The Alliance is committed to working with our provider network in offering our members the highest quality of health care services.

Timely access standards* are state mandated appointment timeframes for which you are evaluated.

All providers contracted with the Alliance are required to offer appointments within the following timeframes:

PRIMARY CARE PHYSICIAN (PCP) APPOINTMENT

Appointment Type: Appointment Within:
Non-Urgent Appointment 10 Business Days of Request
First OB/GYN Pre-natal Appointment 2 Weeks of Request
Urgent Appointment that requires PA 96 Hours of Request
Urgent Appointment that does not require PA 48 Hours of Request

 

SPECIALTY/OTHER APPOINTMENT

Appointment Type: Appointment Within:
Non-Urgent Appointment with a Specialist Physician 15 Business Days of Request
Non-Urgent Appointment with a Behavioral Health Provider 10 Business Days of Request
Non-Urgent Appointment with an Ancillary Service Provider 15 Business Days of Request
First OB/GYN Pre-natal Appointment 2 Weeks of Request
Urgent Appointment that requires PA 96 Hours of Request
Urgent Appointment that does not require PA 48 Hours of Request

 

ALL PROVIDER WAIT TIME/TELEPHONE/LANGUAGE PRACTICES

Appointment Type: Appointment Within:
In-Office Wait Time 60 Minutes
Call Return Time 1 Business Day
Time to Answer Call 10 Minutes
Telephone Access – Provide coverage 24 hours a day, 7 days a week.
Telephone Triage and Screening – Wait time not to exceed 30 minutes.
Emergency Instructions – Ensure proper emergency instructions.
Language Services – Provide interpreter services 24 hours a day, 7 days a week.

* Per DMHC and DHCS Regulations, and NCQA HP Standards and Guidelines

PA = Prior Authorization

Urgent Care refers to services required to prevent serious deterioration of health following the onset of an unforeseen condition or injury (i.e., sore throats, fever, minor lacerations, and some broken bones).

Non-urgent Care refers to routine appointments for non-urgent conditions.

Triage or Screening refers to the assessment of a member’s health concerns and symptoms via communication with a physician, registered nurse, or other qualified health professional acting within their scope of practice. This individual must be trained to screen or triage, and determine the urgency of the member’s need for care.