October 2021
Access Standards for Behavioral Health Providers
When it comes to our members and their mental health, it’s important they have access to care when and where they need it. All contracted providers for Blue Cross and Blue Shield of Oklahoma (BCBSOK) must comply with BCBSOK quality standards, including those relating to members’ access to care.
The standards for members’ access to behavioral health appointments are:
- Initial routine appointments: Within 10 business days
- Follow-up routine visits: Within one to three months
- Urgent appointments: Within 48 hours or refer the member to the emergency room (ER). An example of an urgent appointment is when a member calls reporting a crisis and asks for an appointment as soon as possible, but immediate action isn’t required.
- Non-life-threatening emergency care: Within six hours or refer the member to the ER. In these cases, lack of care wouldn’t likely lead to death or serious injury, unless left untreated. However, clinical evidence shows that immediate care is needed.
Check eligibility and benefits
Behavioral health services are covered in accordance with a member’s benefit plan. They can vary member to member. Use the Availity® Provider Portal or your preferred vendor to check members’ eligibility and benefits before every appointment. Eligibility and benefit quotes include:
- Membership verification
- Coverage status
- Prior authorization requirements
- Provider’s network status for the patient’s policy
- Applicable copayment, coinsurance and deductible amounts
Learn more about access standards online. If you have questions, contact BHQualityImprovement@bcbstx.com.
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSOK. BCBSOK makes no endorsement, representations or warranties regarding any products or services provided by third-party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.