Blue Cross Community Health PlansSM Availability and Access Standards

November 6, 2023

Appointment availability and access guidelines should be used to help ensure BCCHPSM members have timely access to medical care and behavioral health care services. Some of the guidelines are listed below. 

  • Appointments for routine care and preventive care are available within five weeks from the date of request for such care. Appointments for routine care and preventive for infants younger than 6 months are available within two weeks from the requested date.
  • Members with more serious problems not deemed emergency medical conditions are triaged and, if necessary or appropriate, immediately referred for urgent medically necessary care or provided with an appointment within one business day of the request.
  • Members with non-urgent problems needing attention are triaged and an appointment is scheduled within three weeks.
  • Behavioral health providers must provide access to care for:
    • Non-life-threatening emergencies within six hours;
    • Urgent non-emergent care within 48 hours;
    • Initial visit or routine care within 10 business days or two weeks; and
    • Follow-up routine care within 20 days
  • Below are the guidelines for appointments for obstetrics/gynecology:
    • First trimester within two weeks
    • Second trimester within one week
    • Third trimester within three days

Providers are expected to provide coverage for members 24 hours a day, seven days a week. In addition, providers must maintain a 24-hour answering service and assure that each PCP provides a 24-hour answering arrangement, including a 24-hour on-call PCP arrangement for all members. An answering machine does not meet the requirements for a 24-hour answering service arrangement. Hospital emergency rooms or urgent care centers are not substitutes for covering providers.  

For the complete list of Access and Availability standards, please refer to the BCCHP Provider Manual on our Provider website.