Behavioral Health Quality Indicators
Behavioral Health Appointment Access Standards
Behavioral health providers have contractually agreed to offer appointments to our members according to the following appointment access standards:
- Initial Visit for Routine Care – Within 10 working days
- Follow-up for Routine Care – Within 30 calendar days
- Urgent – Within 48 hours or refer to ER
- Non-life-threatening emergency – Within six (6) hours or refer to ER
- Life threatening/emergency – Within one (1) hour
Blue Cross and Blue Shield of Illinois (BCBSIL) is accountable for performance on national measures, like the Healthcare Effectiveness Data Information Set (HEDIS®). Several of these measures specify expected timeframes for appointments with a behavioral health professional. View our HEDIS tip sheets.
It is expected that a member has a follow-up appointment with a behavioral health professional following a mental health inpatient admission within seven and/or 30 days.
For members treated with Antidepressant Medication:
- Medication adherence for 12 weeks of continuous treatment (acute phase)
- Medication adherence for 180 days (continuation phase)
For children (6-12 years old) who are prescribed ADHD Medication:
- One follow-up visit, in the first 30 days after medication dispensed (initiation phase)
- At least two visits, in addition to the visit in the initiation phase, with provider in the first 270 days after initiation phase ends (continuation and maintenance phase)
For members treated with a new diagnosis of alcohol or drug dependence:
- Treatment initiation through an inpatient admission, outpatient visit, intensive outpatient encounter or partial hospitalization program within 14 days following the diagnosis (initiation phase)
- At least two visits/services, in addition to the treatment initiation encounter, within 34 days of initiation visit (engagement phase)
HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).