AdministrativeCommercialDecember 1, 2023

New vendor administering Primary Care Access Survey

In 2024, the annual PCP Access Studies Office Level Survey will be performed by a new vendor, the Center for the Study of Services (CSS). The purpose of this survey is to assess adequate appointment wait times for our members with an urgent condition or for routine services. The survey will be conducted in the same manner as in the past, and your cooperation is expected and appreciated. Kindly notify office staff of the requirement to participate in this survey.

Keeping your data up to date is a condition of your provider contract with Anthem Blue Cross and Blue Shield (Anthem) and a requirement as part of the Consolidated Appropriations Act (CAA). We ask that you update office information using the PDM application on the Availity Essentials platform and that you participate in quality programs such as this critical survey.

Office information crucial for the survey includes:

  • Having correct, working phone numbers.
  • Updating information such as when a practitioner has moved, retired, or is deceased.
  • Updating if your practice is no longer contracted with Anthem, accepts private pay only, or is no longer in business.

You are also required to provide compliant after-hours, 24/7, urgent care messaging, instructing the caller/patient to hang up and call 911 or go to urgent care or emergency room (ER) or you must directly connect the caller with PCP or on-call physician.

Your contract compels access for all covered members to obtain timely needed appointments. The leading timeframes are below.

Colorado

Primary care appointment access

Urgent appointment

Within 24 hours

Routine/initial appointment

Within 7 calendar days

Routine appointment, with symptoms

Non-urgent symptomatic check-up

Within 7 calendar days

Routine appointment

Within 10 business days

Prenatal care

Within 7 calendar days

Routine/follow-up appointment

Evaluate progress from today’s visit

Within 30 calendar days

Preventive/wellness appointment

Includes physicals

Within 30 calendar days

Primary care access to after-hours care

Office number answered 24 hours/7 days a week by answering service or instruction on how to reach a physician

See your Anthem Blue Cross and Blue Shield Provider Manual for details

Anthem Blue Cross and Blue Shield is the trade name of Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. Independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

COBCBS-CM-044754-23-CPN44728

PUBLICATIONS: December 2023 Provider Newsletter