HMO-PPO (and all lines of business)
PRIMARY CARE
BCBS and the Physician Advisory Group have established the following Access to Care Standards for Primary Care Physicians.
EMERGENCY CONCERN(LIFE THREATENING) SHOULD BE REFERRED DIRECTLY TO 911 OR THE CLOSEST EMERGENCY DEPARTMENT. IT IS NOT NECESSARY TO SEE THE PATIENT IN THE OFFICE FIRST.
Waiting time for appointment:
Urgent - not life threatening, but a problem needing care within 24 hours.
Pediatrics
see within 48 hours
Adult
see within 48 hours
Symptomatic non-urgent e.g. cold, no fever.
Pediatrics
within 30 days
Adults
within 30 days
Follow-up of Urgent Care
Pediatrics
within 7 days
Adults
within 7 days
Chronic care follow-up: e.g. blood pressure checks, diabetes checks.
Pediatrics
within 14 days
Adults
within 14 days
Complete Physical/Health Maintainence
Pediatrics
within 60 calendar days
Adults
within 60 calendar days
Coverage
Practice has a recorded telephone message instructing the patient to call 911 or go to the ER for any life threatening event and to refer them to the physician on-call, to an answering service, or nurse triage service.
Office Hours
Indicates the posted hour during which appropriate provider office personnel are available. (Solo doctors need to fully meet this standard individually but groups of providers may share this requirement.)
Daytime hours/weeks
7 hours per day x 5 days = 35 hours
Night hours/weekend
24 hours/day coverage
Standard: Office Hours=35 hrs/week. GOAL: 100% compliance
Definitions of "Regular" appointments:
Pediatrics:
any pediatric patient with a non-emergent, non-urgent condition being referred to a non-MD provider
Adult Sub-acute problem:
any problem which, if treated appropriately, should be of short duration
Adult Chronic problem:
any problem which will require a long period of care to reach solution
BCBS and the Physician Advisory Group have established the following Access to Care Standards for Behavioral Health Providers participating in the BCBS Network.
Average time for appointment:
Life-Threatening Emergency Seen immediately or referred to the ER
Non-life Threatening Emergency Seen within six hours
Urgent Care Seen within forty-eight hours
Initial Visit for Routine Care Seen within 10 business days
Routine Office Visit Seen within 30 business days