December 20, 2023
The following appointment availability and access guidelines should be followed by providers to ensure timely access to medical care for Medicare Advantage HMOSM and PPOSM members. These guidelines also apply to behavioral health services and substance use disorder services.
- Routine and preventive care within 30 business days
- Services that are not emergency or urgently needed, but requires medical attention within seven business days
- Urgently needed services or Emergency Care – Immediately
Adherence to member access guidelines will be monitored through Blue Cross and Blue Shield of Illinois office visits and the tracking of complaints and grievances related to access and availability, which are reviewed by the BCBSIL Quality Improvement Committee.
Participating physician/professional providers are expected to provide coverage to members 24 hours a day, seven days a week. When a participating physician/professional provider is unable to provide services, the participating physician/professional provider must ensure that they have arranged for coverage from another participating physician/professional provider. Hospital emergency room or urgent care centers are not substitutes for covering participating physician/professional providers.