Access to Care

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 100% availability for Emergency Services and 75% or greater for all other services.

Appointment Access

All providers who manage the member’s health care are responsible for providing the following appointments to SWH of NY members in the timeframes noted:

Medical Appointments:


Appointment Types

Standard
 Routine, asymptomatic  Within 28 calendar days
 Routine, symptomatic  Within 2-3 calendar days
 Urgent Care  Within 24 hours
 After Hours Care  24 hours/day; 7 day/week availability
 Specialty Care (High Volume)  Within 28 – 42 calendar days
 Specialty Care (High Impact)  Within 28 - 42 calendar days
 Urgent Specialty Care  Within 24 hours

 

Additional information on appointment access standards is available in your Provider Manual.

Office Wait Time

For scheduled appointments, the wait time in offices should not exceed sixty (60) minutes. All providers are required to monitor waiting times and adhere to this standard.

After Hours

All providers must have back-up (on call) coverage afterhours or during the provider’s absence or unavailability. SWH of NY requires providers to maintain a twenty-four (24) hour phone service, seven (7) days a week. This access may be through an answering service or a recorded message after office hours. For PCPs and OB/GYNs, if a recorded message is used, it must provide an option to direct the member to a live person. The service or recorded message should instruct members with an emergency to hang-up and call 911 or go immediately to the nearest emergency room.

 

Please visit the Provider Manual for additional information on access and availability.