Access Standards
CareSource has a comprehensive quality improvement program to help ensure our members receive the best possible health care services. It includes evaluation of the availability, accessibility and acceptability of services rendered to patients by participating health care providers.
Please keep in mind the following access standards for differing levels of care. Participating providers are expected to have procedures in place to see patients within these timeframes and to offer office hours to their CareSource patients that are at least the equivalent of those offered to fee-for-service Medicaid patients and patients with commercial insurance coverage. Thank you for adhering to these standards.
Primary Care Physicians (PCPs)
|
Patients with. . . |
Should be seen. . . |
|
Emergency needs |
Immediately upon presentation |
|
Persistent symptoms |
No later than the end of the following working day after their initial contact with the PCP site |
|
Routine care needs |
Within 6 weeks |
Non-PCP Specialists
|
Patients with. . . |
Should be seen. . . |
|
Emergency needs |
Immediately upon presentation |
|
Persistent symptoms* |
No later than 30 days after their initial contact with the specialist site |
|
Routine care needs (stable condition) |
Within 12 weeks |
For certain specialties with higher demand (such as dental, dermatology, orthodontia, endocrinology and orthopedics), patients with routine care needs should be seen within 16 weeks.
*A member should be seen as expeditiously as the member’s condition warrants base on severity of symptoms. It is expected that, if a provider is unable to see the member within the appropriate timeframe, CareSource will facilitate an appointment with a participating provider or a non-participating provider, if necessary.