CurrentBlue Cross Blue Shield - New MexicoPolicy N/A

Urgent Care Center (UCC) designation requirements

Defines facility, staffing, equipment, hours, medical director, policies, and attestation requirements for Urgent Care Centers seeking designation/participation with Blue Cross Blue Shield of New Mexico.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyUrgent Care Center (UCC) designation requirements

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionAttesting entity must notify BCBSNM within ten (10) working days of material changes and may be subject to audit or unannounced site visits.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

6+minimum days open per week

4minimum hours open any day

10weekday non-traditional hours/week

X-ray, phlebotomy, provideron-site capabilities

MD/DOrequired medical director

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UCC Designation Criteria

Facility, staffing, equipment, hours, governance, policies, and attestation criteria required for UCC designation

Facility accepts walk-in patients of all ages presenting with a broad spectrum of illness, injury, and disease that require urgent (non-emergent) care during all posted hours; advertising/public notices (if present) must state this.

ALL of the following

X-ray on site
Phlebotomy capability
ALL of the following
- Administer Basic Life Support (BLS) and Cardio-Pulmonary Resuscitation (CPR)
- Obtain and read an EKG on site
- Obtain and read X-rays on site
- Administer PO, IM & IV medications/fluids on site
- Perform minor procedures onsite (e.g., suturing, suture removal, cyst removal, incision & drainage, splinting)

ALL of the following

Automated External Defibrillator (AED) or manual cardioverter defibrillator
Oxygen, ambu-bag, and oral airway
Drug cart stocked appropriately for the facility's patient population
Biohazard disposal containers
Sharps containers
Working phone to dial 911 or otherwise access EMS

ALL of the following

At least one exam room
Separate waiting area
Patient restroom(s)

ALL of the following

Open at least 6 days per week (not including holidays)
Open no less than 4 hours on any day it is open
On weekdays (Mon–Fri), include at least 10 hours per week of non-traditional hours (hours prior to 8 AM or after 5 PM, in any combination)

ALL of the following

Designated Medical Director who is an MD or DO, is licensed in the state where the facility operates, and has successfully completed the Blue Cross and Blue Shield of New Mexico credentialing process
Written policies and procedures that include at minimum: procedure for verifying identity and credentials of licensed professionals; description of duties for supervised practitioners (e.g., physician assistants); emergency procedures; patient confidentiality procedures; maintenance of emergency medications or drug cart

ALL of the following

Entity must complete an attestation and attach current UCA certification if applicable
Attesting entity must notify BCBSNM within ten (10) working days of any material changes to information provided
BCBSNM may audit, request records, and perform unannounced site visits
False or incomplete information may result in non-acceptance or termination from the network

Non-qualifying entities (examples)

Retail or similar clinics with limited scope located within a pharmacy, supermarket, or similar retail facility
Physician offices with only selected hours for walk-ins
Chiropractic offices
Pain clinics
Centers not yet ready for full operation and patient flow
Episodic care providers
Independently practicing CNP/CNFP providers

Attestation, Notification, and Audit Requirements

Documentation Required

Attestation, Notification, and Audit Rights

If any material changes occur in information provided in the application or attachments that make the information no longer correct and complete or affect the Entity's professional status, the Entity must notify Blue Cross and Blue Shield of New Mexico within ten (10) working days. BCBSNM may audit or verify submitted information, request medical records, and conduct unannounced on-site visits; failure to notify or providing false/incomplete information may result in rejection, removal of UCC designation, or termination from the BCBSNM network.

Notify BCBSNM within 10 working days of any material changes to the application or attachments.
BCBSNM may audit, verify information, request member medical records, and perform unannounced on-site visits.
False, incomplete, or misleading information may lead to non-acceptance, removal of UCC designation, or termination from the network.

Key Definitions

inv-03: Urgent Care Center (UCC)

DefinitionAccepts walk-in patients of all ages presenting with a broad spectrum of illness, injury, and disease that requires urgent (non-emergent) care during all posted hours; advertising/public notices must state this acceptance.

On-site capabilities requiredX-ray on site; phlebotomy capability; licensed provider on site able to administer BLS/CPR, obtain and read EKG and X-ray, administer PO/IM/IV medications/fluids, and perform minor procedures (suturing, suture removal, cyst removal, incision & drainage, splinting).

Equipment and support servicesAED or manual defibrillator; oxygen, ambu-bag, oral airway; appropriately stocked drug cart; biohazard and sharps containers; working phone to access 911/EMS.

Physical space minimumsAt least one exam room, a separate waiting area, and patient restroom(s) available during posted hours.

inv-04: Non-qualifying entities

Retail/supermarket clinicsRetail or similar clinics with limited scope of service located within a pharmacy, supermarket, or similar retail facility do not meet UCC intent.

Physician offices with limited walk-in hoursPhysician offices that offer only selected hours for walk-ins are not qualifying UCCs.

Chiropractic, pain, and episodic care providersChiropractic offices, pain clinics, and episodic care providers are excluded from UCC designation.

Centers not ready for full operationCenters not yet ready for full operation and patient flow do not meet the UCC definition.

Independently practicing CNP/CNFP providersIndependently practicing CNP/CNFP providers are listed as non-qualifying entities.

OpenPayer

Urgent Care Center (UCC) designation requirements

Urgent Care Center (UCC) Designation Criteria

Attestation, Notification, and Audit Requirements

Key Definitions