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Working to Improve Member Access to Care
Act
immediately
Effective date
Not stated in the notice
Identified
Oct 3, 2026
Summary
Horizon Blue has published 2022 Access Standard Survey results showing that participating practices must comply with appointment availability and response time guidelines for PCPs, Ob/Gyns, Specialists, and Behavioral Health providers. The policy emphasizes that all staff must follow these standards when offering first-available appointments, responding to after-hours calls, and monitoring office wait times. Survey data reveals significant gaps in compliance, particularly for urgent care, emergent care, and after-hours response times across all provider types.
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What to do
immediately · 7 steps
01All clinical and administrative staff must review and become familiar with Horizon's Appointment Availability Access Standards.
02Identify compliance gaps in your practice using the 2022 survey benchmarks provided (e.g., routine behavioral health appointments should meet 68% compliance, urgent care within 2 days should meet 54%, emergent care within 6 hours should meet 62%).
03Implement workflow changes to meet or exceed the stated targets: routine care appointments within specified timeframes, urgent appointments within 24-48 hours depending on specialty, emergent care referral to ER or treatment within one hour, after-hours response within 30 minutes, and wait time management (30 minutes maximum for commercial, 15 minutes for Medicare Advantage).
04Update scheduling protocols, after-hours call handling procedures, and front desk processes.
05Train all staff on these expectations.
06Monitor compliance through internal audits.
07Document efforts to meet standards as these metrics are tracked via annual Horizon surveys and noncompliance may impact network participation and reimbursement.
Original notice
Working to Improve Member Access to Care
horizonblue.com · Always check the source before changing claims.
Related changes
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