Timely Access to Care. The Contractor shall have contracts in place with all subcontractors that meet state standards for access, taking into account the urgency of the need for services (42 C.F.R. § 438.206(b) & (c)(1)(i))). The Contractor shall ensure that:
6.3.1 Network providers offer access comparable to that offered to commercial enrollees or, if the Contractor serves only Medicaid enrollees, comparable to Medicaid fee-for-service (42 C.F.R. § 438.206(b)(1)(iv) & (c)(1)(ii))).
6.3.2 Mechanisms are established to ensure compliance by providers.
6.3.3 Providers are monitored regularly to determine compliance.
6.3.4 Corrective action is initiated and documented if there is a failure to comply.
Timely Access to Care. Provider shall comply with State standards for timely access to care and services, as specified in the State Contract, taking into account the urgency of the need for services, in accordance with 42 C.F.R. §438.206(c)(1)(i). Provider shall offer hours of operation that are no less than the hours of operation offered to commercial enrollees, or if Provider serves only Medicaid Enrollees, hours of operation comparable to other State Medicaid populations, in accordance with 42 C.F.R. §438.206(c)(1)(ii). Provider shall comply with any corrective action directed by Company to remedy any failure to comply with timely access to care obligations. (State Contract § 1.13.1.2)
Timely Access to Care. Dentist agrees to provide Covered Services to Covered Persons in a Medicare program with timely access to assure availability, adequacy and continuity of care. Dentist shall comply with procedures established by DDN to monitor the provisions of Covered Services to ensure compliance with CMS standards.
Timely Access to Care. The Contractor must have contracts in place with all subcontractors that meet state standards for access, taking into account the urgency of the need for services (42 C.F.R. § 438.206(b) and (c). The Contractor will ensure that:
Timely Access to Care. Provider agrees to provide Covered Services consistent with Plan's: (1) standards for timely access to care and member services; (2) policies and procedures that allow for individual Medical Necessity determinations; and (3) policies and procedures for the Provider's consideration of Covered Individual input in the establishment of treatment plans.
Timely Access to Care. Provider agrees to provide MA Covered Services consistent with Plan's: (1) standards for timely access to care and member services; (2) policies and procedures that allow for MA Member Medical Necessity determinations; and (3) policies and procedures for Provider's consideration of MA Member input in the establishment of treatment plans.
Timely Access to Care. Participating Providers agree to provide timely access to care. This means that when you call for an appointment, you will see your provider within a reasonable timeframe. Blue Shield’s access standards are listed below. Services that do not require prior authorization Within 48 hours Services that do require prior authorization Within 96 hours Primary Care Physician office visit Within 10 business days Specialist office visit Within 15 business days Mental or substance use disorder health provider (who is not a Physician) office visit Within 10 business days When your appointment will occur Follow-up appointments with a mental or substance use disorder health provider (who is not a Physician) Within 10 business days of the prior appointment for those undergoing a course of treatment for an ongoing mental health or substance use disorder condition Other services to diagnose or treat a health condition Within 15 business days Access to a health care professional for phone triage or screening services by calling Customer Service 24 hours a day, seven days a week Call Customer Service if you need help finding a Participating Provider or if a Participating Provider is not available. Please see the If you cannot find a Participating Provider section for more information. Contact Customer Service to schedule interpreter services for your appointment. For more information about interpreter services, see the Language access services notice.
Timely Access to Care. We offer timely access for scheduling appointments with an In-Network physician, mental health professional and specialist for medical/surgical services, per state law. • Xxxxxx care appointments not requiring prior authorization may be obtained within 48 hours of the request for an appointment. • Xxxxxx care appointments requiring prior authorization may be obtained within 96 hours of the request for an appointment. • Non-urgent appointments for primary care may be obtained within 10 business days of the request for an appointment. • Non-urgent appointments with specialist physicians may be obtained within 15 business days of the request for appointment. • Non-urgent appointments with a non-physician mental health care provider may be obtained within ten business days of the request for an appointment. • Non-urgent appointments for ancillary services for the diagnosis or treatment of injury, illness or other health conditions may be obtained within 15 business days of the request for an appointment. • Telephone triage or screening service wait time shall not exceed 30 minutes. The applicable waiting time for a particular appointment may be extended if the referring or treating licensed health care provider, or the health professional providing triage or screening services, as applicable, acting within the scope of his or her practice and consistent with professionally recognized standards of practice, has determined and noted in the relevant record that a longer waiting time will not have a detrimental impact on the health of the Member. Preventive care services, and periodic follow up care, including but not limited to, standing referrals to specialists for chronic conditions, periodic office visits to monitor and treat pregnancy, cardiac or mental health conditions, and laboratory and radiological monitoring for recurrence of disease, may be scheduled in advance consistent with professionally recognized standards of practice as determined by the treating licensed health care provider acting within the scope of his or her practice. Xxxxx provides interpretation services, as described in the “Introduction” section titled “How to Get Language Assistance.” Please see this section for complete instructions and phone numbers to request assistance.
Timely Access to Care. The Contractor shall have contracts in place with all subcontractors that meet state standards for access, taking into account the urgency of the need for services. The Contractor shall ensure that:
5.3.1. Network providers offer access comparable to that offered to commercial enrollees or comparable to Medicaid fee-for-service, if the Contractor serves only Medicaid enrollees. (42 CFR 438.206(b)(1) & (c)(1));
5.3.2. Mechanisms are established to ensure compliance by providers;
5.3.3. Providers are monitored regularly to determine compliance; and
5.3.4. Corrective action is initiated and documented if there is a failure to comply.
Timely Access to Care. Where appropriate and applicable, the PBM agrees to promote access to covered services in accordance with recognized standards for timely access to care and member services. [*] Redacted text. Confidential treatment requested; omitted text filed separately with the Securities and Exchange Commission. 119
