Contract compliance with accessibility standards for appointment availability and emergency care instructions after hours care

Anthem monitors member access to a provider’s care through several 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.

CAHPS^® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

Surveys give insight:

• 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 2024 success is you

If you have already taken steps to comply with the standards — thank you! This year’s surveys are now under way, and with your continued support and commitment, we can achieve the best results possible for 2024.

Take a minute to review the 2023 survey results in the table below. We hope sharing them with you provides a better understanding of how you can help improve 2024 results.

Provider after hours results — 2023 survey

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, or answering machine message specifically informs callers when their urgent (non-emergent) calls will be returned.
• Ensure your after-hours office staff, answering service, 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 2023, and found non-compliant with these standards, a letter with recommended compliance measures was sent to an active mailing address on file for you.

If you have questions, email our Provider Relations team for assistance from the Contact Us section of our provider website. Under the section Additional support, select the link send us a message to open an email form. Make sure to enter the words 2023 Survey After Hours and PAAS Results in the subject field. Visit us online to view other contact options.