AdministrativeCommercialDecember 1, 2024

PCP after‑hours access requirements

We are dedicated to ensuring compliance with NCQA accessibility standards by providing members with phone access to their PCPs beyond regular business hours. The annual after‑hours access study assesses adequate phone messaging for our members with perceived emergencies or urgent situations after office hours. Most of our plans measured still fall short of the after‑hours access expectations that patients have phone access to their practitioners 24 hours a day, 7 days a week, 365 days a year.

The current after‑hours messaging requirement is: When a patient calls after hours, a live person directs them to the practitioner or the on‑call practitioner, or a recording or live person directs the patient to an urgent care center, 911, or the ER.

If a patient reaches a practitioner’s voicemail, compliant messaging is imperative to assist the patient in gaining access to appropriate care.

We continue to work towards identifying simplified ways to access care.

In Missouri (excluding 30 counties in the Kansas City area): Anthem Blue Cross and Blue Shield is the trade name of RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. Independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

MULTI-BCBS-CM-072073-24-CPN70346

PUBLICATIONS: December 2024 Provider Newsletter