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Provider Manual

Access Standards

Last Updated on January 24, 2019

All members have the right to receive timely access to medically necessary health care services. To facilitate this, the Quality Improvement (QI) Committee approves member access standards and annually evaluates Family Health Center’s affiliated providers’ compliance with these standards.

Standards

Members must receive emergency care from affiliated providers and hospitals that are within Family Health Center’s service area. All hospitals in Family Health Center’s service area offer emergency room services 24 hours a day.

Primary care provider standards

Time frames for member requested appointments are:

Service Appointment timing
Life-threatening emergencies Immediate access
Urgent need Within 24 hours (or as soon as the member believes necessary)
Routine preventive exam (adult or child) Within 60 calendar days
Routine non-urgent/problem focused Within 14 calendar days

Behavioral health care provider

Members have direct access to affiliated behavioral health providers. Time frames for member requested appointments are:

Service Appointment timing
Life-threatening emergency Immediate access
Non life-threathening emergency Within 6 hours
Urgent needs Within 48 hours
Routine office visits Within 10 working days
Following hospital discharge for a behavioral health condition Within 7 days

After hours coverage for providers

Physicians who accept “on-call” responsibility for network primary care providers and specialty care physicians are subject to the same standards for access and availability.

Primary care providers and behavioral health providers must have a system in place for ensuring after hours accessibility for their patients, and for informing their patients about how to access after hours care. After-hours patient telephone calls should be returned within 1 hour from the time placed by the patient.

All providers will be required to provide patients with an emergency telephone number for use after regular office hours. Telephone numbers should also include a description of 24-hour/day access to health care.