Help ensure timely access to care for Individual Exchange plan members

If you participate in UnitedHealthcare Individual Exchange plans (also known as UnitedHealthcare Individual & Family ACA Marketplace plans) in Alabama, Arizona, Florida, Indiana, Iowa, Kansas, Louisiana, Michigan, Mississippi, Missouri, Nebraska, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee, Texas, Wisconsin or Wyoming, you must adhere to appointment wait time standards required by CMS.

Required appointment availability standards

To support timely access to care, members must be able to obtain appointments within the following time frames:

These standards apply to participating providers in applicable UnitedHealthcare Individual Exchange plan markets. UnitedHealthcare may monitor appointment availability and take appropriate actions to address access-to-care concerns and support compliance with applicable network adequacy requirements.

What you should do now

To help meet appointment wait time standards:

• Use your practice management or scheduling system to review next available appointment dates and monitor compliance with appointment wait time standards
• Adjust scheduling templates or appointment capacity if wait times exceed required standard
• Document operational or capacity-related barriers and steps your practice is taking to improve access

Appointment wait times are generally measured based on the next available appointment reflected in your scheduling system. Reviewing appointment availability regularly can help you identify potential access issues before they affect members’ access to care.

If you're unable to meet the standard

We understand operational challenges can affect appointment availability. If your practice is unable to meet the required time frames, you should maintain documentation of capacity limitations and any actions being taken to improve access, such as schedule adjustments, expanded appointment availability or referral pathways.

Monitoring and addressing appointment access concerns helps support a positive member experience and ongoing compliance with CMS requirements.