Updates to Access and Availability Standards

Blue Cross Blue Shield of North Dakota (BCBSND) requires all participating network providers, including primary care providers (PCPs) and specialty care providers, to ensure appropriate access and availability of care for our members. These standards help support timely access to medically necessary services and align with federal and state requirements.

In September 2025, BCBSND shared the article Meeting the Medicaid Expansion Access and Availability Contract Standards with the provider community as a reminder of the Centers for Medicare and Medicaid Services (CMS) requirements outlined in 42 C.F.R. §438.206(c). While that communication focused on Medicaid Expansion, it is important to note that Access and Availability contract standards apply across all lines of business, not solely Medicaid Expansion plans.

To comply with the CMS Appointment Wait Time Standards outlined in 42 C.F.R. §438.68(e), BCBSND is updating the required appointment wait time standards as outlined below for Commercial and Medicaid Expansion:

• Primary Care Providers:
  • New standard: 15 business days
  • Old standard: 30 calendar days
• OB/GYN:
  • New standard: 15 business days
  • Old standard: 30 calendar days

Updated appointment wait time standards for Commercial only:

• Prenatal Visits:
  • First Trimester:
    • New standard: within 10 business days of first request
    • Old standard: within 14 calendar days of first request
  • Second Trimester:
    • New standard: within 5 business days of first request
    • Old standard: within 7 calendar days of first request
  • Third Trimester:
    • New standard: within 3 business days of first request
    • Old standard: within 3 calendar days of first request
• Behavioral Health:
  • Remains the same: 10 business days
• Specialty Care (non-urgent):
  • Remains the same: 30 business days

To reflect these updated standards and ensure compliance with CMS policy requirements, please review the Commercial Provider Manual and Medicaid Expansion Provider Manual to ensure scheduling practices align with these requirements.