20-024 Rescheduled Appointments Must Meet Timely Access Standards

Date: 01/10/20

This information applies to Physicians, Participating Physician Groups (PPGs), and Ancillary providers.

Health Net monitors appointments on a quarterly basis to help you meet the requirements

Health Net* is required to monitor timely access to care as mandated by the California Code of Regulations (CCR) Title 28, §1300.67.2.2(c)(3) Rescheduling Appointments, and as specified by our contracts with the California Department of Health Care Services (DHCS) and the Centers for Medicare & Medicaid Services (CMS).

Timely rescheduling of appointments

Health Net monitors and tracks appointment timeliness on a quarterly basis with review of the access to care grievance data for primary and specialty care physicians. Issues found that are related to appointment rescheduling are identified to make sure that education efforts are made. It is important that appointments are rescheduled to continue care for all members. Members who need to reschedule their appointments should also be able to receive an appointment slot within the wait time standards.

Appointment type	Appointment wait time standards
Urgent appointments
Urgent care appointment with primary care physician (PCP)	Within 48 hours of request
Urgent care appointment with specialty care practitioner (SCP)	Within 96 hours of request
Urgent care appointment with non-physician mental health provider	Within 48 hours of request
Urgent care appointment with PCP	Within 48 hours of request
Urgent care appointment with SCP	Within 96 hours of request
Non-urgent appointments
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 appointments, continued
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 with PCP and SCP1	Within 2 weeks of request
Well-child visit1	Within 10 business days of request
Well-woman visit1	Within 30 business days of request

¹ Well-child and first-prenatal visits, and wellness check standards are specific to DHCS regulations.

Health Net offers timely access training webinars for participating physician groups (PPGs), independent practice association (IPAs) and providers. Training courses include a section on regulatory requirements for timely rescheduling of all appointment types within regulatory standards.

Additional information

Providers are encouraged to access Health Net’s provider portal online at provider.healthnet.com for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.

If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email at provider_services@healthnet.com within 60 days, by telephone or through the Health Net provider website as listed in the right-hand column on page 1.