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.