Provider Appointment Availability Standards
Date: 02/19/25
To ensure our Wellcare and Wellcare by Allwell members receive services for medical and behavioral health appointments in a timely manner, we ask providers to implement the following Appointment Availability Standards. These standards can also be found in your provider manual.
After hours, all providers must adhere to the below passing standards:
- Answering service or system that will page physician
- Answering system with option to page physician
- Advice nurse with access to physician
- Answering service that will page the provider after a message is left
Additionally, Wellcare and Wellcare by Allwell plan providers must adhere to the below Appointment Availability Time Frames:
| Primary Care | |
| Emergency | Same day or within 24 hours of member’s call |
| Urgent care | Within 24 hours |
| Routine | Within 30 business days of request |
| Sick care | Within seven business days |
| Behavioral Health | |
| Non-life-threatening psychiatric emergency | Within six hours |
| Urgent care | Within 48 hours |
| Routine (initial assessment) | Within 10 business days |
| Routine follow-up care | Within 30 business days of assessment |
| Sick care | Within seven business days |
| Specialty Referral | |
| Emergency | Within 24 hours of member’s call |
| Urgent care | Within 24 hours |
| Routine | Within 30 business days |