Behavioral Health Appointment Access Standards

Behavioral Health providers have contractually agreed to offer appointments to our members according to the following appointment access standards:

Initial/Routine Care: Within 14 calendar days
Urgent: Within 24 hours
Life threatening/emergency: Within one (1) hour or refer immediately to ER

BCBSTX is accountable for performance on national measures, like the Healthcare Effectiveness Data and Information Sets (HEDIS). Several of these measures specify expected timeframes for appointments with a behavioral health professional. View Behavioral Health HEDIS Tip Sheets.

• Expectation that member has a follow up appointment with a behavioral health professional following a mental health inpatient admission within 7 and/or 30 days
• For members treated with Antidepressant medication
  • Medication Adherence for 12 weeks of continuous treatment (during Acute phase)
  • Medication Adherence for 180 days (Continuation phase)
• For children (6-12 years old) who are prescribed ADHD medication
  • One follow up visit the first 30 days after medication dispensed (Initiation phase)
  • At least two (2) visits, in addition to the visit in the initiation phase with provider in the first 270 days after Initiation phase ends (Continuation and Maintenance phase)
• For members treated with a new diagnosis of alcohol or other drug dependence (AOD):
  • Treatment initiation through an inpatient admission, outpatient visit, intensive outpatient encounter, partial hospitalization program, telehealth or medication treatment within 14 days following the diagnosis (initiation phase)
  • At least 2 visits/services, in addition to the treatment initiation encounter, within 34 days of initiation visit (engagement phase) initial diagnosis (encounter phase)

HEDIS is a registered trademark of NCQA. Use of this resource is subject to NCQA’s copyright, found here. The NCQA HEDIS measure specification has been adjusted pursuant to NCQA’s Rules for Allowable Adjustments of HEDIS. The adjusted measure specification may be used only for quality improvement purposes.

The above material is for informational purposes only and is not intended to be a substitute for the independent medical judgment of a physician. Physicians and other health care providers are encouraged to use their own best medical judgment based upon all available information and the condition of the patient in determining the best course of treatment.