Reminder: Appointment availability and after-hours access requirements

To ensure members receive care in a timely manner, PCPs, behavioral health (BH) providers, and all other specialty providers must maintain appointment availability and after-hours access standards.

PCPs:

Note: In-office wait times for scheduled appointments should not routinely exceed 45 minutes including time in the waiting and examining rooms.

Traditional healthcare by a PCP shall be available for clinical assessment and care planning within seven calendar days of discharge from inpatient or institutional care for physical or BH disorders, or discharge from a substance use disorder treatment program.

Transitional healthcare by a home care nurse or home care registered counselor shall be available within seven calendar days of discharge from inpatient or institutional care for physical or BH disorders, or discharge from a substance use disorder treatment program.

BH providers:

All other specialists:

After-hours access requirements

Providers are required to abide by the following standards to ensure access to care for our members:

• Offer 24/7 telephone access for members. A 24-hour telephone service may be used. The service may be answered by a designee such as:

• An on-call physician.
• A nurse practitioner with physician back-up.

• Be available to provide medically necessary services. A physician must offer this service.
• Follow the referral/precertification guidelines. This is a requirement for covering physician.

 If you have questions, contact your local Provider Relationship Management representative, or call Provider Services at 855-661-2028, extension 106-108-1854.