Access & Availability Standards
Independence Blue Cross has developed Access and Availability Standards to ensure managed care networks are sufficient in numbers, types, and geographic locations of providers. Special circumstances, cultural needs and preferences of members are taken into consideration, and mechanisms are designed to help maintain the availability of primary care and specialty care providers and assure the accessibility of primary care services, urgent care services, and member services.
Access standards for PCPs and specialists
Provider Type |
Access Type |
Standard |
| PCP |
| Primary Care Provider |
Emergent |
Immediate |
| Primary Care Provider |
Urgent |
Within 24 hours |
| Primary Care Provider |
Routine |
Within 2 weeks |
| Primary Care Provider |
Routine Physical |
Within 4 weeks |
| Specialist |
| Cardiology |
Emergent |
Immediate; call 911 or go to nearest Emergency Room |
| Urgent |
Within 24 hours |
| Routine |
Within 2 weeks |
| Orthopedics |
Emergent |
Immediate; call 911 or go to nearest Emergency Room |
| Urgent |
Within 24 hours |
| Routine |
Within 2 weeks |
| OB/GYN |
Emergent |
Immediate; call 911 or go to nearest Emergency Room |
| Urgent |
Within 24 hours |
| Routine |
Within 2 months |
| Other INTR or Surgical Specialty |
Emergent |
Immediate; call 911 or go to nearest Emergency Room |
| Urgent |
Within 24 hours |
| Routine |
Within 2 weeks |
| Podiatry |
Urgent |
Within 24 hours |
| Routine |
Within 2 weeks |
| Chiropractor |
Urgent |
Within 24 hours |
| Routine |
Within 2 weeks |
Minimum Number of Office Hours per Practice per Week
Provider Type |
Practice Size |
Standard |
| PCP |
| Primary Care Provider |
Solo |
20 hours |
| Primary Care Provider |
Dual |
30 hours |
| Primary Care Provider |
Group |
35 hours |
| Specialist |
| Chiropractor |
|
20 hours |
| Capitated Podiatry |
|
20 hours |
| Specialist (other) |
|
12 hours |
| Urgent |
|
Within 24 hours |
| Routine |
|
Within 1 month |
Practices are encouraged to have at least one weekend day or evening session per week included in the hours above.
Maximum Number of Patients Scheduled per Hour per Physician
| Provider Type |
Number of Patients |
| PCP |
6 patients |
| Specialist |
4 patients |
| Podiatrist or Chiropractor |
6 patients |
| OB/GYN (routine) |
6 patients |
Internal Office Waiting Time
- Less than 30 minutes from time of scheduled appointment
Availability
- Coverage: 24 hours a day; seven days a week
- Covering physician must be a participating network provider.
- Providers who use answering machines for after-hour services are required to include:
- Urgent/Emergent instructions (as the first point of instruction)
- Information on contacting a covering provider
- Telephone number for after-hours physician access
After-hours Phone Response
- For Urgent/Emergent problem: within 30 minutes
Patient No-Show
- Should be documented in medical record
