Corrective Action Plan (CAP) Form
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  2. Training and Education
  3. Accessibility to Care Standards
  4. Corrective Action Plan (CAP) Form

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Provider Access Corrective Action Plan (CAP) Online Submission Form

STEP 1: Complete the practice site detail fields below

(*Must be completed)

  • Primary Care
  • Obstetrics and Gynecology
  • Oncology Hematology
  • Psychiatry
  • Psychology
  • Other Specialty
  • Medicaid
  • Medicare
  • Medicaid and Medicare

Note: Choose Medicaid and Medicare only if your practice site was audited for both Medicaid and Medicare and the corrective action plan (CAP) covers all failed standards.

  • Hospital affiliated practice that uses a call center to schedule patient appointments.
  • Large group practice that uses a call center to schedule patient appointments.
  • Practice location that schedules patient appointments on-site
  • Don’t know/Not sure

STEP 2: Please check the box below that identifies your practice site's action plan status

Corrective Action Plan Status

STEP 3: Please identify your site's barrier(s) to meeting the provider access standards

Barrier(s)

STEP 4: Please identify the corrective action(s) your site has taken to ensure the access standards are met

Corrective Action(s)

STEP 5: By entering your name and title below, you are attesting that your practice has completed staff training and a practice self-assessment to ensure that you meet Highmark Health Options access standards.

*Attestation should be completed by an Office Administrator or Corporate Compliance.

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