20-632 Get Ready for the 2020 Provider Appointment Availability and After Hours Access Surveys
Date: 08/21/20
This information applies to Physicians, Participating Physician Groups (PPGs) providers.
For Medi-Cal, this information applies to Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus, and Tulare 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 followed.
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 visit1 | Within 2 weeks of request |
Well-child visit1 | Within 10 business days of request |
Physical/Wellness check1 | Within 30 calendar days of request |
1Applies to Medi-Cal only.
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 phone 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 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, Health Net 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 Health Net with appointment availability information. Health Net 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 DMHC_AccessIP@healthnet.com.
Additional information
If you have questions regarding the information contained in this update, contact the applicable Health Net Provider Services Center at:
Line of Business | Telephone Number | Provider Portal | Email Address |
EnhancedCare PPO (IFP) | 1-844-463-8188 | provider_services@healthnet.com | |
EnhancedCare PPO (SBG) | 1-844-463-8188 | ||
Health Net Employer Group HMO, POS, HSP, PPO, & EPO | 1-800-641-7761 | ||
IFP (CommunityCare HMO, PPO, PureCare HSP, PureCare One EPO) | 1-888-926-2164 | ||
Medicare (individual) | 1-800-929-9224 | ||
Medicare (employer group) | 1-800-929-9224 | ||
Medi-Cal | 1-800-675-6110 | N/A |