20-014 Improve Your Patients' Experience with Timely Access

Date: 01/15/20

MAKE APPOINTMENTS OR RESPOND TO PATIENTS WITHIN REGULATORY STANDARDS

Appointment wait time standards¹ must be met by primary care physicians (PCPs) or specialty care physicians (SCPs). Your patients have the right to appointments within these standards.

Appointment	Access standard
Urgent care
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
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
Wellness check	Within 30 calendar days of request

In-office wait time for scheduled appointments must not exceed 30 minutes.

Directing patients to the appropriate after-hours care can:

• Reduce improper use of emergency room (ER) services.
• Improve health outcomes.

Be sure to discuss after-hours and weekend access to care during your first visit with each patient and at least yearly.

After-hours access	Standard
Emergency care	Call 911 or go to the emergency room.
Urgent care	Call the provider’s office 24 hours a day, 7 days a week. Expect a call back from a provider within 30 minutes.

 

Telephone response	Standard
Telephone answer time at provider’s office	Answer calls within 60 seconds.
Telephone call back during normal business hours for non-urgent issues	Call patients back within 1 business day

Schedule same day access

Advance Access is the system of scheduling same-day appointments. California Health & Wellness urges same day access to appointments for your patients. 

Check out the Provider Manual on the provider portal at www.CAHealthWellness.com for more details. Search under For Providers > Provider Resources > Manuals, Forms and Resources > Provider Manual / Billing Manual. Then go to Chapter 10: Primary Care Providers (PCP) and Other Providers > Appointment Accessibility Standards.

 

¹ The Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), Centers for Medicare & Medicaid Services (CMS), and National Committee for Quality Assurance (NCQA) require health plans to assess and report availability by contracted providers.