Access requirements for Behavioral Healthcare services

Anthem has been advising, via this publication and the Provider Manual, of the requirement that your practice provide the capability for a new patient appointment within a given timeframe. We annually conduct appointment access studies to assess how well practices are meeting this provision and a high percentage of Behavioral Health (BH) offices do not have timely access for new patients.

 

To be compliant, providers are expected to make best efforts to meet the following access standards:

• Initial routine office visit – A new patient must be seen in the office by a designated BH Practitioner or another equivalent Practitioner in the practice within ten business days.
• Explanation – This is a routine call for a new patient defined as a patient with non-urgent symptoms, which present no immediate distress and can wait to schedule an appointment without any adverse outcomes. It can be after the Practitioners intake assessment or a direct referral from a treating Practitioner.

 

Is your practice compliant?