24-653m Be Ready for the 2024 Provider Appointment Availability, After-Hours and Phone Surveys
Date: 07/03/24
Surveys take place July through December 2024
To prepare for the surveys, please verify that your office meets appointment availability, after-hours and phone access requirements. Call your office to ensure the standards and instructions on page two are being followed.
Survey methodology
Surveys will be initiated via email or fax, per the Department of Managed Health Care (DMHC). You will get an email or fax invitation asking you to complete the survey via an online link. Please respond within five business days 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.
Please note that:
- The DMHC acknowledges telehealth as a next available appointment.
- For 2024, DMHC has made changes in calculating appointment wait times, inclusion of holidays and weekends for urgent care appointments.
- A new question has been added to assess the alternative methods providers use to ensure enrollees receive timely access to urgent care services.
Purpose of the surveys, and impact of not meeting standards
Health Net, conducts annual surveys on primary care physician (PCP) and specialty care provider (SCP) appointment availability, in-office wait time and phone access. The surveys help us learn how effective our network is in meeting the needs and preferences of members.
We conduct the Provider Appointment Availability and After-Hours surveys in accordance with regulatory requirements from the DMHC and Department of Health Care Services (DHCS). Under California law, health plans are required to obtain information from their contracted providers regarding appointment availability.
Compliance is demonstrated by:
- Requiring participating physician groups PPGs/providers to respond to the surveys. Non-response to the surveys would result in PPGs/providers not adhering to their contractual obligations to furnish Health Net with appointment availability information.
- Requiring providers to verify their information on a periodic basis per Senate Bill (SB) 137, effective July 1, 2016. Failure to respond may result in a delay in payment or reimbursement of a claim. And, your information may be removed from the printed and online provider directory.
- Keeping your office information current to avoid being removed from the provider directory. This lets members reach you to schedule appointments or select you as their provider. Be sure to validate your demographic information each month so it’s correct in the Provider Search tool at healthnet website.
- Monitoring PPGs/providers for patterns of non-compliance with survey response, which may require a corrective action plan. Providers who failed to meet timely appointment and after-hours access standards are subject to a corrective action plan. This may also impact a provider’s network participation.
Providers can work with their PPGs or Health Net if they have questions or concerns about their ability to meet these standards. Providers may contact Health Net via email.
Provider Appointment Availability Survey
Providers who offer walk-in or same-day appointments and telehealth should be sure to indicate that on the survey.
| Appointment type | Access standard |
| Urgent care | |
| Urgent care appointment with PCP. | Within 48 hours of request. |
| Urgent care appointment with Specialist (prior approval needed). | 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 Specialist. | Within 15 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 2 weeks of request. |
| Preventive Health check-up1. | Within 30 calendar days of request. |
1Health plan standard. Appointment scheduled through the provider for a preventive checkup will be dependent on the type of service, and a provider may recommend a different schedule depending on the need.
| Urgent care appointment with non-physician behavioral health care provider or behavioral health care physician (psychiatrist) that does not require prior authorization. | Within 48 hours of request. |
| Urgent care appointment with non-physician behavioral health care provider or behavioral health care physician (psychiatrist) that requires prior authorization. | Within 96 hours of request. |
| Non-urgent care appointment with non-physician behavioral health care provider. | Within 10 business days of request. |
| Non-urgent appointment with behavioral health care physician (psychiatrist). | Within 15 business days of request. |
| Non-urgent care follow-up appointment with non-physician mental health care provider (NPMH). | Within 10 business days of request. |
| After-hours access | Access standard |
| After-hours physician availability. | Call back within 30 minutes of call. |
| After-hours emergency room (ER) instruction. | Appropriate emergency instructions. |
Provider Office Phone Access Survey
The survey evaluates provider compliance with the phone access
standards as set forth by DHCS.
| Phone access | Access standard |
| Answer member calls (can be live or recorded). | Within 60 seconds. |
| Return member calls for non-urgent issues. | Within one business day. |
| Access | Access standard |
| In-office wait time for scheduled appointments (PCP and Specialists). | Not to exceed 30 minutes. |
Questions?
The PAAS will be conducted by the third-party survey vendor, Sutherland Global. For questions regarding the survey, please email.
Additional information
If you have questions regarding the information contained in this update, contact the applicable Health Net Provider Services Center by phone or through the Health Net provider portal.
| Line of business | Phone number |
| Ambetter from Health Net IFP Ambetter HMO | 888‑926‑2164 |
| Ambetter from Health Net IFP Ambetter PPO | 844‑463‑8188 |
Health Net Employer Group HMO, POS, & PPO | 800‑641‑7761 |
Medicare (Individual & Employer Group) (Wellcare By Health Net) | 800‑929‑9224 |
| Medi-Cal (including CS and ECM providers) | 800‑675‑6110 |
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, Community Supports (CS) Providers, and Enhanced Care Management (ECM) Providers.
For Medi-Cal, this information applies to Amador, Calaveras, Inyo, Los Angeles, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.