Access to Care Standards
May 1, 2023, 7:26 pm
Cox HealthPlans (CHP) is committed to ensuring that members have access to and receive primary care and behavioral health services in a timely manner. Standards are also in place for telephone access to member services. CHP monitors access through a variety of measures, including appointment and office wait times, complaints, and responses from our member satisfaction surveys.
Access and availability standards are shared with members and providers through Provider Manuals and Member Handbooks. CHP monitors access and availability performance and completes a thorough analysis to check for concerns or opportunities for improvement each year, taking action as needed to improve access to care.
CHP’s access standards and measures are outlined in the table below.
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Access Standards |
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Practitioner Type |
Standard |
Source of data/goal |
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Medical Care |
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Regular and routine care |
An appointment within 30 days |
CHP member satisfaction survey Q5, CAHPS Q7, Review of member Complaints |
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Routine, symptomatic care |
An appointment within one (1) week or five (5) business days |
CHP member satisfaction survey Q3, CAHPS Q5, Review of member Complaints |
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Urgent care |
An appointment within 24 hours |
CHP member satisfaction survey Q3, CAHPS Q5, Review of member Complaints |
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Obstetrical care |
An appointment within one (1) week for enrollees in the first or second trimester of pregnancy and within three (3) days for enrollees in the third trimester |
Review of member complaints
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After-hours care |
After- hours care is available to members through later clinic hours and walk-in clinics |
90% on after-hours call audit, Review of member complaints |
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Behavioral Health |
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Routine care |
Within 30 days |
Review of hours for behavioral health, Review of member complaints |
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Urgent care |
Within 48 hours |
Review of hours for behavioral health and urgent care, Review of member complaints |
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Non-life-threatening emergency care |
Within 6 hours |
Immediate ER Access, Review of member complaints |
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Life-threatening emergency care |
24 hours / 7 days per week |
Immediate ER access |
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Plan Member Services |
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Telephone access to member services |
Call answered within 60 seconds, Call abandonment less than 5%
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Telephone system reports |