DMHC ACCESS STANDARDS Help obtain health care services in a timely manner. Please schedule appointments for your members in accordance with the following time frames. Commercial Non-Emergent Medical Appointment Access Standards Appointment Type Time-Elapsed Standards Non-urgent Care appointments for Primary Care Must offer the appointment within 10 Business Days of (PCP) the request Non-urgent Care appointments with Specialist Must offer the appointment within 15 Business Days of (SCP) the request Urgent Care appointments that do not require Must offer the appointment within 48 hours of request prior authorization (PCP) Urgent Care appointment that require prior Must offer the appointment within 96 hours of request authorization Non-urgent Care appointments for ancillary Must offer the appointment within 15 Business Days of services (for diagnosis or treatment of injury, the request illness, or other health condition) Not to exceed 15 minutes In-office wait time for scheduled appointments *Note: Taking Vital Signs or bringing patients to the exam room (PCP and SCP) within 15 minutes of check-in meets requirement Behavioral Health Emergent & Non-Emergent Medical Appointment Access Standards Appointment Type Time-Elapsed Standards Non-urgent appointments with a physician Must offer the appointment within 10 Business Days of mental health care provider the request Non-urgent appointments with a non-physician Must offer the appointment within 10 Business Days of mental health care provider the request Urgent Care appointments Must offer the appointment within 48 hours of request Access to Care for Non-Life Threatening Within 6 hours Emergency Access to Life-Threatening Emergency Care Immediately Must Provide Both: One follow-up encounter with a mental health provider Access to Follow Up Care After Hospitalization for within 7 calendar days after discharge mental illness Plus One follow-up encounter with a mental health provider within 30 calendar days after discharge.
DMHC ACCESS STANDARDS Help obtain health care services in a timely manner. Please schedule appointments for your members in accordance with the following time frames. Commercial Non-Emergent Medical Appointment Access Standards Appointment Type Time-Elapsed Standards Non-urgent Care appointments for Primary Care (PCP) Must offer the appointment within 10 Business Days of the request Non-urgent Care appointments with Specialist (SCP) Must offer the appointment within 15 Business Days of the request Urgent Care appointments that do not require prior authorization (PCP) Must offer the appointment within 48 hours of request Urgent Care appointment that require prior authorization Must offer the appointment within 96 hours of request Non-urgent Care appointments for ancillary services (for diagnosis or treatment of injury, illness, or other health condition) Must offer the appointment within 15 Business Days of the request In-office wait time for scheduled appointments (PCP and SCP) Not to exceed 15 minutes *Note: Taking Vital Signs or bringing patients to the exam room within 15 minutes of check-in meets requirement Behavioral Health Emergent & Non-Emergent Medical Appointment Access Standards Appointment Type Time-Elapsed Standards Non-urgent appointments with a physician mental health care provider Must offer the appointment within 10 Business Days of the request Non-urgent appointments with a non-physician mental health care provider Must offer the appointment within 10 Business Days of the request Urgent Care appointments Must offer the appointment within 48 hours of request Access to Care for Non-Life Threatening Emergency Within 6 hours Access to Life-Threatening Emergency Care Immediately Access to Follow Up Care After Hospitalization for mental illness Must Provide Both: One follow-up encounter with a mental health provider within 7 calendar days after discharge Plus One follow-up encounter with a mental health provider within 30 calendar days after discharge.