Name of Manual - Blue Cross and Blue Shield of Minnesota

Quality Improvement
Cooperation with Blue
Cross QI Program
Telephone Care:
During Office Hours
Telephone Care:
In-coming Calls
Rationale:
Collaborative efforts need to mutually service our
members/patients with excellent care and services.
Requirements:
• Consultation and cooperation to resolve individual patient
complaints.
• Provide medical records for QI purposes upon request.
• Collaborate on corrective action plan when Blue Cross quality
thresholds are not met. The Blue Cross Quality Council
determines thresholds.
Rationale:
Patients need telephone access to medical care with a response
time based on the urgency of their symptoms.
Requirements:
During office hours, members calling a provider will be assessed
according to patient care needs by a physician or designee:
• Immediately for emergencies, 100% of the time
• Within 30 minutes for urgent issues, 85% of the time
• Within four hours for all other call types, 85% of the time
Rationale:
A timely response to incoming phone calls promotes patient
satisfaction.
Requirements:
• Calls answered in six rings or fewer
• On hold two minutes or less
3-4 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (08/11/11)