Provider availability standards

Priority Health has set standards for our members' accessibility to health care: appointments, urgent care, returning calls, and waiting to see a provider. These are set out in the chart below. Providers must ensure that their office hours for Medicare enrollees are consistent with those for other members.

Related information:

• How to provide after-hours care
• Requirements for office locations

Patient Request	Acceptable Time Frame
Emergency care	Immediately or within 24 hours, depending on nature of illness (medical) Immediately (behavioral health, life-threatening) Within 4 hours (behavioral health, non-life-threatening)
Urgent care	Two days or less (medical) Within 24 hours (behavioral health)
Appointments for routine or regular care	30 business days (medical) 14 business days (medical, for Medicaid members) 10 business days (behavioral health)
Physical exam/preventive care	90 business days or less
Return phone calls (during business hours)	4 hours or less (medical) Reach a non-recorded voice in 25 seconds or less (behavioral health only)
Return phone calls (after hours)	2 hours or less 10 minutes or less (behavioral health only)
Waiting time in office	20 minutes or less (average)

More about our standards for accessibility and after-hours service

• Medical Accessibility Standards, including the methodology for determining acceptability.
• Behavioral Health Accessibility Standards, including the methodologies for determining acceptability.
• Guidelines for billing after-hours services