Blue Cross Community Health PlansSM (BCCHPSM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM Appointment Availability Timeframes
Posted October 30, 2019
To ensure that BCCHP and MMAI members have timely access to care, the following appointment standards are specified in your provider agreements:
- Routine preventive care appointments – Available within five weeks of the request and within two weeks from the date of the request for infants under 6 months.
- Serious problem but not an emergency medical condition – Within one business day of the request.
- Non-urgent/needs attention – Within three weeks of the date of the request.
- Initial prenatal visits without problems – Within two weeks of the date of request for a member within the first trimester, within one week in the second trimester and within three days in the third trimester.
- Behavioral health emergency care – Within six hours of the request.
- Behavioral health initial visit for routine care – Within two weeks of the date of the request.
- Behavioral health routine follow-up care – Within three months of the request.
- Behavioral health urgent/non-emergent – Within 48 hours of the request.
In addition to the above appointment timeframes, providers are contractually required to ensure that provider coverage is available for members 24 hours a day, seven days a week. In addition, providers must maintain a 24-hour answering service and ensure that each primary care physician (PCP) provides a 24-hour answering arrangement, including a 24-hour on-call PCP arrangement for all members. An answering machine doesn’t meet the requirements for a 24-hour answering service arrangement. Hospital emergency rooms or urgent care centers aren’t substitutes for covering providers.
We routinely monitor for compliance with the above standards. Compliance monitoring includes, but is not limited to, conversations with your Provider Network Consultant (PNC), site visits and “Secret Shop” calls. Lack of compliance may lead to corrective actions, which may include corrective action plans or termination.
If you have questions regarding these requirements, contact your assigned PNC or send an email to firstname.lastname@example.org.