PCP after-hours access requirements
Anthem has been advising via this publication and letters to your offices, of the requirement that your practice provide continuation of care for our members outside of regular business hours. We have annually conducted after-hours access studies to assess how well practices are meeting this provision, and a high percentage of primary care physicians (PCP) offices do not have the basic messaging for our members for perceived emergency or urgent situations after regular office hours.
To be compliant, have your messaging or answering service include appropriate instructions.
The compliant response for an emergency instructs the caller/patient to hang up and call 911 or go to ER or connects caller directly to the physician.
The response for urgent would direct the caller to Urgent Care or ER, to call 911 or directly connect the caller to their physician or the physician on call.
Messaging that only gives callers the option of contacting their health care practitioner (via transfer, cell phone, pager, text, email, voicemail, etc.) or to get a call back for urgent questions or instructions is not compliant, as there is no direct connection to their health care practitioner.
Is your practice compliant?
September 2019 Anthem Provider News - Virginia