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CLOSING PATIENT PANELS
When a Participating Primary Care Physician elects to stop accepting new patients, the Provider’s patient
panel is considered closed.
If a Participating Primary Care Physician closes his or her patient panel, the decision to stop accepting new
patients must apply to all patients regardless of insurance coverage. Providers may not discriminate against
Bravo Health Members by closing the patient panels for Bravo Health Members only, nor may they
discriminate among Bravo Health Members by closing their panel to certain product lines.
Providers who decide that they will no longer accept any new patients must notify Bravo Health’s Network
Management Department, in writing, at least 60 days before the date on which the patient panel will be
closed.
PROVIDER ACCESS AND AVAILABILITY STANDARDS
A Primary Care Physician (PCP) must have their primary office open to receive Bravo Health Members
five (5) days and for at least 20 hours per week. The PCP must ensure that coverage is available 24
hours a day, seven days a week. PCP offices must be able to schedule appointments for Bravo Health
Members at least two (2) months in advance of the appointment. A PCP must arrange for coverage during
absences with a Bravo Health Participating Provider in an appropriate specialty which is documented on the
Provider Application and agreed upon in the Provider Agreement.
Primary Care Access Standards
Appointment Type Access Standard
Urgent Within 24 hours
Non-Urgent/Non-Emergent Within 48 hours
Routine and Preventative Within 4 weeks
On-Call Response (After Hours) Within 30 minutes for emergency
Waiting Time in Office 30 minutes or less
Specialist Access Standards
Appointment Type Access Standard
Urgent Within 24 hours
Non-Urgent/Non-Emergent Within 48 hours
Elective Within 4 weeks
High Index of Suspicion of Malignancy Less than one (1) week
After-hours Access Standards
All Participating Providers must return telephone calls related to medical issues. Emergency calls must be
returned within 30 minutes of the receipt of the telephone call. Non-emergency calls should be returned
within a 24 hour time period. A reliable 24 hours a day, 7 days a week answering service with a beeper or
paging system and on-call coverage arranged with another Participating Provider of the same specialty is
preferred.
Behavioral Health Access Standards
Appointment Type Access Standard
Emergency Within 6 hours of the referral
Urgent/Symptomatic Within 48 hours of the referral
