Timely Access to Care
The Alliance is required to monitor timely access to care as mandated by Title 28 CCR Section 1300.67.2.2 and as specified by our contracts with the Department of Health Care Services (DHCS) and the Department of Managed Health Care (DMHC).
Alliance-specific guidelines and procedures for monitoring timely access to care are included in the Alliance Provider Manual. They are outlined in:
- Alliance Policy 401-1509 – Timely Access to Care.
- Alliance Policy 300-8030 – Monitoring Network Compliance with Accessibility Standards.
To monitor member access to care, the Alliance conducts the Provider Appointment and Availability Survey (PAAS) annually.
Alliance Provider Relations staff are here to support our providers in meeting timely access standards. Our staff can answer questions, provide information on Alliance incentive programs and deliver on-site consultation on timely access guidelines.
For more information, call your Provider Relations Representative at 800-700-3874, ext. 5504.
The Alliance monitors the following timely access to care standards for primary and specialty care services. In order to meet the standard, members must be able to schedule an appointment at the provider practice within the prescribed times listed below.
|Urgent Appointments||Wait Times|
|Services that do not require prior authorization||48 hours|
|Services that do require prior authorization||96 hours|
|Non-Urgent Appointments||Wait Times|
|Primary care appointment (including first pre-natal visit and preventive visits)||10 business days|
|Mental health care appointment (with a non-physician provider)||10 business days|
|Specialist/specialty care appointment (including psychiatrists)||15 business days|
|Ancillary service appointment for the diagnosis or treatment of injury, illness or other health condition||15 business days|
- Maintain a waitlist for same-day or next-day appointments and fill appointments as cancellations occur. Some clinics integrate the wait list into the Electronic Medical Records (EMR).
- Implement same-day confirmation calls a few hours before the appointment to avoid no-shows and schedule waitlist patients as appointments open up.
- Block up to four appointments in the morning and afternoon on each provider’s schedule to accommodate same-day requests.
- Assign RN or LVN staff to phone triage patients to ensure appropriate scheduling of same-day appointments.
- Consider rotating provider shifts to see walk-in, overflow or waitlist patients.
- Make use of informative hold messages that include:
- After-hours on-call providers.
- The Alliance’s Nurse Advice Line (NAL).
- Triage availability during business hours.
Flexibility is Key
- Offer extended office hours on certain days to accommodate same-day and waitlist patients.
- If a patient arrives early, consider seeing them upon arrival, potentially freeing up an appointment slot for a waitlist patient.
- Consider double-booking patients with a history of no-shows.
- If a clinic has multiple sites and the patient is able to commute, refer to providers with last-minute appointments at other sites.
Educate and Organize
- Provide receptionists with timely access standards in training materials and follow up with reminders on a regular basis.
- Motivate staff to ensure patients are scheduled as soon as possible, whenever possible.
- Assign each reception employee specific roles (checking in, checking out, phone calls, etc.).
As an Alliance provider, meeting timely access standards may increase your incentive dollars as you work toward milestones for Care-Based Incentives. This is because:
- Member access to urgent visits and phone triage may reduce the number of emergency department (ED) visits members make.
- Availability of timely appointments can assist providers in meeting benchmarks for post-discharge care.
The Alliance will initially send an e-mail or fax to providers with an invitation to complete the survey online or by fax. Providers have five days to respond to the invitation. At the conclusion of the five days, the Alliance will start calling providers who have not completed the survey.
To ensure that the Alliance and our providers are reporting accurate information to DHCS, please make sure that your staff is prepared to receive these phone calls and answer questions.
The Alliance surveyor asks to speak to the person that is responsible for scheduling appointments in each provider’s office. There are nine questions in the phone survey and one or more providers associated with the clinic site may be surveyed. We encourage clinic leadership to use this guide as an opportunity to educate staff.
Your Participation is Important!
How your staff answers the PAAS questions will determine whether a deficiency exists. Make sure that staff is familiar with your clinic’s policies and procedures. This will help the Alliance collect responses that are consistent with your clinic’s standards of care.
- If a provider’s appointment availability does not meet the standard as outlined in Alliance Policy 401-1509 and shown in the table above, a letter of deficiency is issued.
- A corrective action plan (CAP) is issued when a provider group has the same deficiency for two consecutive years. If providers have received a CAP, Alliance staff will contact the provider to schedule an appointment to review the standards and address any questions.
Practice and Contact Information Changes
Ensure the Alliance has the most up-to-date information for each practice by notifying your Provider Relations Representative immediately of any changes to the medical staff roster.
If a provider is no longer with your practice and staff is contacted by a surveyor, please state that the provider does not practice at the site. This will end the survey for this provider.
Accurate contact information is important, as the phone number which the Alliance has on file for your practice will be used during survey administration. To verify your contact information, please visit the Alliance website and review your information listed in the Provider Directory. After you have completed your review, submit any information updates on our Provider Directory Information Update Form.
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