Complying With Access and Availability Standards
Date Issued: 2/19/2014
Is Your Office Compliant With Our Access and Availability Standards?
At this time each year, the Island Peer Review Organization (IPRO), on behalf of the New York State Department of Health (NYSDOH), contacts a sample of our network providers to verify their:
- Telephone number, and confirm that they can speak to a live person to schedule an appointment within three calls without an excessive wait-time
- 24-hour-a-day accessibility to members
- Participation in our commercial HMO, Medicaid, Family Health Plus and Child Health Plus programs
- Compliance with our Appointment Availability and 24-Hour Access Standards
Is your office prepared?
- Go to www.emblemhealth.com/providers to review and update your provider profile. Please make sure your telephone number, practice locations and provider specialty are correct.
- Remind your staff that:
Print and post our standards summary card where all staff members can see it.
- You are contracted to serve members in one or more of our commercial HMO, Medicaid, Family Health Plus and Child Health Plus programs. Note: IPRO may refer to these plans as either HIP or EmblemHealth.
- If you require a copy of a new member’s medical records, they should schedule an appointment, pending receipt of the records.
- They should not say you are “not accepting new patients” or “are not scheduling appointments at this time” unless we have officially closed your panel.
- After hours, members have access to a “live voice” answering service or your beeper number.
IPRO verification surveys are important to you, us and NYSDOH. In addition to verifying that your patients – our members – have appropriate access to covered care and services, they impact NYSDOH’s ability to obtain Centers for Medicare & Medicaid approval to implement planned Medicaid Redesign Team benefit and population changes.
Note: Compliance with our Access and Availability Standards is also a requirement of your practitioner agreement with us.