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Our Commitment to Compliance

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Appointment Availability

Did you know that Health Plans frequently call to check that your office is complying with appointment availability agreements? As a reminder, as a contracted provider, you have agreed to maintain the following availability standards:

Requires immediate face-to-face medical attention. Call 911 or go to the nearest ER.


Requires timely face-to face medical attention within 24 hours.


Requires face-to-face medical attention within 48 to 72 hours.


Requires a face-to-face visit within 4 weeks.

Medical care for a condition that, without immediate treatment, could result in:

Placing the member’s life or general health in severe jeopardy

Causing severe impairment in one or more bodily function(s)

Causing severe dysfunction of one or more body organ(s) or parts

Examples of emergency conditions include:


Stab/gunshot wound

Diabetic coma

Cardiac arrest


Obvious fracture

Download the Appointment Reminder Standards Guide

NOTE: If a practitioner is not available, the member should call 911.

Medical care given for a condition that, without timely treatment, could result in:

Deteriorating into an emergency

Causing prolonged impairment of bodily functions

Developing a chronic illness

Examples of urgent conditions include:

Abdominal pain of unknown cause

Unremitting new symptoms of dizziness

Suspected fracture

Download the Appointment Reminder Standards Guide

Medical care given for a condition that:

Is not emergent or urgent in nature

A delay of several hours would NOT increase the likelihood of an adverse outcome

Examples of non-urgent sick visit include:

Cold symptoms

Sore throat

Nasal congestion

Download the Appointment Reminder Standards Guide

Medical care given to diagnose and treat conditions to prevent deterioration:

Minimize/reduce risk of development of chronic illness

Minimize the need for complex treatments

Help prevent health problems before symptoms appear

Examples of routine primary care visits include:


Breast, cervical and colorectal cancer screenings

Blood pressure, diabetes and cholesterol tests

Download the Appointment Reminder Standards Guide