Eye doctors that accept blue cross community family health plan

July 2020

To ensure that BCCHP and MMAI members have timely access to care, the following appointment standards are specified in your provider agreements:

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• Provider Finder® Disclaimer
• Is Blue Cross Blue Shield of Illinois Medicaid?
• What is covered by Blue Cross Blue Shield of Illinois?
• Is EyeMed part of Blue Cross Blue Shield Illinois?
• Who takes Illinois Medicaid?

• Routine preventive care appointments – Available within five weeks of the request and within two weeks from the date of the request for infants under 6 months.
• Serious problem but not an emergency medical condition – Within one business day of the request.
• Non-urgent/needs attention – Within three weeks of the date of the request.
• Initial prenatal visits without problems – Within two weeks of the date of request for a member within the first trimester, within one week in the second trimester and within three days in the third trimester.
• Behavioral health emergency care – Within six hours of the request.
• Behavioral health initial visit for routine care – Within two weeks of the date of the request.
• Behavioral health routine follow-up care – Within three months of the request.
• Behavioral health urgent/non-emergent – Within 48 hours of the request.

In addition to the above appointment timeframes, providers are contractually required to ensure that provider coverage is available for members 24 hours a day, seven days a week. In addition, providers must maintain a 24-hour answering service and ensure that each primary care physician (PCP) provides a 24-hour answering arrangement, including a 24-hour on-call PCP arrangement for all members. An answering machine doesn’t meet the requirements for a 24-hour answering service arrangement. Hospital emergency rooms or urgent care centers aren’t substitutes for covering providers.

We routinely monitor for compliance with the above standards. Compliance monitoring includes, but is not limited to, conversations with your Provider Network Consultant (PNC), site visits and “Secret Shop” calls. Lack of compliance may lead to corrective actions, which may include corrective action plans or termination.

If you have questions regarding these requirements, contact your assigned PNC or email our Government Programs Provider Relations team.

Blue Cross Community Centennial has a network of doctors, specialists and hospitals. These providers are contracted with BCBSNM to provide medical services to members.

You must use in-network providers. If you choose to see a doctor who is not part of our network, you will have to pay for the services. Except in an emergency, this plan does not cover care received from out-of-network providers. Check with the provider to make sure that he or she is in the network before you get care.

You must choose a PCP when you join the plan. Our network has PCPs in almost every county in the state. There's also a wide selection of specialists.

If you need help finding Medicaid providers, call 1-866-689-1523.

If your Blue Cross and Blue Shield of New Mexico (BCBSNM) plan includes vision coverage, select from the links below to search for a vision provider.

• BCBSNM Vision Plans *
  
• Medicaid Plan (Blue Cross Community CentennialSM) **
• Medicare Advantage Plans *

Provider Finder® Disclaimer

You are about to leave the BCBSNM website. You are going to a different website. This other site may have information about:

• Medical conditions
• Providers (doctors, dentists, hospitals or other health care professionals)
• Prescription drugs
• Treatments
• Products or services 

Please note that your health plan may not cover the items found on this other site.

The information on this other site may not always state the views of BCBSNM. You should not think BCBSNM endorses all views you find on this other site.

BCBSNM is not liable or responsible for damage or injury to persons or property that result from the use of anything found on this other site such as:

• Products or services
• Information or ideas
• Instructions, especially for health care

 BCBSNM cannot guarantee the accuracy of any statements made on other websites.

The information on this other site does not replace professional health care. For example, if you have questions about vision care, talk with your doctor. For questions about your BCBSNM health plan, call Customer Service at the number listed on your BCBSNM member ID card. 

* EyeMed Vision Care is an independent company that administers the vision benefits for Blue Cross and Blue Shield of New Mexico.

** Davis Vision is an independent company that provides vision care benefits for the BCBSNM Medicaid plan (Blue Cross Community Centennial). Such services are funded in part with the State of New Mexico.

Blue Cross®, Blue Shield® and the Cross and Shield symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.

Is Blue Cross Blue Shield of Illinois Medicaid?

What is covered by Blue Cross Blue Shield of Illinois?

Is EyeMed part of Blue Cross Blue Shield Illinois?

Who takes Illinois Medicaid?