All behavioral health providers, including psychiatrists, clinical nurse specialists, psychiatric nurse practitioners, independent clinical social workers, psychologists, licensed marriage and family therapists, and licensed mental health counselors, are responsible for adhering to BCBSRI’s outpatient access standards. The requirements include:

Waiting time for appointments:

• Emergency care: Immediately or referred as medically necessary
• Urgent care: Within 24 hours, depending on the severity of symptoms
• Non-life-threatening emergency: Within six hours
• Initial visit for routine care: Within 10 business days
• Follow-up visit for routine care: Within 30 days for a non-prescriber; within 90 days for a prescriber
   
  Office waiting times:

• Within 15 minutes for Medicare members
• Within 30 minutes for all other members
• If the waiting time exceeds these timeframes, the office will update the member and offer the choice to reschedule or continue to wait to see the provider.
   
  Hours of care:

• Behavioral health providers are required to practice a minimum average of 20 hours per week. Minimum practice requirements are in place to ensure effective coordination of care for our members.
• All providers shall make necessary arrangements to ensure the availability of care to members on a 24/7 basis, including coverage by another physician/providers.
   
  Phone call response:

• After hours: Calls must be returned within one hour by the provider or covering provider.
• During business hours: Calls must be returned the same business day.
   
  Additional information regarding behavioral health access standards can be found in BCBSRI’s Participating Provider Administrative Manual.