Access to Care
Passport maintains access to care standards and processes for ongoing monitoring of access to health care (including behavioral health care) provided by contracted primary PCPs (adult and pediatric) and participating specialist (to include OB/GYN, Behavioral Health Providers, and high volume and high impact specialists). Providers are required to conform to the Access to Care appointment standards listed below to ensure that health care services are provided in a timely manner. The standards are based on 90% or greater availability for Emergency Services and 90% or greater for all other services. The PCP or their designee must be available 24 hours a day, 7 days a week to Members.
Appointment Access
All Providers who oversee the Member’s health care are responsible for providing the following appointments to Passport Members in the timeframes noted:
Medical Appointments:
|
Appointment Types |
Standard |
|
Preventive Care, non-urgent |
Within 30 calendar days |
|
Family Planning (Counseling & Medical Services |
Age 18 years and up: As Soon As Possible, and within 30 calendar days
Less than 18 years: As immediately as possible and within 10 calendar days |
|
PCP |
Urgent: within 48 hours Non-Urgent: within 30 calendar days |
|
Specialists |
Urgent: within 48 hours Non-Urgent: within 30 calendar days |
|
Dental |
Urgent: within 48 hours Non-Urgent: within 30 calendar days |
|
Vision |
Urgent: within 48 hours Non-Urgent: within 30 calendar days |
|
Labs & Radiology |
Urgent: within 48 hours Non-Urgent: within 30 calendar days |
|
After Hours Care |
24 hours per day/7 days per week and in accordance with Commonwealth standards |
Behavioral Health Appointments:
|
Appointment Types |
Standard |
|
Life Threatening Emergency |
Immediately |
|
Non-life Threatening Emergency |
Within 6 hours |
|
Urgent Care |
Within 24 hours |
|
Routine Care |
Initial Visit: Within 10 business days of request Follow-up visit: within 30 calendar days of request |
|
Post-Discharge Outpatient Aftercare |
Within 7 calendar days of discharge |
|
Referrals |
Within 30 calendar days |
Note: Behavioral Health Providers must contact Members who have missed an appointment within 24 hours to re-schedule.
Additional information on appointment access standards is available from your local Passport Quality department toll free at (844) 795-3508.
Office Wait Time
For scheduled appointments, the wait time in offices should not exceed thirty (30) minutes. All PCPs are required to monitor waiting times and adhere to this standard.
After Hours
PCPs must have back-up (on call) coverage after hours or during the Provider’s absence or unavailability. Passport requires Providers to maintain a 24-hour telephone service, 7 days a week.
Acceptable arrangements include:
Office phone is answered after hours by an answering service that can contact the PCP or another designated medical practitioner and the PCP or designee is available to return the call within a maximum of thirty (30) minutes;
Office phone is answered after hours by a recording directing the Member to call another number to reach the PCP or another medical practitioner whom the Provider has designated to return the call within a maximum of thirty (30) minutes; and
Office phone is transferred after office hours to another location where someone shall answer the phone and be able to contact the PCP or another designated medical practitioner within a maximum of thirty (30) minutes.
Please visit the Provider Manual for additional information on access and availability.