Access to care standards reminder

Anthem's standards for timely and appropriate access to quality healthcare follows guidelines set by the National Committee for Quality Assurance (NCQA), the American College of Obstetricians and Gynecologists (ACOG), and the Wisconsin Department of Health Services (DHS). These standards help ensure that medical appointments, emergency services, and continuity of care for new and transferring members are provided fairly, reasonably and within specific time frames. Please act today to ensure that you are compliant with the requirements listed below as they appear in Chapter 14 of our Medicaid Provider Manual.

General appointment scheduling

PCPs and specialists must make appointments for members according to the following scheduling standards:

Services for members under 21 years of age

Anthem strongly recommends that our members see their PCP as soon as possible after enrollment.

Services for members 21 years of age and older

Prenatal and postpartum visits

Wait times

When a provider's office receives a call from an Anthem member during regular business hours for assistance and possible triage, the provider or another healthcare professional must take or return the call within 30 minutes.

Nondiscrimination and office hours

Providers must post a statement in their offices detailing hours of operation. These hours of operation must not discriminate against Anthem members enrolled in BadgerCare Plus and Medicaid Supplemental Security Income. The statement must include the following:

• Waiting times for appointments
• Waiting times for care at facilities
• Languages spoken

Interpreter services

Anthem will ensure that members who need interpreter services have access to a telephone interpreter 24 hours a day, seven days a week, free of charge. Services include assistance during office visits and telephone assistance. To request interpreter services during business hours, call:

• Providers call Provider Services: 855-558-1443.

• Members call Member Services: 855-690-7800.

To request interpreter services after-hours, providers and members call the 24/7 NurseLine:

• Phone: 855-690-7800 (24 hours a day, 7 days a week)
• TTY: 711

Please note: To schedule face-to-face interpreter services, please allow 72 hours. To cancel, please provide 24 hour notice.

We recognize that cultural and linguistic barriers may affect our members’ ability to understand or comply with certain instructions or procedures. To break through those barriers and ensure that our access standards can be met, we encourage providers to access Caring for Diverse Populations Toolkit and Cultural Competency Training. Locate this information on our website at providers.anthem.com/WI under Provider Training Academy and scroll down to Cultural Competency Resources. Or for additional information on cultural diversity and interpreter services, please refer Culturally and Linguistically Appropriate Services in the Chapter 22 of the Medicaid Provider Manual.