20-536 Get Ready for the 2020 Provider Appointment Availability and After-Hours Access Surveys

Date: 07/23/20

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

This information applies to Medi-Cal in Fresno, Kings and Madera counties.

Surveys start in August through December 2020

To prepare for the surveys, please verify that appointment availability and after-hours requirements are being met by calling your office to ensure the following standards and instructions are being communicated.

For providers who offer walk-in or same-day appointments, be sure to indicate this on the survey.

Appointment type	Access standard
Urgent care
Urgent care appointment with primary care physician (PCP)	Within 48 hours of request
Urgent care appointment with specialty care provider (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 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 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
Physical/Wellness check	Within 30 calendar days of request

After-hours access	Access standard
After-hours physician availability	Within 30 minutes of call
After-hours emergency room (ER) instruction	Appropriate emergency instructions

Survey methodology

The Department of Managed Health Care (DMHC) has issued a survey methodology that states how the Provider Appointment and Availability Survey will be conducted. Surveys will be initiated via email or fax. An email or fax invitation will be sent to providers asking them to complete the survey via an online link. Providers will have five business days to respond to the email or fax surveys.

A telephone survey will be conducted if:

• A provider does not respond to the survey after five business days.
• A provider’s email address or fax number is not in the system.

When responding to the survey questions, please note that the DMHC acknowledges telehealth as a next available appointment.

Purpose of the surveys, and impact of not meeting standards

Health Net, on behalf of CalViva Health, conducts its annual PCP and SCP appointment availability and after-hours access surveys to find out how effective our network is to meet the needs and preferences of members.

Provider Appointment Availability and After-Hours surveys are conducted in accordance with regulatory requirements set forth by the DMHC, Department of Health Care Services and California Department of Insurance. To demonstrate compliance with the timely access standards, contracting participating physician groups (PPGs)/independent practice associations (IPAs)/providers are required to respond to the surveys. Non-response to the surveys would result in PPGs/IPAs/providers not adhering to their contractual obligations to furnish the plan with appointment availability information. The plan will monitor PPGs/IPAs/providers for patterns of non-compliance with survey response, which may escalate to issuance of a corrective action plan as needed.

Providers are subject to a corrective action plan and possibly an impact to network participation if they fail to meet timely appointment and after-hours access standards. Providers can work with their PPG, IPA or Health Net if they have questions or concerns about their ability to meet these standards. Providers may contact Health Net via email at CVH-CAP@Healthnet.com.

Additional information

Providers are encouraged to access the provider portal 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 CalViva Health at 1-888-893-1569.