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Provider Administrative Policy

Section
Commercial Managed Care
Policy Date
July 2007
Status/Date
Reviewed/May 2008
Provider Type(s)
Physician  

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

The provider agrees to facilitate reasonable access to medical care for plan members. The following time frames should be adhered to:

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 care appointments for treatment of unforeseen illnesses or injuries requiring immediate attention 

24 hours

Waiting time in provider’s office for scheduled appointment

Less than 45 minutes

24-hour physician coverage, provided by the physician or with an on-call arrangement.  Routine referral to the local emergency room is not acceptable.

 


Policy History

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