Spring Access Surveys Begin Soon
The New York State Department of Health (DOH) has established appointment access and availability standards and conducts annual audits of physicians and practitioners to ensure they are compliant. DOH mandates that plans conduct appointment availability and 24-hour access surveys as well, to determine individual practitioner and overall network compliance. To comply with DOH contract requirements at least 75 percent of providers must meet the DOH access and availability standards. In the survey conducted in the fall of 2013, EmblemHealth providers did not meet that benchmark.
The first of our semiannual surveys will begin in April; the second survey will be administered in the fall. Please ensure that your address and telephone number are kept current in our online Find a Doctor directory and that your office staff is aware of your EmblemHealth network and benefit plan participation.
The standards were sent in January to our entire provider network as part of the annual Regulatory and Plan News mailing. The Access to Care and Delivery System chapter of the EmblemHealth Provider Manual sets out all access and availability requirements. You can subscribe electronically to any chapter in our provider manual to receive email notifications whenever an update is made.
Practitioners who fail to meet access standards are notified of their noncompliance and may be required to submit an attestation confirming that they have reviewed and understood requirements and will adhere to them in the future. They will be 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 plan's Credentialing/Recredentialing Committee for review and will be subject to remedies available to the plan, according to the terms of their practitioner agreements.