21-543m Get Ready for the 2021 Provider Appointment Availability, After-Hours and Telephone Access Surveys
Date: 07/28/21
Surveys take place August through December 2021
To prepare for the surveys, please verify that your office meets appointment availability, after-hours and telephone access requirements. Call your office to ensure the standards and instructions on page two are being followed.
Survey methodology
Surveys will be initiated via email or fax, per the Department of Managed Health Care (DMHC). You will get an email or fax invitation asking you to complete the survey via an online link. Please respond within five business days to the email or fax surveys.
A phone survey will be conducted if:
- A provider does not respond to the survey after five business days.
- A provider’s email address or fax number is not in the system.
Please note that the DMHC acknowledges telehealth as a next available appointment.
Purpose of the surveys, and impact of not meeting standards
California Health & Wellness Plan (CHWP) conducts its annual primary care physician (PCP) and specialty care provider (SCP) appointment availability, after-hours access and telephone access surveys to find out how effective our network is to meet the needs and preferences of members.
We conduct the Provider Appointment Availability and After-Hours surveys in accordance with regulatory requirements from the DMHC, Department of Health Care Services (DHCS) and California Department of Insurance. Compliance is demonstrated by:
- Requiring Health Net participating physician groups (PPGs)/providers to respond to the surveys. Non-response to the surveys would result in PPGs/providers not adhering to their contractual obligations to furnish Health Net with appointment availability information.
- Monitoring PPGs/providers for patterns of non-compliance with survey response, which may escalate to issuance of a corrective action plan as needed. Providers are subject to a corrective action plan and possibly an impact to network participation if they fail to meet timely appointment and after-hours access standards.
Providers can work with their IPA or CHWP if they have questions or concerns about their ability to meet these standards. Providers may contact CHWP via email.
Provider Appointment Availability Survey
For providers who offer walk-in or same-day appointments, be sure to indicate this on the survey.
Appointment type | Access standard |
|---|---|
Urgent care appointment with PCP | Within 48 hours of request |
Urgent care appointment with SCP (prior approval needed) | Within 96 hours of request |
Urgent care appointment with non-physician mental health provider | Within 48 hours of request |
Non-urgent care appointment with PCP | Within 10 business days of request |
Non-urgent care appointment with SCP | Within 15 business days of request |
Non-urgent care appointment with non-physician mental health provider | Within 10 business days of request |
Appointment for ancillary services | Within 15 business days of request |
First prenatal visit | Within 2 weeks of request |
Well-child visit | Within 10 business days of request |
Physical/Wellness check | Within 30 calendar days of request |
After-Hours Survey
After-hours access | Access standard |
|---|---|
After-hours physician availability | Within 30 minutes of call |
After-hours emergency room (ER) instruction | Appropriate emergency instructions |
Provider office Telephone Access Survey
The survey evaluates provider compliance with the telephone access standards as set forth by DHCS.
Telephone access | Access standard |
|---|---|
Answer member calls (can be live or recorded) | Within 60 seconds |
Return member calls for non-urgent issues | Within one business day |
Additional information
If you have questions regarding the information contained in this update, contact CHWP at 877-658-0305