Timeframes for Access Requirements. HMO must have sufficient network providers and establish procedures to ensure Members have access to routine, urgent, and emergency services; telephone appointments; advice and Member service lines. These services must be accessible to Members within the following timeframes:
Timeframes for Access Requirements. INSURER must have sufficient network of providers and must establish procedures to ensure beneficiaries have access to routine, urgent, and emergency services; telephone appointments; advice and Beneficiaries service lines. These services must be accessible to beneficiaries within the following timeframes: - Urgent Care within 24 hours of request; - Routine care within 2 weeks of request; - Physical/Wellness Exams for adults must be provided within 8 to 10 weeks of the request; - Referrals: Appointments of referrals must be delivered and notified to beneficiaries within five (5) days from the date prescribed by the provider.
Timeframes for Access Requirements. INSURER must have sufficient network of providers and must establish procedures to ensure beneficiaries have access to routine, urgent, and emergency services; telephone appointments; advice and Beneficiaries service lines. These services must be accessible to beneficiaries within the following timeframes: - Urgent Care within 24 hours of request; - Routine care within 2 weeks of request; - Physical/Wellness Exams for adults must be provided within 8 to 10 weeks of the request; - Referrals: Appointments of referrals must be delivered and notified to beneficiaries within five (5) days from the date prescribed by the provider. The services required must be delivered or rendered within a reasonable period as medically needed by the beneficiary, in a time frame which may not exceed thirty (30) days from the time of the appointment, except in cases where the particular nature of specialist services require additional waiting time because of unavailability of a specialty service.
Timeframes for Access Requirements. INSURER must have sufficient network of providers and must establish procedures to ensure beneficiaries have access to routine, urgent, and emergency services; telephone appointments; advice and Beneficiaries service lines.
Timeframes for Access Requirements. INSURER must have sufficient network of providers and must establish procedures to ensure beneficiaries have access to routine, urgent, and emergency services; telephone appointments; advice and Beneficiaries service lines. These services must be accessible to beneficiaries within the following timeframes: - Urgent Care within 24 hours of request; - Routine care within 2 weeks of request; - Physical/Wellness Exams for adults must be provided within 8 to 10 weeks of the request; - Referrals: Appointments of referrals must be delivered and notified to beneficiaries within five (5) days from the date prescribed by the provider. THE SERVICES REQUIRED MUST BE DELIVERED OR RENDERED WITHIN A REASONABLE PERIOD AS MEDICALLY NEEDED BY THE BENEFICIARY, IN A TIME FRAME WHICH MAY NOT EXCEED THIRTY (30) DAYS FROM THE TIME OF THE APPOINTMENT, EXCEPT IN CASES WERE THE PARTICULAR NATURE OF SPECIALIST SERVICES REQUIRE ADDITIONAL WAITING TIME BECAUSE OF UNAVAILABILITY OF A SPECIALTY SERVICE.
Timeframes for Access Requirements. The TPA/HCO must assure that its providers comply with the standards for timely care and services, considering the urgency of required services. TPA/HCO must have a providers network to guarantee enrollees access to routine, urgent, and emergency services; telephone appointments; advice and enrollee service lines. These services must be accessible to enrollees within the following timeframes: • Urgent Care within twenty four (24) hours of request; • Routine care within two (2) weeks of request; • Physical/Wellness Exams for adults shall be provided within 8 to 10 weeks of the request; • Referrals: Whenever medically necessary, enrollees must be referred to a specialist; referral appointments must be delivered or notice thereof provided to enrollees within five (5) days from the date prescribed by provider who issued the referral. The services from said specialist must be delivered within a reasonable period, as medically needed by the enrollee, but never later than thirty (30) days from the date the appointment was made, except in cases where the particular nature of the services rendered by the specialist require additional waiting time because of unavailability of a specialty service. A reasonable period of time may be, for example, the average commercial sector waiting time for such services. • Implement procedures to assure that each enrollee has access to mental health outpatient and inpatient services
Timeframes for Access Requirements. The MBHO must have sufficient network of providers and must establish procedures to ensure beneficiaries have access to routine, urgent, and psychiatric emergency services; telephone appointments; advice and beneficiaries service lines. These services must be accessible to beneficiaries within the following timeframes: o Urgent Care within 24 hours of request; o Routine care within 5 days of request; o Immediate access to detoxification services when medically necessary; o Immediate access to emergency services; o Referrals: Appointments pursuant to referrals must be delivered and notified to beneficiaries within five (5) days from the date prescribed by the provider; o Access to prescribed medication: within 24 hours of request; o Obtaining prescribed medication within 24 hours of request.
