Behavioral Health Appointment Standards
Sets maximum wait-times for scheduling behavioral health appointments and describes the access complaint and referral process for members who cannot schedule within those timeframes. Applies to Fidelis Care (Wellcare By Fidelis Care) members seeking behavioral health services.
No material clinical or coverage changes in this revision.
Behavioral Health Appointment Wait-Time Standards
Behavioral health appointment standards and remedies
Covered when the following appointment wait-time standards and access-remedy processes are followed:
ALL of the following
Initial appointment (10 business days)
- Initial appointment with an outpatient facility or clinic: maximum wait 10 business days.
- Initial appointment with a behavioral healthcare professional who is not employed by or contracted with an outpatient facility or clinic: maximum wait 10 business days.
Follow-up / Non-urgent (5 business days)
- Follow-up visit after a mental health or substance abuse emergency room (ER) or inpatient visit: maximum wait 5 business days.
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