About facility site visits

Facilities include ambulatory surgery centers, home health agencies, hospitals, skilled nursing facilities, sleep centers, behavioral health facilities.

When is a Blue Cross site visit required?

A Blue Cross site visit is required when a facility does not meet the following requirements:

Medical facility:

  • Accreditation by an accrediting agency listed in the Credentialing Manual, Section 1400
  • Medicare Certification including an onsite visit by the Department of Health on behalf of Medicare (CMS) within the past 36 months resulting in the facility being in substantial compliance

Behavioral Health facility:

  • Accreditation by an accrediting agency listed in the Blue Cross Credentialing Manual, Section 1400
  • Completion of a post-licensing review by the Department of Human Services within the past 36 months resulting in the facility being in substantial compliance.
  • Completion of a post-licensing review by a government agency delegated by the Department of Human Services resulting in the facility being in substantial compliance.

What will be reviewed during the site visit?

The site visit form will be emailed or faxed to the facility prior to the site visit, so the provider can review the requirements. Some of the areas reviewed are Physical Environment, Policies/Procedures, Quality Improvement and Record Keeping Practices.

What if the facility is missing some of the requirements?

Blue Cross has policy templates for many of the policy requirements that can be emailed to assist the facility in developing policies.

How soon will the site visit be scheduled?

When the facility can meet the requirements, the site visit will be scheduled. Licensure and insurance requirements must be met prior to the site visit being conducted.