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 the next available appointment for urgent and non-urgent care would be.

 

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 2021 success is…YOU!

If you have already taken steps to comply with the standards – thank you! Your efforts make a direct positive impact on the level of service and access to care for our members. This year’s surveys are under way and with your continued support and commitment, we can achieve the best results possible for 2021.

 

Take a minute to review the 2020 survey results in the table below.  We hope sharing them with you provides a better understanding of how you can help improve 2021 results.

 

Provider After Hours Results – 2020 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:  94.5%

Behavioral Health:  81.8%

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:  71.3%

Behavioral Health:  38%


PAAS Results – 2020 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:  75%

Specialist Physician:  65%

Behavioral Health:  72%

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:  92%

Specialist Physician:  86%

Behavioral Health:  78%

Ancillary:  95%

 

How Can You Make a Difference?

  • Review the Commercial Access Standards under the Legal and Administrative Requirements section in your Anthem Blue Cross 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 2020 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 provider network and appreciate your efforts to meet compliance with established access standards.

If you have questions, please email your Provider Experience representative for assistance from the Contact Us page. Select Provider Experience team to open the email form and make sure to enter the words, ‘2020 Survey After Hours and PAAS Results’ in the subject field.  Visit us online to view other contact options.

1448-1221-PN-CA

 

 



Featured In:
December 2021 Anthem Blue Cross Provider News - California