AdministrativeMedicaidFebruary 13, 2024

Timely access to care

We need your help to ensure our members receive the care they deserve!

The state requires Anthem care providers in Nevada offer medical appointments within the timely access standards listed below.

PCP appointments

Type of care

Requirement

Emergency

Same day

Urgent

Within two calendar days

Routine

Within two weeks

Prenatal care appointments

Type of care

Requirement

First trimester

Within seven calendar days of the first request

Second trimester

Within seven calendar days of the first request

Third trimester

Within three calendar days of the first request

High-risk pregnancies

Within three calendar days of identification of high risk by the health plan or maternity care provider

Emergent

Immediately if an emergency exists

Specialist appointments, including behavioral health

Type of care

Requirement

Emergency

Within 24 hours of referral

Urgent

Within three calendar days of referral

Routine

Within 30 calendar days of referral

Practitioners must also maintain compliance with the timely access standards after hours by:

  • Connecting a caller with a medical care provider within one hour for an urgent medical condition.

Compliance with timely access to care is measured annually as part of the Provider Appointment Availability Survey administered by Anthem and its contracted vendors. Failure to comply with the standards may result in enforcement actions up to and including termination of the contract.

Anthem Blue Cross and Blue Shield Healthcare Solutions is the trade name of Community Care Health Plan of Nevada, Inc. Independent licensee(s) of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

NVBCBS-CD-049116-24

PUBLICATIONS: March 2024 Provider Newsletter