Name of Manual - Blue Cross and Blue Shield of Minnesota

Quality Improvement
Physical Facility Rationale:
Urgent appointment: 100% of requests within 24 hours. Urgent
care is defined as a circumstance in which the individual presents
no emergency or immediate danger to self or others; however, the
individual, clinician, or concerned party believes that the
individual’s level of distress and/or functioning warrants
assessment as soon as possible. An urgent condition is a situation
that has the potential to become an emergency in the absence of
prompt treatment.
Non-life-threatening emergency appointment: 100% of requests
within 6 hours. A non-life-threatening emergency is defined as a
circumstance in which the individual is experiencing a severe
disturbance in mood, behavior, thought, or judgment. There may
be evidence of uncontrolled behavior and/or deterioration in ability
to function independently that could potentially require intense
observation, restraint, or isolation.
Emergency care: 100% of member requests immediately. An
emergency is defined as a circumstance in which there is imminent
risk of danger to the physical integrity of the individual; the
individual cannot be maintained safely in his or her typical daily
environment.
Blue Cross requires behavioral health clinics to provide a safe
environment, which protects patient privacy and ensures handicap
accessibility for disabled patients. Blue Cross will monitor and
review physical environment to evaluate conformity with
regulatory, plan, and accreditation standards.
Requirements:
• Provider is open reasonable working hours
• Provide 24 hour/7 day on-call coverage
• Accessibility for handicapped members as defined by the
Americans with Disabilities Act, 1990
• Controlled substances are secure in a locked cabinet or space
and dispensation is logged
• A system is in place to ensure that all medications are within
the expiration date
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (08/11/11) 3-21