Skip left navigation

Appointment Availability Standards and Surveys

Last update: October 14, 2020

The Arizona Health Care Cost Containment System (AHCCCS) requires care providers to comply with specific appointment availability standards – as outlined in the AHCCCS Contractor Operations Manual, Policy 417 – so members have access to timely medical care. UnitedHealthcare Community Plan works with DialAmerica to conduct quarterly appointment availability surveys to help ensure care providers follow these requirements.

Adhering to the following AHCCCS appointment availability standards will help ensure you have successful survey results and availability to care for your patients, who are UnitedHealthcare Community Plan members.

Provider Type

Appointment Availability
for Urgent Care

Appointment Availability for Routine Care

Primary Care Provider (PCP)

No later than two business days of request*

Within 21 calendar days of request

Specialty Provider

No later than three business days of request*

Within 45 calendar days of referral

Dental

No later than three business days of request*

Within 45 calendar days of request. Routine for CMDP only: Within 30 calendar days of request.

Maternity

High-risk pregnancies – no later than three business days of identification of high risk by contractor* or immediately if an emergency exists

  • First trimester – Within 14 calendar days of request
  • Second trimester – Within seven calendar days of request
  • Third trimester – Within three business days of request

Behavioral Health

No later than 24 hours from identification of need*

  • Initial assessment within seven calendar days of referral or request for services
  • First services following assessment no later than 23 calendar days after initial assessment
  • All following services no later than 45 calendar days from identification of need

Psychotropic Medications

Urgency will be assessed immediately

No later than 30 calendar days from request. If necessary, appointments will be provided to help ensure that:

  • The member does not run out of medications OR
  • The member does not decline in behavioral health

*As quickly as the health condition requires, but no later than the time frames noted above
    

Additional Guidelines for Appointment Availability

  • If there isn’t an appointment available with the requested care provider, you can offer another appointment with a different provider of the same specialty.
  • You must complete appointment availability surveys when DialAmerica calls or a failure will be documented.
  • Repeated quarterly failures will result in a corrective action plan.

We’re Here to Help

If you have questions, call Provider Services at 800-445-1638 for AHCCCS Complete Care (ACC) and Developmental (DD) or 800-293-3740 for Arizona Long Term Care System (ALTCS). Thank you.