Accessibility to Care Standards

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

The audit addresses:

• Appointment availability based on Highmark Health Options Delaware standards
• Access to care 24 hours a day/7 days a week

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

Accessibility Audit

The accessibility audit is conducted at least annually.

• Press Ganey will contact a sample of the Delaware provider network by phone to complete the audit. Call center agents will ask a series of questions to determine compliance with the 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.
• Scheduling staff should be educated on the standards
• 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 the Highmark Health Options Delaware 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 Delaware Practice Self Assessment Tool. The tool contains the accessibility standards monitored by Highmark Health Options Delaware, 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.

Medicaid Provider Access Audit Process

Medicare Provider Access Audit Process

Provider offices that are non-compliant with one or more standards based on the 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
• Complete staff training
• Complete a practice self-assessment of compliance
• Provider will be re-audited in the next audit cycle.

Example: Medicaid Non-Compliant Letter

Example: Medicare Non-Compliant Letter

• Ensure that your practice site has coverage for vacations or an extended absence by another practice.
• 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.

Medicaid Practice Assessment Tool

Medicare Practice Assessment Tool

Medicaid Provider Access FAQs

Medicare Provider Access FAQs  

Thank you for choosing to complete your Provider Access Corrective Action Plan (CAP) online. Your practice site should have received a Provider Report Card. This Report Card outlines your Provider Access Audit Results and what standards your site has failed that require a CAP. PLease follow the below steps to complete the CAP form. 

Click here to see what is needed to complete the online submission form. 

Click here to complete the CAP form.