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MA PAP203

Access to Care Guidelines


Provider Administrative Policy

Section
Provider Information
Policy Date
April 2007
Status/Date
Reviewed/May 2008

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Policy

Access to Care Guidelines

The provider agrees to facilitate reasonable access to medical care for plan members. The following time frames should be adhered to, to provide reasonable access to care.  These time frames consider the member`s need and common waiting times for comparable services in the community.

 Preventive care appointments for wellness exams and immunizations  42 calendar days
 Routine assessment appointment for follow-up evaluations of stable or chronic conditions  30 calendar days
 Non-urgent medical care appointments for treatment of stable conditions  7 calendar days
 Urgent appointments for treatment of illnesses or injury requiring immediate attention  24 hours
 Waiting time in provider`s office for scheduled appointment  Less than 45 minutes
 Available 24-hour coverage provided by physician or on-call arrangement.  Referral to the emergency room is not   acceptable.

Provider Relations will notify provider`s office in writing if notification is received and confirmed that the office is not able to comply with the Access to Care Guidelines as listed above.

Access to Care Letter attachment

If you feel you cannot meet the access to care guidelines as specified above, please contact your Provider Contract Specialist to discuss your options.


Policy History

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