Appointment Availability Standards

Last update: Oct 1, 2020

As a reminder, UnitedHealthcare Community Plan has appointment availability requirements for primary care providers (PCPs) and specialists. The requirements apply to routine, urgent and after-hours care.

These standards are imposed by state regulators, which is why they are contractually required of network providers. UnitedHealthcare Community Plan of Mississippi uses a company called Dial America to perform quarterly accessibility surveys for its CAN and CHIP products.

This is required by the Division of Medicaid. Follow-up letters are often sent to care providers who fall short of the standards. Care providers should make every effort to help ensure that appointments are available to members according to the following Medicaid-established criteria:

Primary care (PCP, PED, OB-GYN):

Primary care providers (PCPs) should schedule appointments as follows:

  • Urgent care: Within 24 hours
  • Routine sick care: Within seven days
  • Well care: Within 30 days
  • After-hours care: As highlighted below*

Specialty care:

Specialists and specialty clinics should schedule appointments within 45 days.

Dental care:

Dental providers should schedule appointments as follows:

  • Urgent care: Within 48 hours
  • Routine visits: Within 45 days

Behavioral health care:

Behavioral health care providers should schedule appointments as follows:

  • Urgent care: Within 24 hours
  • Routine care: Within 21 days
  • Post-discharge care: Within seven days when you know a member is discharged from an acute psychiatric hospital

Urgent care:

Urgent care providers should provide care within 24 hours.

Emergency care:

Emergency care providers should provide care immediately, 24 hours a day, seven days a week, and without prior authorization.