Reminder: Appointment availability and after-hours access requirements

Anthem Blue Cross and Blue Shield Kentucky Medicaid

 

To ensure members receive care in a timely manner, PCPs, specialty providers and behavioral health (BH) providers must maintain the following appointment availability and after-hours access standards.

PCPs:

Appointment type	Appointment standard
Emergency	Immediately
Urgent care	Within 48 hours
Non-urgent sick care	Within 10 calendar days
Routine or preventive care	Within 30 calendar days

 

Transitional health care by a PCP shall be available for clinical assessment and care planning within 7 calendar days of discharge from inpatient or institutional care for physical or BH disorders, or discharge from a substance use disorder treatment program.

Transitional health care by a home care nurse or home care registered counselor shall be available within 7 calendar days of discharge from inpatient or institutional care for physical or BH disorders, or discharge from a substance use disorder treatment program.

 

Note: In-office wait time for scheduled appointments should not routinely exceed 45 minutes including time in the waiting room and examining room.

 

BH Care Providers:

Appointment type	Appointment standard
Emergency	Immediately
Non life-threatening emergency (crisis stabilization)	Within 24 hours
Urgent care	Within 48 hours
Outpatient treatment by a BH provider post-inpatient discharge	Within 7 calendar days
Routine	Within 10 calendar days

 

All Other Specialists:

Appointment type	Appointment standard
Emergency	Immediately
Urgent care	Within 48 hours
Routine	Within 30 calendar days

 

After‑hours Access Requirements:

You are required to abide by standards to ensure access to care for our members. You must:

• Offer 24/7 telephone access for members. A 24-hour telephone service may be used. The service may be answered by a designee such as:
  • o An on-call physician.
  • o A nurse practitioner with physician backup.
• Be available to provide medically necessary services. You or another physician must offer this service.
• Follow the referral/precertification guidelines. This is a requirement for covering physicians.

 

Additionally, we encourage you to offer after-hours office care in the evenings and on Saturdays.

 

What if I need assistance?

If you have questions, contact your local Provider Relations representative or call Provider Relations at 1-502-619-6800, extension 106-108-1854.

 

https://mediproviders.anthem.com/ky

^{Anthem Blue Cross and Blue Shield Medicaid is the trade name of Anthem Kentucky Managed Care Plan, Inc., independent licensee of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc.}