MedicaidOctober 1, 2021
Appointment availability and after-hours access requirements
General appointment scheduling |
|
Emergency examination |
Immediate access 24/7 |
Urgent examination |
Within 48 hours of request |
Routine examination |
Within 30 calendar days of request |
Voluntary family planning Members under 18 years of age |
Within 30 calendar days of request If complete medical services cannot be provided on short notice, counseling and a medical appointment shall be provided right away, if possible, or within 10 calendar days of request. |
Prenatal |
Within 14 calendar days of request |
Third trimester |
Within five calendar days of request |
High risk pregnancy |
Within 14 calendar days of request |
Postpartum exam |
Four to eight weeks after delivery |
Behavioral health appointment standards |
|
Life-threatening emergency |
Immediately |
Crisis stabilization |
Within 24 hours of request |
Urgent behavioral health services |
Within 48 hours of request |
Outpatient treatment post-psychiatric inpatient care |
Within seven calendar days from the date of discharge |
Routine behavioral health visits, including the initial visit and follow-up visits |
Within 10 calendar days of request |
General and pediatric dental care appointment standards |
|
Urgent examination |
Within 48 hours of request |
New patient exam (dental) |
Within 30 calendar days of request |
Routine exam after initial diagnosis (dental) |
Within 30 calendar days of request |
After-hours access requirements
PCPs are required to abide by a set of standards to ensure access to care for Anthem Blue Cross and Blue Shield Medicaid members. PCPs must:
- Offer members access to quality, comprehensive healthcare services 24/7.
- Have either a recording or an answering service for members during after-hours for assistance that follow the acceptable after-hours arrangements:
- Office phone is answered after hours by an answering service that can contact the PCP or another designated medical practitioner and the PCP or designee is available to return the call within a maximum of 30 minutes;
- Office phone is answered after hours by a recording directing the enrollee to call another number to reach the PCP or another medical practitioner whom the provider has designated to return the call within a maximum of 30 minutes; and
- Office phone is transferred, after office hours to another location where someone shall answer the phone and be able to contact the PCP or another designated medical practitioner within a maximum of 30 minutes
- Be available to provide medically necessary services or from another
- Follow the referral/precertification guidelines. This is a requirement for covering
- For emergent issues, both the answering service and answering machine will direct the member to call 911 or go to the nearest emergency
Additionally, we strongly encourage offering after-hours appointments in the evenings and on Saturdays. For additional information regarding access and availability, please reference the provider manual on the provider page at https://providers.anthem.com/kentucky-provider/home.
What if I need assistance?
If you have questions, contact your local Provider Experience consultant or call Provider Services at 855-661-2028.
PUBLICATIONS: October 2021 Anthem Provider News - Kentucky
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