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.
Questions?
Please call Provider Services at 866-815-5334.
