As you know, Anthem Blue Cross (Anthem) monitors member access to a provider’s care through a number of mechanisms, including provider and member surveys. These surveys are conducted by Anthem and external entities such as Sutherland Healthcare Solutions, North American Testing Organization (NATO), and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) program.  In surveying compliance with After Hours standards, participating providers’ offices are called outside of normal business hours to determine if callers are given appropriate emergency instructions and have a mechanism to reach a provider after regular hours for urgent situations.  In surveying compliance with appointment availability standards, participating providers’ offices are called within normal business hours and are asked when would be the next available appointment for urgent and non-urgent care.

 

Members are also surveyed via mail. The surveys, in addition to monitoring member complaints, help us to identify whether access to care is available to our members after or before normal business hours.

The key to our 2020 success is…YOU!

We thank those of you who have already taken steps to comply with the standards. Your efforts make a direct positive impact on the level of service and access to care for our members. We need your continued support and commitment in helping us achieve the best results possible for our 2020 surveys, which are currently being conducted.

In an effort to improve our results for 2020, Anthem is sharing the 2019 results below.

Provider After Hours Results – 2019 Survey

Question

Threshold >85% of providers comply with the standard

Result

(% compliant with standard)

“What would you tell a caller who states he/she is dealing with a life-threatening emergency?” (Compliant Answers: Hang up and Dial 911 or go to the nearest emergency room; go to nearest emergency room; or Hang up and Dial 911)

 

Medical:  99.9%

Behavioral Health:  100%

Urgent Request After Hours. “In what time frame can the patient expect to hear from the provider or on-call provider?” Note: Providers are expected to provide a specific timeframe in that a member can expect a return call. If a specific timeframe is not provided, the answer is considered “non-compliant.”

 

Medical:  100%

Behavioral Health:  100%

 

PAAS Results – 2019 Survey

Question

Threshold >85% of providers comply with the standard

Result

(% compliant with standard)

“When is the next available appointment time for an urgent appointment?

Compliant answer: Appointment available within 48 hours (PCP), or within 96 hours (Specialist)

Primary Care Physician:  69%

Specialist Physician:  57%

Behavioral Health:  66%

Ancillary:  N/A

“When is the next available appointment time for a non-urgent appointment?”

Compliant answer:  Appointment available within 10 business days (PCP) or within 15 business days (Specialist)

Primary Care Physician:  84%

Specialist Physician:  71%

Behavioral Health:  78%

Ancillary:  95%

 

How Can You Make a Difference?

  • Review Anthem’s Access Standards under the Legal and Administrative Overview section of your Anthem California Facility and Professional Provider Manual. Make sure your practice policy and procedures comply with the standards.
  • Ensure your After Hours office staff, answering service and/or answering machine message specifically informs callers when their urgent (non-emergent) calls will be returned.
  • Ensure your After Hours office staff, answering service and/or answering machine message directs callers to dial 911 or go to the nearest emergency room if they are experiencing an emergency.
  • Ensure that your office staff are aware of and able to comply with the appointment availability standards when setting appointments for our members.

 

If your office was surveyed in 2019 and found non-compliant with these standards, a letter with recommended compliance measures was sent to your mailing address on file with Anthem 

We value your participation in the Anthem Blue Cross Network and appreciate your efforts to meet compliance with established access standards.

If you have questions, please email the Network Relations team that meets your needs. 

  1. Medical inquiries - CAContractSupport@anthem.com
  2. Behavioral Health inquiries - CABHNetworkRelations@anthem.com

 

838-1220-PN-CA

 

 

 

 

 

 

 

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Featured In:
December 2020 Anthem Blue Cross Provider News - California