*  Missed appointments by the member must be followed-up by the provider.

The CarePlus Member Services Department will assist the Provider in this process if necessary. If the patient does not go to the previously scheduled appointment without prior cancellation, Provider must document within the medical records.  A Provider may charge a fee for missed appointments,  provided  such fees apply uniformly and at the same amount for all Medicare and non-Medicare patients.


To ensure accessibility and availability of health services to plan members, the following standards have  been set forth by the Centers for Medicare & Medicaid Services (CMS):

*  Urgently needed services or Emergency – immediately.
 *   Non-urgent, but in need of attention – within one (1) week.

* Routine and Preventive Care – within 30 days. Non-emergent complaints that do not restrict a member’s activity or are chronic in nature.

*   Provider  agrees  to  maintain  hours  that  do  not  discriminate  against  Members’  accessibility  to   Provider.

In addition, CarePlus recommends the following standards for all physicians:

 *  Response to urgent calls within 15 minutes; response to routine calls within 24 hours.

*  After hours, response to urgent calls within 15 minutes; nonurgent response in 30 minutes.

 *  The average wait time should not exceed 60 minutes from the scheduled appointment time. This includes  time  spent  both  in  the  waiting  and  examination  room  prior  to  being  seen  by  the physician.  In  the  case  of  an  unexpected  emergency,  which  may  cause  this  standard  to  be exceeded,  the  member  should  be  promptly  notified  and  given  the  option  of  waiting  or rescheduling.

By monitoring compliance with these guidelines over time, CarePlus can take action to improve member  service availability and access to medical services when necessary. CarePlus may monitor compliance  with  the  above-mentioned  access  standards  through  a  variety  of  ways  including  site  visits,  telephone  audits, member surveys and complaints.