Access, Availability & After-Hours Coverage Standards

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Access, Availability & After-Hours Coverage Standards

ConnectiCare is committed to helping our members stay healthy, get well, and receive health care services in a timely manner. Providers are expected to have procedures in place to see patients within the following time frames and provide 24-hour accessibility as outlined below.

We evaluate our contracted providers’ compliance with these access and availability standards through audits.




Urgent care

Within 48 hours

Non-Urgent appointments for primary care

Within 10 business days

Non-Urgent appointments for specialist care

Within 15 business days

Non-Urgent for non-physical mental health

Within 10 business days

Non-Urgent for ancillary services

Within 15 business days




  • All network practitioners must be available, either directly or through coverage arrangements, 24 hours a day, 7 days a week, 365 days a year.
  • Availability must be by live voice direct to the practitioner or covering practitioner, or via an answering service that can reach the practitioner or covering practitioner.
  • If an answering machine is used, it must provide an option for the member to directly contact the practitioner or covering practitioner in case of emergencies.
  • An answering machine cannot simply refer the member to an emergency room unless it is a life-threatening issue.



Tips for ensuring compliance with requirements:

  • Periodically review the access and availability standards with your appointment schedulers.
  • Conduct your own secret shopper audits (evaluate a random sample of practices annually).
  • Monitor practices that did not meet these standards. Implement corrective action plans to ensure compliance.