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For Health Professionals

Quality Management Program

Making sure your health needs are attended to in a timely manner

Continuous improvement in the quality of care and services available to our members is the foundation of our Quality Management Program. The program, through a series of activities, provides for monitoring, evaluating, measuring, improving, and reporting on the quality of care and service provided to our members.

If you would like further information on the Quality Management Program please call the Customer Service Department toll free at 800–962-2242. We will provide you with a description of the program and tell you about our progress in meeting our goals. If you would like to suggest improvements to our program your suggestions are welcome.

Access to Care

As a Capital BlueCross member, you have a right to timely access to participating physicians in order to obtain covered services. Participating physicians agree to be available to provide the following types of covered services to members in accordance with the following time frames:

Type of Care* Availability Guidelines
Emergency Immediate
Urgent Urgent
Acute Within 72 hours
Routine Follow-up Within 4 weeks
Preventive Within 8 weeks
After hours 24 hours, 7 days/week

* Click on the specific Type of Care to get an accurate definition.

Mental Health and Substance Abuse Access Standards

Type of Care* Availability Guidelines
Non Life Threatening Emergency Within six hours
Urgent Care Appointment Within 48 hours
After Hours Care 24 hours/7 days a week
Regular and Routine Appointments Within 10 business days

* Click on the specific Type of Care to get an accurate definition.

For questions or comments regarding our Quality Management Program, please call the Clinical Management Department toll-free at 1.800.471.2242.