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Provider Access and Availability Requirements

MedStar Family Choice providers must offer hours of operation to MedStar Family Choice members that are no less in number or scope than the hours of operation offered to commercial or other Medicaid patients. Providers are required to offer MedStar Family Choice members appointments within the following timeframes:

  • Well-child assessments, routine and preventative primary care appointments: 30 days from request
  • Routine specialist follow-up appointments: 30 days from request
  • Newborn visits: 3-5 days, if home visit did not occur
  • Lab, X-ray: 30 days from request
  • Urgent care requests: 48 hours from request
  • Initial assessment of pregnant and postpartum women and those requesting family planning services: 10 days from request

Providers must maintain:

  • 24 hour phone coverage
  • Same-day, non-life threatening emergency appointments
  • Urgent Care appointments within 48 hours
  • Routine office visits and physicals within 30 days from request

In addition, it is important that members know how to reach their providers after hours when they have urgent issues. Provider contracts with MedStar Family Choice require all providers to have mechanisms in place for after-hours coverage. Examples of this type of coverage include cell phone numbers, answering services, or pager numbers.

Information current as of: 07/25/17