Contract compliance with accessibility standards for Emergency Care instructions After Hours Care

As you know, Anthem Blue Cross (Anthem) monitors member access to Behavioral Health care through a number of mechanisms, including provider and member surveys. These surveys are conducted by Anthem Behavioral Health and external entities such as 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. Members who have received Behavioral Health care within the previous year 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 2019 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 2019 surveys, which are currently being conducted.

In an effort to improve our results for 2019, Anthem is sharing the 2018 results below.

Provider After Hours Survey 2018

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:  92.4% Behavioral Health:  88.4%
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:  85.0% Behavioral Health:  87.8%

 

How Can You Make a Difference?

• Review Anthem 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 inform 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.

If your office was surveyed in 2018 and found non-compliant with these After Hours requirements, you have received a letter with recommended compliance measures. 

We value your participation in the Anthem commercial Behavioral Health Network, and appreciate your efforts to meet compliance with established access standards. If you have questions, please email our commercial Behavioral Health Provider Relations team at CABHNetworkRelations@anthem.com.