AdministrativeCommercialDecember 1, 2023

New vendor administering behavioral health access survey

The annual behavioral health access studies will see a change in 2024 as a new vendor, Center for the Study of Services (CSS) in Washington, D.C., will be performing the office level survey and making calls during the first through third quarters. The survey will be conducted in the same manner as in the past and your cooperation is expected and appreciated. The purpose is to assess adequate appointment wait times for our members with an urgent condition or for routine services.

Consequently, we ask that you update office information using the PDM application on Availity Essentials or follow processes if assigned to Carelon Behavioral Health, Inc., and that you participate in quality programs, such as this critical survey, as a condition of your contract. The main challenges the vendor encounters are incorrect or non-working phone numbers; practitioner moved, retired, or is deceased; the practice has left their Anthem Blue Cross (Anthem) contract, accepts private pay only, or is no longer in practice; and staff refusing to participate in the survey. Please take time to update information for each practitioner associated with the practice phone number(s), past or present.

Your contract compels access for all covered individuals to obtain timely needed appointments. The leading timeframes are below. See your Anthem provider manual for details. And don’t forget your compliant after-hours emergency or urgent messaging 24/7. For emergency situations, instruct (by a recording or a live person) caller/patient to hang up and dial 911 or go the nearest emergency room. For urgent issues, directly connect patient with a practitioner or give a timeframe when the on-call practitioner will call the patient back.

California behavioral healthcare appointment access

Emergent — non-life threatening

Within six hours

Urgent care

Within 48 hours

Urgent care (requiring pre-authorization)

Within 96 hours

Discharge follow-up BH appointment (new or existing patient)

Within seven days

Routine appointment (EAP office visit)

Within five business days

Routine — initial appointment (new patient)

Within 10 business days

Routine appointment

  • Non-physician: within 10 business days
  • Physician: within 15 business days

Routine — follow-up appointment (monitoring a course of treatment

Non-physician/substance use provider: within 10 business days

Routine — follow-up appointment (evaluating progress)

Within 30 calendar days

After hours extended messaging

  • Emergency: Member to reach a recorded message or live response providing emergency instructions — Direct member to hang up and dial 911 or go to the nearest emergency room.
  • Urgent (available 24 hours a day/7 days a week): For urgent matters, directly connect patient with a practitioner — Provide a mechanism to reach a medical professional or a practitioner (non-MD) with information as to when to expect a call back.

We are committed to helping patients more easily access the care they need.

Carelon Behavioral Health, Inc. is an independent company providing utilization management services on behalf of the health plan.

Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

CABC-CM-044740-23-CPN44731

PUBLICATIONS: December 2023 Provider Newsletter