Nov. 12, 2024
To ensure timely access to medical care for our members, follow CMS guidelines for Qualified Health Plan appointment wait time standards for behavioral health services, routine primary care and non-urgent specialty care.
Impacted health plans: Wait time standards apply to our members with Blue Focus POSSM and Blue Preferred PPOSM health plans.
According to CMS guidelines as of Jan. 1, 2025: Ensure that our members seeking an appointment are able to schedule an appointment within the time frames below at least 90% of the time:
Provider Specialty Type |
Appointments Must Be Available Within |
Behavioral Health |
10 business days |
Primary Care (Routine) |
15 business days |
Specialty Care (Non-urgent) |
30 business days |
For more information refer to CMS Appointment Wait Time FAQs.