Corrective Action Plan (CAP) Form
suitcase-icon Careers
join-our-mailing-list Join Our Mailing List
question-mark-logo Contact Us
location-icon Region
mobile-logo
search

NEW! Search CPT Codes in the Main Search Bar: To check prior authorization requirements, please use the Search Bar at the very top of the page. It's always available, so you can check codes from anywhere on the site!

Share

  1. Home
  2. Member Care
  3. Accessibility to Care Standards
  4. Corrective Action Plan (CAP) Form

Share

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.

Back to TopAuthentication Required

This link requires authentication. If you are not already logged in you will need to log into Availity and link to this site from there.
CancelAuthentication Required

This link requires authentication. If you are not already logged in you will need to log into Availity and link to this site from there.
SUBMIT CORRECTIVE ACTION PLANAuthentication Required

This link requires authentication. If you are not already logged in you will need to log into Availity and link to this site from there.

Be Informed

About Highmark Health Options