Missouri Medicaid: Access to care and appointment availability standards

One of the ways you can help UnitedHealthcare Community Plan of Missouri members get the right care at the right time is by following the access to care and appointment availability standards.

Please use the following information as a guide to help ensure you’re providing prompt care and are in compliance with MOHealthNet.

All provider types

Appointment type – Urgent care appointments for physical or behavioral illness injuries that require care immediately but do not constitute emergencies (e.g., high temperature, persistent vomiting or diarrhea, symptoms which are of sudden or severe onset, but do not require emergency room services)

Appointment standard – 24 hours

Appointment type – Routine care with physical or behavioral symptoms (e.g., persistent rash, recurring high-grade temperature, non-specific pain, fever)

Appointment standard – 1 week or 5 business days

Appointment type – Routine care without physical or behavioral symptoms (e.g., well-child exams, routine physical exams)

Appointment standard – 30 days

Appointment type – After-care appointments

Appointment standard – 7 calendar days after hospital discharge

Appointment type – After-hours phone messaging

Appointment standard – Medically necessary emergency phone service must be provided 24 hours per day, 7 days per week. Offices must have a phone message or answering service available that instructs members how to contact a physician for urgent or emergency conditions.

Maternity

Appointment type – First trimester appointment

Appointment standard – 7 calendar days of first request

Appointment type – Second trimester appointment

Appointment standard – 7 calendar days of first request

Appointment type – Third trimester appointment

Appointment standard – 3 calendar days of first request

Appointment type – High-risk pregnancy

Appointment standard – 3 calendar days of identification of high risk to the health plan or maternity care provider

UnitedHealthcare Community Plan periodically conducts surveys to check appointment availability and access standards. Care providers are required to participate in all activities related to these surveys.