Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerPolicy UpdatesAdministrative/Operational PolicyAmerigroup appointment scheduling policy update | …
    Ask Trek AI about this page
    CurrentAmerigroupPolicy N/A

    Appointment scheduling standards

    Customize your policy alerts

    Sign up for all Amerigroup policy alerts

    Know when Amerigroup releases new policies or updates existing guidance.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    Defines maximum wait times for appointments for Amerigroup Georgia Families and Georgia Families 360° members across primary care, sick visits, maternity care, therapy, specialists, dental and emergency services; applies to participating providers in the referenced Georgia plans.

    Policy Summary
    PayerAmerigroup
    PolicyAppointment scheduling standards
    Policy CodePolicy N/A
    Change TypeNo material change
    Effective DateN/A
    Next Review DateN/A
    Key ActionSchedule member appointments within the specified maximum wait times (e.g., PCP routine ≤14 calendar days; sick visits ≤24 hours; prenatal by trimester as listed).
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    14 daysPCP routine / 1st trimester
    24 hrsSick visits / urgent appointments
    30 daysTherapy / specialists
    20 minUrgent call response
    1 hrOther call response
    10 daysInitial placement screenings (physical/dental)

    Appointment and Access Time Standards

    inv-01: Appointment wait-time criteria

    Covered when ALL of the following maximum wait-time standards apply for Georgia Families and Georgia Families 360°SM members:

    PCP — routine visits: Not to exceed 14 calendar days (PCP routine visit).
    PCP — adult sick visit: Not to exceed 24 clock hours.
    PCP — pediatric sick visit: Not to exceed 24 clock hours.
    Maternity care — first trimester: Not to exceed 14 calendar days.
    Maternity care — second trimester: Not to exceed 7 calendar days.
    Maternity care — third trimester: Not to exceed 3 business days.
    Where noted for unspecified/general contact: Not to exceed 24 clock hours.

    inv-02: Access time criteria

    Maximum allowable scheduling intervals for members:

    Maternity — first trimester: 14 calendar days.
    Maternity — second trimester: 7 calendar days.
    Maternity — third trimester: 3 business days.
    Therapy (physical therapy): Not to exceed 30 calendar days.

    inv-03: Appointment scheduling criteria

    Maximum allowable scheduling timeframes by service and prenatal trimester as stated in these sections.

    Routine appointments: Not to exceed 30 calendar days.
    Prenatal — first trimester: Not to exceed 14 calendar days.
    Prenatal — second trimester: Not to exceed 7 calendar days.
    Prenatal — third trimester: Not to exceed 3 business days.
    Therapy (physical, occupational, speech): Not to exceed 30 calendar days.
    Specialists: Not to exceed 30 calendar days.

    inv-04: Appointment and call response criteria

    Maximum scheduling and response time standards by provider and call type.

    Specialist appointments: Not to exceed 30 calendar days.
    Therapy (physical, occupational, speech): Not to exceed 30 calendar days.
    Routine dental visits: Not to exceed 21 calendar days.
    Urgent dental care: Not to exceed 48 clock hours.
    Elective hospitalizations: Not to exceed 30 calendar days.
    Mental health providers (routine appointments): Not to exceed 14 calendar days.

    inv-05: Initial screenings for children in placement

    Initial screening completion timelines for children placed in care under Georgia Families 360°SM:

    Physical health screening: to be completed within 10 days of placement.
    Dental health screening: to be completed within 10 days of placement.
    Mental health screening: all children four years of age and older shall receive a mental health screening conducted by a licensed mental health professional and completed within 30 days of placement.
    Developmental assessment: all children under four years of age shall receive a developmental assessment conducted by a licensed professional and completed within 30 days of placement.

    Codes and Key Thresholds

    Not specified in this excerptmixed
    No codes listed
    not specifiedmixed
    No CPT/HCPCS/ICD codes present in these chunks
    inv-08: Appointment wait-time thresholds
    PCP (routine visit)Not to exceed 14 calendar days
    PCP (adult/pediatric sick visit)Not to exceed 24 clock hours
    General therapy/specialist appointmentsNot to exceed 30 calendar days
    Maternity care (see trimester-specific thresholds)First trimester: ≤14 calendar days; Second trimester: ≤7 calendar days; Third trimester: ≤3 business days
    inv-09: Maternity scheduling thresholds
    First trimesterNot to exceed 14 calendar days

    Provider Requirements and Operational Highlights

    Note

    No prior authorization specified

    No prior authorization or other authorization rules are specified in this portion of the document.

    Prior Authorization

    Therapy scheduling standard

    Schedule physical therapy appointments so they do not exceed a 30 calendar day wait from request to appointment.

    • Therapy: physical therapists — Not to exceed 30 calendar days.
    Note

    Specialist scheduling timeframe

    Schedule specialist appointments so they do not exceed a 30 calendar day wait from request to appointment.

    Key Terms and Definitions

    inv-16: PCP (routine visit)
    Maximum waitPCP routine visit — Not to exceed 14 calendar days
    ContextApplies to Georgia Families and Georgia Families 360° members for routine primary care appointments
    Source noteSpecified repeatedly in appointment standards table
    inv-17: PCP (sick visit)
    Maximum waitPCP sick visit (adult/pediatric) — Not to exceed 24 clock hours
    ScopeIncludes both adult and pediatric sick visits as listed in provider table
    Reference
    Policy Summary
    PayerAmerigroup
    PolicyAppointment scheduling standards
    Policy CodePolicy N/A
    Change TypeNo material change
    Effective DateN/A
    Next Review DateN/A
    Key ActionSchedule member appointments within the specified maximum wait times (e.g., PCP routine ≤14 calendar days; sick visits ≤24 hours; prenatal by trimester as listed).
    SourceLink
    On This Page
    Appointment and Access Time StandardsCodes and Key ThresholdsProvider Requirements and Operational HighlightsKey Terms and Definitions
    Urgent care provider appointments: Not to exceed 24 clock hours.
    Emergency providers: Immediate availability (24 hours a day, 7 days a week) without prior authorization.
    Scheduled appointment waiting time in office: Shall not exceed 60 minutes; after 30 minutes patient must be given an update with option to wait or reschedule.
    Work-in/walk-in appointment waiting time in office: Shall not exceed 90 minutes; after 45 minutes patient must be given an update with option to wait or reschedule.
    PCP after-hours urgent calls: Shall not exceed 20 minutes for response.
    Other calls (non-urgent): Shall not exceed one hour for response.
    Second trimester
    Not to exceed 7 calendar days
    Third trimesterNot to exceed 3 business days
    • Specialists — Not to exceed 30 calendar days.
    Prior Authorization

    Emergency services availability

    Provide emergency services immediately; emergency care is available 24 hours a day, seven days a week and does not require prior authorization.

    • Emergency providers — Immediately (24 clock hours a day, seven days a week) and without prior authorization.
    Documentation Required

    Call response time standards

    Answer urgent telephone calls within 20 minutes and all other calls within one hour.

    • Urgent calls — Shall not exceed 20 minutes.
    • Other calls — Shall not exceed one hour.
    Documentation Required

    Initial screenings timeline

    Complete required initial screenings for children placed in care within the stated timeframes: physical and dental within 10 days; mental health screening (age ≥4) and developmental assessment (under 4) within 30 days.

    • Physical health screening — Within 10 days of placement.
    • Dental health screening — Within 10 days of placement.
    • Mental health screening (children ≥4) — Completed within 30 days of placement by a licensed mental health professional.
    • Developmental assessment (children <4) — Completed within 30 days of placement by a licensed professional.
    Repeated across appointment standards sections
    inv-18: Maternity care
    DefinitionMaternity care appointment timing standards vary by trimester
    ApplicationStandards apply to prenatal scheduling for Georgia Families and Georgia Families 360° members
    Related thresholdsSee trimester-specific timeframes (first/second/third) for exact limits
    inv-19: Maternity appointment timeframes
    First trimesterNot to exceed 14 calendar days
    Second trimesterNot to exceed 7 calendar days
    Third trimesterNot to exceed 3 business days
    inv-20: Therapy appointment timeframe
    Therapy (physical/occupational/speech)Not to exceed 30 calendar days
    SpecialistsNot to exceed 30 calendar days
    Routine appointments (general)Not to exceed 30 calendar days
    inv-21: Appointment scheduling timeframes
    Prenatal scheduling by trimesterFirst: 14 calendar days; Second: 7 calendar days; Third: 3 business days
    Therapy/specialist visitsNot to exceed 30 calendar days
    Routine appointment standardGeneral routine appointments not to exceed 30 calendar days
    inv-22: Waiting time / Appointment waiting time
    Scheduled appointment waiting timeShall not exceed 60 minutes (update after 30 minutes with option to wait or reschedule)
    Work-in/walk-in appointment waiting timeShall not exceed 90 minutes (update after 45 minutes with option to wait or reschedule)
    ApplicabilityApplies to on-site waiting room times for scheduled and walk-in visits
    inv-23: After-hours call response times
    Urgent calls (after-hours)Shall not exceed 20 minutes for return/response
    Other callsShall not exceed one hour for response
    ContextStandards apply to PCP after-hours returned calls and call response handling
    inv-24: Urgent calls
    Response timeTelephone calls requiring urgent response shall not exceed 20 minutes
    ScopeCovers urgent telephone calls to PCPs (after-hours response standard)
    Source noteRepeated in call type sections of appointment standards
    inv-25: Other calls
    Response timeTelephone calls not classified as urgent shall not exceed one hour for response
    ApplicationApplies to PCP after-hours returned calls and other non-urgent communications
    DocumentationStandard reiterated across call type sections
    inv-26: Initial screenings
    Physical health screeningTo be completed within 10 days of placement
    Dental health screeningTo be completed within 10 days of placement
    Mental health screening / developmental assessmentChildren ≥4 years: mental health screening by licensed professional within 30 days; Children <4 years: developmental assessment by licensed professional within 30 days