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April 2013
Health reform law requires Blues providers to meet PPO accreditation standards
According to the Patient Protection and Affordable Care Act, Blue Cross Blue Shield of Michigan must be accredited to offer any PPO product in the Health Insurance Marketplace**. To qualify for PPO accreditation, we have to meet the requirements of the National Committee for Quality Assurance.
As such, we are asking our participating doctors and other health care professionals to immediately begin following NCQA standards. These include those listed in the table below. They indicate the maximum wait time allowed for patients, beginning at the time the patient calls the doctor or hospital.
We’ll conduct annual surveys to determine whether providers are complying with the standards. We will also notify you of other NCQA requirements.
Nonbehavioral health
Treatment |
Standard |
Preventive care (no symptoms) |
30 business days |
Routine (symptoms are not urgent) |
10 business days |
Urgent (acute symptoms) |
48 hours |
Emergency Care |
Immediately |
Waiting room time |
30 minutes |
Behavioral health
Treatment |
Standard |
Routine |
10 business days |
Urgent |
48 hours |
Emergency (not life-threatening) |
6 hours |
Life-threatening emergency |
Immediately |
Waiting room time |
30 minutes |
**The Health Insurance Marketplace was formerly known as the Health Insurance Exchange. The name was changed recently by the U.S Department of Health and Human Services.
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