region/plan-specific news
: Commercial Health Plans in AZ, DC, DE, FL, GA, IL, MD, NJ, OH, PA, TX, VA
Timeliness of member access to care improves, but not for urgent cases
Survey shows that provider appointments aren't consistently available within standards
Magellan has reviewed the results of its 2021 Provider Accessibility Survey—applicable to the Magellan center managing member care in the states listed above—and found that the timeliness of member access to care has improved from the prior year. However, many providers still are not meeting the accessibility targets for members in crisis, i.e., urgent and emergent cases.
Magellan’s timeliness standards for access to care—which are crucial elements of quality member service, are the following for individual practitioners:
- Non-life-threatening emergent appointments: The member is seen within 6 hours of their request.
- Urgent appointments: The member is seen within 48 hours of their request.
- Initial routine appointments: The member is seen within 14 days of their request.
- Follow-up routine appointments: The member is seen within 30 days for non-prescribers, and within 90 days for prescribers.
The summary graph below outlines accessibility results by type of provider. Areas needing improvement appear in bold. Note that “prescribers” are psychiatrists and non-psychiatrist physicians.
Provider appointment accessibility rates for 2021 and 2020
The tabulated results show that network providers of all types should improve their capacity to make appointments for non-life-threatening emergency care, and for urgent care, more accessible to members needing these services. This could entail reviewing your operations and capacity to ensure that your practice meets the timeliness standards outlined above. Meeting the access standards is required by your Magellan provider agreement.
Finally, remember to keep your availability up to date. Sign in to MagellanProvider.com, select Display/Edit Practice Information, and attest to the accuracy and currency of your practice data.