Oakland Southfield Physicians

OSP News

BCBSM/BCN Appointment Access Verification Calls by Quality Management

Posted: 09/30/2019

BCBSM/BCN offers this explanation regarding their interpretation of the Appointment Access Standards as set forth by the National Committee for Quality Assurance (NCQA):

The scripting scenario for calls to primary care physician (PCP) offices regarding Access of Care is as follows: “If I was an established patient wanting to make an appointment for a preventive care visit, what would be the first date available for me?”

If, at the time of the call, the provider office asks for an example of a preventive service, we reference annual exams (i.e., physical exams), which are considered preventive care and are expected to be scheduled within 30 business days of the member’s request.

For reference, NCQA states that health plans have to check on access of care for preventive services  While NCQA does not define what a preventive service is, BCBSM/BCN as an organization define preventive services to include annual/physical exams.

 Any further questions/comments related to appointment access standards or compliance should be sent to the following mailbox: QualityManagementBCN@bcbsm.com.

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