Appointment Accessibility Standards
Type of Appointment | Scheduling Time Frame | |
Emergency Services | ||
Emergency Services | Shall be provided immediately on 24 hours/7 days a week with unrestricted access, to a qualifying provider in network or out of network |
|
Primary Care Appointments | ||
Emergent Care | Same day care | |
Urgent | Within (2) calendar days | |
Routine Care | Within 2 weeks. The 2 weeks standard does not apply to regularly scheduled visits to monitor a chronic medical condition if the schedule calls for visits less frequent than once every 2 weeks. | |
Specialist Appointments (For specialty Referrals to, Behavioral Health Services, physicians, therapists, vision services, and other diagnostic and treatment Providers) *Access available to a child/adolescent specialist if requested by the parent(s). | ||
Emergency | Same day, within (24) hours of referral | |
Urgent | Within (3) calendar days of the referral | |
Routine | Within thirty (30) days of referral | |
Prenatal Care Appointments Initial prenatal care appointments must be provided for pregnant members as follows: | ||
First Trimester | Within 7 calendar days of the first request | |
Second Trimester | Within 7 calendar days of the first request | |
Third Trimester | Within 3 calendar days of the first request | |
High Risk Pregnancies | Within three (3) calendar days of identification of high risk by SilverSummit Healthplan or by the maternity care provider or immediately if an emergency exists | |
Home Health, Private Duty Nursing and Personal Care Services Initiation of ongoing services according to the Member’s identified needs must be provided as follows: | ||
Urgent Needs | Same day | |
Non urgent needs | Within fourteen (14) Calendar Days | |
Appointments to Maintain Efficacy of Treatment (For conditions that are not urgent or emergent, but where treatments are more medically effective when delivered sooner than routine care (for example, physical therapy)), services must be provided as follows: | ||
Not urgent or emergent | Within fourteen (14) Calendar Days of the first request. or Within the timeframe recommended by the referring Provider. |