Accessibility to Care Standards

Overview

Our Health Plan maintains Accessibility to Care Standards and processes for ongoing monitoring of access to health care. Providers are contractually required to conform to the Accessibility Standards to ensure that health care services are provided to Highmark Health Options West Virginia members in a timely manner.

Accessibility standards
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Highmark Health Options Accessibility Standards - Timeliness of access to care

West Virginia Medicaid Timeliness of Access to Care Standards

Monitoring compliance with accessibility standards

Highmark Health Options West Virginia has contracted with Press Ganey, a National Committee for Quality Assurance (NCQA) certified vendor to conduct annual audits to assess our provider network’s ability to provide Highmark Health Options West Virginia members with timely access to care.

The audit addresses:

  • Appointment availability based on Highmark Health Options West Virginia standards
  • Access to care 24 hours a day/7 days a week
  • Wait time in the office waiting room

The audit results are utilized to identify plan strengths and barriers to care, and provides Highmark Health Options West Virginia with the opportunity to develop initiatives to improve access.

ACCESSIBILITY AUDIT

The Accessibility audit is conducted annually, typically in the 2nd Quarter of the year.

  • Press Ganey will contact a random sample of our provider network by phone to complete the audit. Call-center agents will ask a series of questions to determine compliance with the Highmark Health Options West Virginia Accessibility Standards
  • The call-center agent will request that the office appointment schedule be reviewed (real-time) to obtain a specific date and time of the office’s next available appointment
  • Identification of office protocol or instructions provided to members by provider offices may also be included as part of the audit.

IMPORTANT AUDIT INFORMATION

  • Providers are contractually obligated to participate in the audit.
  • Highmark Health Options will announce the upcoming annual audit via fax blast and provider newsletter.
  • Scheduling staff should be educated on the standards and aware of the audit time frame.
  • The audit is conducted telephonically and will take approximately 5 minutes to complete.
  • Provider offices that are non-compliant with one or more standards will receive a report card identifying each non-compliant standard along with required actions to complete.

WHAT YOU CAN DO TO PREPARE FOR THE AUDIT

  • Key office staff that schedule member appointments should review Highmark Health Options Accessibility Standards. Important: Education of staff responding to the accessibility audit questions is a contributing factor to compliance with the standards.
  • Conduct a Practice Self-Assessment using the Highmark Health Options West Virginia Practice Self-Assessment Tool: The tool contains the accessibility standards monitored by Highmark Health Options West Virginia, the criteria a practice must meet to be compliant with the standards, and identifies questions that may be asked by call-center agents during an Accessibility Audit.
Annual provider accessibility audit process

Highmark Health Options West Virginia Annual Provider Accessibility Audit Process:

Annual Provider Accessibility Audit Process

Provider non-compliance with standards

Provider offices that are non-compliant with one or more standards based on the annual audit results will receive a report card identifying each non-compliant standard along with required actions to mitigate non-compliance.

Provider Non-Compliant Actions:

  • Provider must submit a corrective action plan (CAP) for failed standards within 45 calendar days
  • Complete staff training within 45 calendar days
  • Complete a practice self-assessment of compliance within 45 calendar days
  • Provider will be re-audited in the following year's annual audit.
Accessibility compliance tips
  • Ensure that your practice site has coverage for vacations or an extended absence by another practice or you can refer members to another practice or telemedicine provider. Refer to Highmark Health Options West Virginia Medicaid Provider Manual on our provider website for more inormation regarding telemedicine.
  • Share the accessibility standards and audit questions with key staff that schedule appointments, including call center and central scheduling staff. Education of the staff responding to the audit questions is a contributing factor to compliance with the standards.
Practice self assessment tool

Highmark Health Options West Virginia Practice Self-Assessment Tool:

Practice Self-Assessment Tool

Frequently asked questions (FAQs)

Highmark Health Options West Virginia Frequently Asked Questions

Frequently Asked Questions (FAQs)

Provider access corrective action plan (CAP) - online submission form

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