CommercialAdministrativeHigh impact
[New York] Access surveys for primary care practitioners, specialty care practitioners, and behavioral health practitioners
Anthem BCBS·NY · Family Medicine, Internal Medicine, General Practice +3 more·Specialty Services
Effective date
Aug 1, 2026
We identified it
Aug 2, 2026
Summary
Anthem Blue Cross New York has implemented new access-to-care standards for primary care, specialty care (OB/GYN and oncology), and behavioral health practitioners, effective August 1, 2026. Providers must meet specific appointment timeframes (24 hours for urgent care, 60 days for preventive care, 10 business days for routine visits) and maintain 24/7 after-hours coverage, with compliance monitored through surveys, member grievances, and satisfaction data.
Action Required
By August 1, 2026: Front desk and scheduling staff must implement new appointment availability standards for Anthem NY commercial members—preventive care within 60 calendar days, urgent acute symptoms within 24 hours, routine check-ups within 10 business days for PCPs; specialty care (OB/GYN, oncology) urgent within 24 hours and routine within 30 calendar days; behavioral health non-emergency within 6 hours, urgent within 24 hours, initial routine within 10 business days, follow-up within 14 calendar days, and post-discharge within 5 calendar days. Immediately: Verify after-hours access meets compliance requirements (live person or recording directing to urgent care, 911, ER, or on-call physician—answering machines alone are insufficient). Billing/provider relations team must ensure telehealth status is updated in Availity by July 1, 2028 to display telehealth indicator in member directory. Practices must document reasons for any access standard failures to demonstrate good-faith compliance efforts. Non-compliance will result in member complaints, provider surveys, and potential contract penalties.