Quality Management
Access & Availability Standards

Independence Blue Cross (IBC) has developed the following standards to help maintain the availability of primary and specialty care providers and to ensure the accessibility of primary care, urgent care, and member services within our managed care networks. As part of these standards, IBC considers the types of providers and their geographical locations and takes into account the cultural needs, special circumstances, and preferences of members.

Access Standards

Provider Type
Access Type Standard
PCP
Primary Care Provider Emergent Immediate: call 911 or go to nearest emergency room
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

Practices are encouraged to have at least one weekend day or evening session per week included in the hours below.

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

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

  • Patient's wait time should be less than 30 minutes from the time of the 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

  • Urgent/Emergency problems should be addressed within 30 minutes.

Patient No-show

  • If a member does not keep a scheduled appointment (a no-show) it should be documented in his or her medical record.