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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


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).


Same day, within (24) hours of referral


Within (3) calendar days of the referral


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.


Within the timeframe recommended by the referring Provider.