Appointment Availability Standards

Date: 02/12/18

As a reminder and in preparation of the upcoming calls, below are appointment standards to ensure that health care services are provided to patients in a timely manner appropriate for the nature of the patient’s condition and consistent with good professional practice.

For providers who offer walk-in or same-day appointments, be sure to indicate this on the call with the surveyor.

*Appointment Type*	*Appointment Standard*
PCPs and Specialists
Urgent care appointments with PCPs that do not require prior authorization	Appointment within 48 hours of request
Urgent care appointments with specialist that do not require prior authorization	Appointment within 48 hours of request
Non-urgent appointments with PCP	Appointment within 10 business days of request
Non-urgent appointment with specialist	Appointment within 15 business days of request
Physical exams and wellness check appointment	Appointment within 30 calendar days of request
First prenatal appointment with PCP	Appointment within 10 business days of request
First prenatal appointment with specialist	Appointment within 10 business days of request1
Well-child visit with PCP	Appointment within 10 business days of request
Ancillary Services
Access to non-urgent ancillary services for magnetic resonance imaging (MRI), mammogram, physical therapy	Appointment within 15 business days of request
Behavioral Health Services
Access to non-urgent appointment with physician (psychiatrist) for routine care	Appointment within 15 business days of request
Access to non-urgent appointment with nonphysician behavioral healthcare provider	Appointment within 10 business days of request
Access to urgent care (psychiatrist)	Appointment within 48 hours
Access to urgent care (non-physician)	Appointment within 48 hours