After-hours messaging reminder

During the most recent Anthem Blue Cross and Blue Shield (Anthem) survey for Medicaid providers, there were numerous practices that did not have adequate after-hours messaging in place. It is important to our members — your patients — that after-hours messaging provides sufficient information, particularly if answering machines are used. Please act today to ensure that you are compliant with the requirements listed below as they appear in our Medicaid provider manual.

After-hours services

Anthem's policy, as well as the state of Wisconsin's requirement, is for our members to have access to quality healthcare services 24 hours a day, seven days a week. This kind of access means PCPs must have a system in place to ensure members may call after hours with medical questions or concerns. Anthem monitors PCP compliance with after-hours access standards on a regular basis. Failure to comply may result in corrective action.

PCPs must adhere to the answering service and answering machine protocols defined in the sections below.

Answering service

Answering service or after-hours personnel must:

• Forward member calls directly to the PCP or on-call provider or instruct the member that the provider will contact the member within 30 minutes.
• Ask the member if the call is an emergency. In the event of an emergency, immediately direct the member to dial 911 or proceed to the nearest hospital emergency room.
• Be able to contact a telephone interpreter for members with language barriers.
• Return all calls.

Answering machine messages

Answering machine messages:

• May be used when provider office staff or an answering service is not immediately available.
• Must instruct members with emergency health care needs to dial 911 or proceed to the nearest hospital emergency room.
• Must provide instructions on how to contact the PCP or on-call provider in a non-emergency situation.
• Must provide instructions in English, Spanish, and any other language appropriate to the PCP’s practice.

We offer the following suggested text for answering machines:

“Hello, you have reached [insert physician office name]. If this is an emergency, hang up and dial 911 or go to the nearest hospital emergency room. If this is not an emergency and you have a medical concern or question, please call [insert contact phone or pager number]. You will receive a return call from the on-call physician within [time frame].”

Note: Anthem prefers that PCPs use an in-network provider for on-call services. When this is not possible, PCPs must use their best efforts to ensure the covering on-call provider abides by the terms of the provider agreement.