Timely access reminders

After-hours physician exchanges (answering service)

The after-hours survey for Anthem Blue Cross (Anthem) commenced in October 2023. A common barrier to survey compliance is that providers’ after-hours physician exchanges (answering service) are instructed not to participate in after-hours surveys, leading to a non-compliant survey result.

Providers must instruct their after-hours answering service to answer Anthem’s after-hours survey questions.

Non-compliant providers are subject to contractual enforcement actions, such as corrective action plans (CAP) or escalated contractual sanctions for breach of contract.

After-hours calls:

• The answering service or after-hours personnel must ask the member if the call is an emergency. In the event of an emergency, the member must be immediately directed to dial 911 or to proceed directly to the nearest hospital emergency room.
• If staff or answering service is not immediately available, an answering machine may be used. The answering machine message must instruct members with emergency healthcare needs to dial 911 or go directly to the nearest hospital emergency room. The message must also give members an alternative contact number so they can reach the primary care physician (PCP) or on-call provider with medical concerns or questions.
• In an urgent but not emergency situation, where the member requests to speak with an on-call provider, the provider must return the member’s call within 30 minutes.
• In a nonemergency situation, members should receive instruction on how to contact the on-call provider. If an answering service is used, the service should know where to contact a telephone interpreter.
• Non-English-speaking members who call their PCP after hours should expect to get language-appropriate messages. In the event of an emergency, these messages should direct the member to dial 911 or proceed directly to the nearest hospital emergency room.

Long wait times

Wait times:

• When a provider's office receives a call from an Anthem member during regular business hours as well as after hours for assistance and possible triage, the provider or another healthcare professional must either take the call or call the member back within 30 minutes of the initial call.
• When an Anthem member arrives on time to an appointment, the member should be seen within 15 minutes of the scheduled appointment.
• When Anthem members and/or prospective members call a physician’s office, they should not be placed on hold for longer than 10 minutes.

Schedule of timely access surveys

Provider Appointment Availability Survey (PAAS):

• Survey subject(s): appointment availability
• Contractor conducting survey: Sutherland
• Schedule: July 2023 through November 2023

After Hours and Appointment Availability Survey:

• Survey subject(s): emergency and urgent after-hours calls
• Contractor conducting survey: SPH Analytics
• Schedule: October 2023 through November 2023

Primary Care and Specialty Care Appointment Availability Survey:

• Survey subject(s): appointment availability, interpretation services
• Schedule:
  • Q1: January to March
  • Q2: April to June
  • Q3: July to September
  • Q4: October to December

Non-compliant providers are subject to contractual enforcement actions, such as CAP or escalated contractual sanctions for breach of contract.