The New York State Department of Health (NYSDOH) has established appointment availability access standards as a way to measure and improve patient access to practitioners for routine, urgent, preventive and specialty care and 24-hour access standards to measure after-hours access. As part of this initiative, EmblemHealth is mandated by NYSDOH to conduct appointment availability and 24-hour access surveys. We conduct semiannual surveys to determine individual practitioner and overall network compliance with NYSDOH standards.
We also conduct surveys as part of our Quality Improvement program and to fulfill contractual obligations. The spring surveys will begin in April 2013. A second survey will be administered in the fall.
The process for both our surveys and the NYSDOH surveys are much the same. Surveyors will call a randomly selected sample of practitioners to ascertain compliance with NYSDOH standards using two survey methodologies. The appointment availability survey methodology includes telephone calls to practice offices during regular office hours to determine the next available appointment for a given type of service. The 24-hour access methodology includes calling practitioners' after-hours telephone numbers to determine whether a caller can reach a live voice and be connected directly with their clinician or a covering clinician, or at least receive a return call from their clinician or the covering clinician within 30 minutes.
Surveyors will identify themselves to office staff and answering services, and reveal which company they represent. Or you may receive a call from a NYSDOH-contracted surveyor posing as one of our members. In either case, calls should be answered in the same way as calls from EmblemHealth, GHI and HIP members.
Practitioners who fail to meet access standards are notified of noncompliance and are resurveyed approximately six months after the first survey. Practitioners who are not compliant with these standards after the second survey will be brought to the attention of the planís Credentialing Recredentialing Committee for review and will be subject to remedies available to the plan, according to the terms of their practitioner agreements.
To minimize the inconvenience to you and your staff, we do not call any practitioner more than once a year, unless found to be noncompliant. NYSDOH may call more often.
If you have questions regarding the standards or the surveys, please contact EmblemHealth at your convenience, 24 hours a day, 7 days a week! Simply sign in to emblemhealth.com and go to our Message Center. You may easily send your inquiry using the general information drop-down menu. Or you may call to speak to a customer service representative. A complete listing of important telephone numbers is available in our Provider Manual.