CommercialAdministrativeMedium impact
[Ohio] Access surveys for primary care practitioners, specialty care practitioners, and behavioral health practitioners
Anthem BCBS·OH · General Practice, Family Medicine, Internal Medicine +3 more·Specialty Services
Effective date
Aug 1, 2026
We identified it
Aug 3, 2026
Summary
Anthem Ohio has established new access-to-care standards for primary care, specialty care (OB/GYN and oncology), and behavioral health practitioners effective August 1, 2026. The policy mandates specific appointment availability timeframes (ranging from 24 hours for urgent care to 30 calendar days for routine visits), requires 24/7 after-hours coverage, and monitors compliance through vendor surveys, member grievances, and satisfaction data. Practices must ensure telehealth services are updated in provider directories by July 1, 2028.
Action Required
By August 1, 2026: Front desk and scheduling staff must implement new appointment availability standards—urgent care within 24 hours, routine PCP check-ups within 10 business days, preventive care within 30 calendar days for PCPs; urgent specialty care (OB/GYN, oncology) within 24 hours, routine specialty within 30 calendar days; behavioral health non-life-threatening emergencies within 6 hours, urgent within 24 hours, initial routine within 10 business days, follow-ups within 30 calendar days, and post-discharge psychiatric care within 7 days. Ensure 24/7 after-hours coverage is established with live staff or recorded messages directing members to urgent care, on-call physicians, or appropriate resources (not just 911/ER referrals). By July 1, 2028: Update telehealth provider information in the Anthem directory via Availity.com if your practice offers telehealth services. Billing and clinical teams should document scheduling challenges if standards cannot be consistently met. Non-compliance may result in member complaints, satisfaction survey penalties, and potential contract review.