Gateway has contracted with SPH Analytics, a National Committee for Quality Assurance
(NCQA) certified vendor to conduct annual audits to assess our provider network’s ability to provide Gateway members with timely access to care.
The audit addresses:
■ Appointment availability based on Gateway standards
■ Access to care 24 hours a day/7 days a week
■ Wait time in the waiting room
■ Missed appointment protocol
The audit results are utilized to identify plan strengths and barriers to care, and provides Gateway with the opportunity to develop initiatives to improve access.
Accessibility Audit
The Accessibility audit is conducted annually, typically in the 3rd Quarter of the year.
■ SPH Analytics will contact a random sample of our provider network by phone to complete the audit. Call-center agents will ask series of questions to determine compliance with Gateway Accessibility Standards.
■ The call-center agent will request that the office appointment schedule be reviewed (real-time) to obtain a specific date and time of the office’s next available appointment.
■ Identification of office protocol or instructions provided to members by provider offices may also be included as part of the audit.
Important Audit Information
■ Providers are contractually obligated to participate in the audit.
■ Gateway will announce the upcoming annual audit via fax blast and provider newsletter
■ Scheduling staff should be educated on the standards and aware of the audit time frame
■ The audit is conducted telephonically and will take 5 minutes to complete
■ Provider offices that are non-compliant with one or more standards will receive a report card
identifying each non-compliant standard along with required actions
■ Practices that identify as Open access or a walk-in clinic as defined below will receive an automatic pass score for the audit.
Open access- also known as advanced access and same-day scheduling—is a method of scheduling in which all patients can receive an appointment slot on the day they call, almost always with their personal physician. Rather than booking each physician’s time weeks or even months in advance, this model leaves about half of the day open; the other third is booked only with clinically necessary follow-up visits and appointments for patients who chose not to come on the day they called (typically no more than 25% percent of patients).
Walk-in Clinic- a medical facility that accepts patients on a walk-in basis and with no appointment required.
What you can do to prepare for the audit
■ Key office staff that schedule member appointments should review Gateway’s Practitioner Accessibility Standards.
Important: Education of staff responding to the accessibility audit questions is a contributing factor to compliance with the standards.
■ Complete a Practice Self-Assessment to determine if your practice meets Gateway’s Access to Care Standards.
Practice Self-Assessment Tool: The tool contains the accessibility standards monitored by Gateway for both Medicaid and Medicare, the criteria a practice must meet to be compliant with the standards, and identifies questions that may be asked by call-center agents during an Accessibility Audit.