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

November 3, 2022

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 to email Texas Medicaid Network Department.