Appointment wait time standards
The Centers for Medicare & Medicaid Services sets guidelines for appointment availability and access to primary care, specialist and behavioral health services.
To ensure timely access to care for our members, providers who contract with us to provide Medicare Advantage services should adhere to the following wait time standards.
Behavioral health access standards
| Appointment type | Access standard |
|---|---|
| Emergency | Immediately |
| Urgent | Immediately |
| Routine | Within seven business days |
Primary care access standards
| Appointment type | Appointment availability |
|---|---|
| Urgent or emergency | Immediately |
| Nonurgent and nonemergency | Within seven business days |
| Routine, preventive care | Within 30 business days |
| On-call response (after hours) | Not to exceed one hour in the event of an emergency |
| Waiting time in office | 15 minutes or less |
Specialist access standards
| Appointment type | Appointment availability |
|---|---|
| Urgent or emergency | Immediately |
| Nonurgent and nonemergency | Within seven business days |
| Elective | Within 30 business days |
| High index of suspicion of malignancy | Less than seven days |
| Waiting time in office | 15 minutes or less |
After-hours access standards
| Call type | Access standard |
|---|---|
| Emergency | Return call within 60 minutes of receiving it |
| Nonemergency | Return call within 24 hours |
| After-hours (when office is closed) |
|
Annual survey on access and appointment availability
Each year, we contact a random sample of primary care and behavioral health providers and specialists in our networks to conduct a survey on wait time standards.
To support access to care, please ensure that your office staff are able to answer access and availability questions, and can help members with their routine, urgent and emergency care needs.
Learn more in our provider manual.
