Administrative Manual > Health Management and Quality Improvement > Appointment Access and Office Wait Time
Appointment Access and Office Wait Time
Medica's guidelines for appointment access and office wait time delineate acceptable time standards for patients making appointments and for wait times in the office. If unable to see the member, the participating provider should refer to another provider within the office, another clinic, an urgent care center or emergency room in accordance with the following guidelines.
Please note the separate standards for after-hours access and behavioral health appointments.
Appointment Access
| Purpose of Visit |
Member Should Be Served |
|
Life threatening: A condition that requires immediate treatment to preserve the member’s life or avoid permanent harm to the member’s physical or mental health.
|
Immediately, or told to call 911
|
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Emergency health services: Inpatient and outpatient services that are needed to evaluate or stabilize an emergency medical condition.
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Immediately, 24 hours per day, seven days per week
|
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Urgent: Health services required to treat an unforeseen sickness or injury that is less serious than an emergency but requires prompt treatment to prevent serious deterioration of the member’s health.
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Within 24 hours
|
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Non-urgent visit: Prescheduled office visits for diagnostic or therapeutic purposes. Services required are related to education; management of minor illness or injury; counseling; or management of stable, chronic conditions.
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10 business days for primary care; 30 business days for specialty care
|
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Periodic health assessment: Clinical services provided for the person without known disease or symptoms related to that service, for the prevention of health problems, or the early diagnosis of conditions where early intervention has been demonstrated to significantly improve clinical outcomes.
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10 business days
|
After-hours Access
In order for the member to receive care after regular business hours, physicians and other providers must use a 24-hour answering service and return the member’s call within one hour.
Medica CallLink
Medica CallLink® for Commercial members is a 24-hour-a-day, 365-day-a-year health information and referral service staffed by registered nurses and referral specialists. Nurses provide education and assistance regarding health care questions, and offer recommendations for dealing with medical situations and symptoms. Referral specialists, using a database of Medica providers, can help members find a health care provider. Also, members may call for the location of the nearest urgent care center.
To reach Medica Call Link®, please call 1 (800) 962-9497.
NurseLine by Health Advocate
NurseLine by Health AdvocateTM services are available 24-hours a day, seven days a week. Through one simple phone call to HealthAdvocate, you can consult with a registered nurse to receive guidance on appropriate treatment options and get support for non-urgent illnesses. Nurses can also provide support with simple, self-care tips for non-urgent concerns.
To reach NurseLine by Health Advocate, please call 1 (866) 668-6548.
Wait Time: In Office
Wait time is measured from the scheduled appointment time until the patient is seen by the provider.
Wait time should be less than 20 minutes, but no greater than 45 minutes.
Should unforeseen circumstances (e.g., OB delivery or an emergency) make it impossible for the provider to see the patient within this time period, offer the following options:
- See a different provider within the provider group.
- Reschedule the appointment.
- Continue to wait.
Telephone Access During Business Hours
The telephone must be answered by a live clinic representative, with voicemail available when the line is busy or unattended.
Behavioral Health Appointment Access
| Purpose of visit |
Member should be seen |
|
Behavioral health emergency
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Immediately
|
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Behavioral health non-life-threatening emergency
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Within six hours
|
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Behavioral health urgent care
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Within 24 hours
|
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Behavioral health routine office visit
|
Within 10 business days
|
REV 10/2023