Access and Availability Standards

Last update: October 16, 2020

UnitedHealthcare Community Plan has appointment availability requirements for primary care providers (PCPs) and specialists. The requirements apply to routine, urgent and after-hours care. Your practice may have received a call from a third-party surveyor asking for appointment scheduling information availability that your practice has available for your patients. These calls are made to care provider offices on a random basis to confirm if a practice meets the access and availability standards set by the Division of Medical Assistance and Health Services (DMAHS). Please help ensure that your practice meets the following appointment availability scheduling timeframes.

Primary Care Providers for Adults

• Urgent care visit completed within 24 hours of member appointment request for new or existing members
• Acute care visit completed within 72 hours of member appointment request for new or existing members
• Preventive health/physical exam within 28 days of member appointment request for existing members
• Routine care provided within 28 days of member appointment request for new or existing members
• Baseline physicals for new Division of Developmental Disabilities (DDD) members completed within 90 days
• Baseline physicals for new adult members completed within 180 days

Primary Care Providers for Children

• Urgent care visit completed within 24 hours of member appointment request for new or existing members
• Acute care visit completed within 72 hours of member appointment request for new or existing members
• Preventive health/physical exam within 28 days of member appointment request for existing members
• Routine care provided within 28 days of member appointment request for new or existing members
• Baseline physicals for new Division of Developmental Disabilities (DDD) members completed within 90 days
• Baseline physicals for new child members completed within 90 days

OB-GYN Care Providers

• First trimester care visit completed within three weeks of appointment request for new or existing members
• Second trimester care visit completed within seven days of appointment request for new or existing members
• Third trimester care visit completed within three days of appointment request for existing members
• Third trimester care visit completed within three days of appointment request for new members
• Third trimester care visit completed within three days of appointment request for transferring patients
• High-risk care visit completed within three days of appointment request for new or existing members

Specialists

• Urgent appointment completed within 24 hours of PCP referral or requested appointment
• Regular appointment completed within four weeks of PCP referral or requested appointment

Dental Providers

• Emergency care completed within 48 hours of appointment request
• Urgent care visit completed within three days of appointment request
• Preventive or routine care visit completed within 30 days of appointment request

Primary care and OB-GYN care providers are required to have after-hours access to speak directly with a live person outside normal business hours if contacted for any urgent medical matters by a patient. Care provider offices may be able to coordinate after-hours coverage with their affiliated hospital or provide coverage through an answering service.

For more information about access and availability guidelines, go to the Provider Administrative Manual at UHCprovider.com > Menu > Choose Your State: New Jersey > Go to UHCCommunityPlan.com > Provider Administrative Manual under Chapter 12: Participating Provider Responsibilities.