Reminder: Blue Cross and Blue Shield of Texas (BCBSTX) Appointment Accessibility Standards

January 25, 2023

Friendly Reminder:

Blue Cross and Blue Shield of Texas (BCBSTX) reminds all Primary Care Physicians (PCPs) about Appointment Accessibility Standards. PCPs and Specialty Providers will be surveyed throughout the year regarding Appointment Accessibility standards.

The following is a breakdown of those requirements, as indicated by Texas Health and Human Services Commission (HHSC).

Appointment Accessibility Standards
Prenatal Care Visit Type	Access Standards
Prenatal care (first and second trimesters)	Within 14 days of request
Prenatal care (third trimester or high-risk pregnancy)	Within 5 days of request or immediately if an emergency exists
Prenatal Care (after initial visit)	Appointments for ongoing care must be available in accordance with the treatment plan as developed by the provider.
Primary Care Physician (PCP) Visit Type	Access Standards
Primary Routine Care	Within 14 days of request
For STAR, Preventive Covered Services including annual adult well checks	Within 90 days of request
For STAR, Preventive Covered Services for members younger than six months of age	Within 14 days of request
For STAR, Preventive Covered Services for members six months through age 20	Within 60 days of request
For CHIP, Preventive Care	Per the American Academy of Pediatrics (AAP) Periodicity Schedule¹
Medicaid members, Preventive Care	Per Texas Health Steps (THSteps) Periodicity Schedule
BCBSTX new members 20 years of age or younger, THSteps Check-up	Within 90 Days of enrollment
Other Visit Type	Access Standards
Urgent Care	Within 24 hours
Specialty Care examinations	Within 21 days of request
Behavioral Health, Urgent Care	Within 24 hours
Outpatient Behavioral Health examinations	Within 14 days of request
Routine Behavioral visits	Within 10 days of request
Outpatient Treatment, Post-Psychiatric Inpatient Care	Within 7 days from the discharge date

¹ American Academy of Pediatrics (AAP) Periodicity Schedule

For more information regarding appointment accessibility, please contact your BCBSTX Medicaid Network Representative at 1-855-212-1615 or via email Texas Medicaid Network Department.