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Provider Accessibility Standards
Provider accessibility represents an important element of healthcare quality. So that our members may have access to needed healthcare services in a timely manner, please strive for complete compliance with these accessibility standards. We recognize that when unpredictable circumstances and emergencies occur, you may not be able to accommodate these time frames.
Medical / Surgical Accessibility Standards and Related Definitions
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Type of Service
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Definition
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Performance Goal
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Emergency
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Sudden, life-threatening symptom(s) or condition requiring immediate medical treatment.
Example: Major injuries; chest pain; severe abdominal pain; new onset shortness of breath.
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Immediate appointment or patient is directed to nearest emergency room.
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Urgent
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Onset of symptom(s) or health problem requiring prompt, but not immediate, medical attention.
Example: Minor injuries; unrelieved fever; signs/symptoms of urinary tract infection; children with ear pain and fever.
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Appointment available within 24 hours.
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Routine
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Non-acute symptoms or follow-up care
Example: Non-urgent, non-emergency assessments or visits; follow-up/post-hospitalization visits; visits for recurring/chronic problems.
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Appointment available within 3 weeks.
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Preventive Care
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Routine, regularly scheduled health assessment.
Example: Well-child visits; routine physical or gynecological exam.
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Appointment available within 8 weeks.
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After Hours Care
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Accessibility outside of normal business hours.
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24-hours-a-day/7-days-a-week on-call coverage.
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Office Wait Time
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Duration of time (when patient arrives on-time for appointment) between patient arrival and beginning of physician encounter.
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Average wait time should not exceed 30 minutes for scheduled appointment.
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