When patients receive the right care at the right time, it can result in better health outcomes and an improved care experience. California HMO network-participating providers play an important role in helping members receive medically necessary physical and behavioral health care within required appointment access standards. These timely access requirements support member health outcomes, improve the care experience, and are reflected in the California provider access expectations and provider agreement requirements of Cigna Healthcare^®.

Timely appointment access standards

The California Department of Managed Health Care (DMHC) sets appointment access standards for medical and behavioral health services based on member needs and service type.

Please use the graphic below as a quick visual reminder of appointment access standards based on the urgency of the patient’s need and the type of service requested.

Timely access to care requirements*

Reprinted with permission from the Department of Managed Health Care; graphic adapted only to clarify terminology.

Annual Provider Appointment Availability Survey (PAAS)

The DMHC monitors timely access compliance through the annual Provider Appointment Availability Survey (PAAS). Health plans must follow the DMHC methodology when measuring and reporting access compliance. Each year, selected Cigna Healthcare network-participating providers may be asked to participate. Your timely participation and accurate appointment availability information supports California access compliance and ongoing access-to-care monitoring.

Arranging medically necessary out-of-network care

When medically necessary covered care is not available from a participating provider within California’s required time and geographic access standards, providers and medical groups should help arrange timely care with another appropriate provider. This may include arranging out-of-network care when necessary.

Use the contracted Division of Financial Responsibility (DOFR) to determine the correct process. If Cigna Healthcare is financially responsible for the service, fax a Network Exception Request form to 800.558.3710. If the service is the responsibility of your medical group and affiliated physicians, the Network Exception Request form is not required.

Language assistance services

Free interpreter services are available for members who need language assistance at the time of their appointment. Call the telephone number on the member’s Cigna Healthcare ID card for assistance.

Resources

For more information about California timely access standards and related provider requirements, refer to the resources below.

Thank you for supporting timely access to care. Consistent appointment availability helps members receive appropriate care when needed and supports compliance with California timely access requirements.

Questions? We’re here to help.

Please reach out to Access2Care@Cigna.com.

*Appointment wait times are measured from the date of request for an appointment.