MedicaidAdministrativeHigh impact
[California] Access to care standards
Anthem BCBS·CA·Provider Bulletin
Effective date
Aug 14, 2026
We identified it
Aug 15, 2026
Summary
Anthem Blue Cross Medi-Cal has issued mandatory access-to-care standards effective immediately (policy dated August 14, 2026) requiring all participating providers to offer 24/7 access to covered services, meet specific appointment scheduling timeframes (urgent within 48-96 hours, routine within 10 business days), answer phones within 30 minutes during business hours, and see patients within 15 minutes of appointment time. Non-compliance is subject to corrective action plans or contract termination. Billing teams must ensure scheduling systems enforce these timeframes and that providers complete the mandatory Timely Access Course.
Action Required
IMMEDIATELY (by August 14, 2026): (1) Ensure all scheduling staff and providers complete the mandatory Timely Access Course available at https://providers.anthem.com/ca. (2) Update scheduling system parameters to enforce appointment availability standards: urgent (sick) exams within 48 hours if no auth required or 96 hours if auth required; routine primary care within 10 business days; specialty referrals within 15 business days; mental health/SUD appointments within 10 business days; initial health assessments within 120 days; preventive care within 14 days. (3) Configure phone system to track and enforce 30-minute callback standards for daytime calls and ensure after-hours answering service/machine directs emergencies to 911 or nearest ER. (4) Post Timely Access Flier in front office for scheduling staff. (5) For Los Angeles County providers specifically: Implement policy requiring missed appointment follow-up calls within 48 hours. (6) Ensure after-hours messages provide emergency instructions and alternative contact numbers for non-emergency callback. (7) Confirm language-appropriate messaging for non-English-speaking members. (8) Providers will be surveyed by Sutherland (July-December) on compliance; delegates below 70% compliance for urgent/nonurgent appointments or 80% for mental health follow-ups face corrective action up to contract termination. Billing team should flag any scheduling violations during claim processing and escalate to compliance.