After-hours care requirements

Use one of these methods to help members after regular business hours:

A professional answering service that contacts you or the provider covering for you

A high-quality answering machine or voice mail system that tells members:

• How to reach you or your substitute in an emergency, including phone number(s)

• What do do in an emergency, including local emergency room phone numbers if available

Rural Behavioral Health Providers may direct members to the emergency room via an answering machine only if there is no participating provider in the same field of practice to share on-call coverage.

• Instructions must clearly direct members with non-emergency situations to call the emergency room first.

• The message should also provide the telephone number(s) of the emergency room(s) available in the area.

If your instructions ask the member to leave a message, you are expected to respond to the message quickly.

Requirements for PriorityMedicare members

Under its contract with the Centers for Medicare and Medicaid Services (CMS), PriorityMedicareSM is required to notify all providers that under CFR 422.11(a)(7), they are required to:

Provide services, both clinical and nonclinical, that are readily available, accessible, and appropriate, when medically necessary (24 hours a day/7 days a week) to all enrollees, including those with limited English proficiency or reading skills and those with diverse cultural and ethnic backgrounds. Services include access to specialty care such as women's health services.

More about after-hours services:

• Read the full policy covering the after-hours medical care requirements for Priority Health providers.
• Read about how to bill for after-hours services.
• Read the full standards for after-hours behavioral health care.