, or emergent situations to contact the PCCM nurse helpline at 1-800-304-5468.

•Community Health Services (CHS). PCCM clients are eligible to receive services provided by CHS. CHS staff includes registered nurses, social workers, nutritionists, and health educators from all over Texas who can provide counseling for clients who do not keep appointments, or who inappropriately use the ER. CHS staff can also educate PCCM clients about the role of a primary care provider, the referral process, or the Medicaid change from fee-for-service to managed care. CHS staff can also provide information about disease prevention, care coordination, and location of resources. CHS staff is available to meet with clients in a provider's office. Providers can refer clients for CHS services by calling the CHS toll-free number at 1-888-276-0702, Monday through Friday, 8 a.m. to 5 p.m., Central Time. A message can be left after 5 p.m. and before 8 a.m. TMHP staff will return calls on the next business day. Providers can also fax a PCCM Community Health Services Referral Request Form to 1-512-302-0318. Providers can refer up to four clients on a request form. The PCCM Community Health Services Referral form is located on page B-67.

•Nurse Helpline. PCCM provides a toll-free clinical nurse helpline at 1-800-304-5468 for all PCCM clients. The nurse helpline is staffed (nationally) by registered nurses who use physician-developed, symptom-based algorithms and 1,200 sets of self-care instructions to provide information, triage, and clinical assessment services for health plan clients 24 hours a day, 7 days a week. The nurse helpline nurses do not diagnose; they assess the client's symptoms and guide the client to the most appropriate care setting. The nurse helpline number is widely publicized to PCCM clients. The nurse helpline can:

•Provide triage, assistance, and reassurance to clients.

•Direct clients to the most appropriate care setting.

If a nurse determines that a client needs emergency care, the nurse will direct the client to the nearest emergency facility or contact 9-1-1 on the client's behalf.

In addition, PCCM publishes a semi-annual newsletter in both English and Spanish for client heads of household. The focus of the newsletter is on health-related topics (such as the importance of well-child care, and the significance of early entry into prenatal care), but it also provides useful information about services to improve clients' access to health care, such as nonemergent medical transportation, community child care resources, and clinical services offered during nontraditional hours of operation.

Linguistic Services

It is the provider's responsibility to ensure that interpretive services are available to his practice. Interpretive services include language interpreters, American Sign Language (ASL) interpreters, and RELAY TEXAS (TDD) access. When interpretive services are necessary to ensure effective communications regarding treatment, medical history, or health education, PCCM providers may contact the PCCM nurse helpline at 1-800-304-5468. For assistance to clients who are hearing impaired, call RELAY TEXAS (TDD) at 1-800-735-2988. If the provider's staff is in need of translation services to meet requirements on limited English proficiency, call 1-800-752-0093.

Refer to: "Provider Responsibilities" .

"Cultural Competency and Sensitivity" .