June 2017  

Appointment Availability and Access Guidelines

As a contracted Blue Cross and Blue Shield of New Mexico (BCBSNM) provider, the following appointment availability and access guidelines should be used to ensure timely access to medical and behavioral health care for our BCBSNM membership:

• Routine, asymptomatic, member-initiated, outpatient appointments for primary medical care – within 30 days unless patient requests a later time
• Routine, symptomatic, member-initiated, outpatient appointments for non-urgent primary medical and care – request-to-appointment time no greater than 14 days unless patient requests a later time
• Non-urgent behavioral health care – request-to-appointment time no greater than 10 days unless patient requests a later time
• Primary medical and behavioral health care outpatient appointments for urgent conditions shall be available within 24 hours
• Emergency care – 24 hours a day, 7 days per week
• Specialty outpatient referral and consultation appointments, excluding behavioral health – request-to-appointment time shall generally be consistent with the clinical urgency, but no more than 21 days, unless patient requests a later time

After-Hours Care
PCP offices are to communicate after-hours care either via an answering system or answering service to the member who calls for information and/or instructions as to how to obtain health care when the practitioner's office is closed.

The following after-hours information is to be communicated to the member:

• Current office hours (when to call back)
• Instructions on calling for an office appointment
• Information on how to access the on-call practitioner, as appropriate
• Instructions to call “911" or to go to the emergency room if patient is experiencing a life-threatening condition