July 6, 2017
Premera conducts annual surveys and data collection to assess our members' access to care, including timeliness of access to after-hours care, urgent care, and regular and routine care appointments. In recent surveys, we found some providers did not have required after-hours care coverage.
Providers must have coverage for their practices 24 hours a day, 7 days a week. This coverage includes a published after-hours phone number to a pager, answering service, or a recorded message directing members to a physician for after-hours care.
Check and update your after-hours care access/messaging to make sure members are being appropriately directed when your office is closed.
Our provider appointment accessibility standards are based on requirements of the National Committee for Quality Assurance (NCQA) Accreditation Program and Washington Administrative Code 284-170-200(13).
Below are the standards for member access to care that we measure in our monitoring.
Access to Appointments: Primary Care Providers
| Appointment Type |
Standard |
| Regular or routine care appointments |
Within 10 business days |
| Physical exams, preventive care appointments |
Within 30 business days |
| Urgent care appointments |
Within 48 hours |
| After-hours care |
Providers must provide coverage for their practices 24 hours a day, 7 days a week with a published after-hours phone number to a pager, answering service, or recorded message directing members to a physician for after-hours care. |
Access to Appointments: Specialty Care Providers
| Appointment Type |
Standard |
| Regular or routine care appointments |
Within 15 business days |
| Urgent care appointments |
Within 48 hours |
| After-hours care |
Providers must provide coverage for their practices 24 hours a day, 7 days a week with a published after-hours phone number to a pager, answering service, or recorded message directing members to a physician for after-hours care. |
Access to Appointments: Behavioral Health Providers
| Appointment Type |
Standard |
| Behavioral health: Regular or routine care appointments |
Within 10 business days |
| Behavioral health: Urgent care appointment |
Within 48 hours |
| Behavioral health: Care for a non-life- threatening emergency |
Within six hours |
| After-hours care |
Providers must provide coverage for their practices 24 hours a day, 7 days a week with a published after-hours phone number to a pager, answering service, or recorded message directing members to a physician for after-hours care. |
If you have questions about either after-hours care or member access to appointments, see the General Information Section of the Premera Provider Reference Manual (available on the secure provider pages) or contact your provider network executive or provider network associate.