Access and Availability Surveys
Date Issued: 4/23/2013
EmblemHealth is mandated by the New York State Department of Health (NYSDOH) to conduct an appointment availability standards survey (to measure and improve patient access to routine, urgent, preventive and specialty care) and a 24-hour access standards survey (to gauge after-hours access to care). They are conducted twice a year, during spring and fall, to determine individual practitioner and overall network compliance with the NYSDOH standards. The next survey is now underway.
Review the Appointment Availability Standards During Office Hours & After Office Hours Access Standards.
Surveyors call a randomly selected sample of practitioners. When calling, they identify themselves to office staff and answering services, and state which company they represent. They conduct each survey as follows:
- Appointment availability survey: Surveyors call practice offices during regular office hours to determine the next available appointment for a given type of service. For more information, refer to our Appointment Availability Standards.
- 24-hour access survey: Surveyors call practitioners' after-hours phone number(s) to determine whether callers can reach a live person, an answering machine or a voicemail system, or obtain a beeper number to reach their clinician or a covering clinician or leave a name and number so their call can be returned immediately.
We do not call any practitioner more than once a year, unless they are found to be noncompliant. You may, however, also get a call from an NYSDOH-contracted surveyor posing as one of our members. NYSDOH may call you more than once per year. Please answer these survey calls just as you would for EmblemHealth, GHI and HIP plan members.
Ensure Your Compliance
Please be sure the address and phone number in your profile are current and that your office staff knows the EmblemHealth plans you are contracted with. You can update this information through the “Provider Profile” feature, available after signing in to our secure Web site. We also recommend that you read and print the standards.
Consequences of Noncompliance
Practitioners who fail to meet access standards are notified of noncompliance and resurveyed about five months after the first survey. Practitioners who are not compliant with the standards after the second survey will be brought to the attention of our Credentialing/Recredentialing Committee. They will be subject to remedies available to EmblemHealth, according to the terms of their practitioner agreements.
If you have questions regarding the standards or surveys, please forward your inquiries by signing in to our secure site and proceeding to our Message Center. When composing your message, select “General Information” as the category in the drop-down menu on the “Ask a Question” page.