National appointment and availability standards

Q1 Word of Mouth newsletter 2024

Dental Benefit Providers/UnitedHealthcare has the following national standards that apply to contracted providers who participate with the UnitedHealthcare commercial networks:

  • Standards for emergency coverage
  • Standards for Practice capacity and appointment scheduling
  • Standards for walk-in appointments
  • Standards missed appointments

Emergency coverage

All network dental providers must be available to members during normal business hours. You’ll need to provide members access to emergency care 24 hours a day, 7 days a week, through their practice or through other resources (such as another practice or a local emergency care facility).  The out of office greeting must instruct callers what to do to obtain services after business hours and on weekends, particularly in the case of an emergency .

Member Services, Provider Services and Quality Management staff monitor and document all instances of provider unavailability to ensure continuity of care.  UnitedHealthcare conducts periodic surveys to ensure that access and availability standards for members are in compliance with state requirements and UnitedHealthcare standards.  Network dentists are required to participate in all activities related to these surveys . Offices out of compliance will be required to submit a corrective action plan to UnitedHealthcare.

Practice capacity and appointment scheduling

UnitedHealthcare is committed to ensuring that its providers are accessible and available to their members for the full range of services specified in the UnitedHealthcare Provider Agreement and Provider Manual.

Participating providers must comply with any state-mandated appointment scheduling requirements for emergency care as well as elective or routine care appointments.

In states where there are specified access and availability standards, UnitedHealthcare will monitor the access and availability of our participating providers through a variety of methods, including member feedback/surveys, a review of appointment books, spot checks of waiting room activity, investigation of member complaints and random calls to provider offices. Any noted concerns are discussed with the participating provider(s), and corrective action may be taken.

Walk-in appointments

Dental offices that operate by “walk-in” or “first come, first served” appointments are monitored for access and waiting times, where applicable.

Missed appointments

Offices should inform patients of office policies relating to missed appointments and any fees that will be incurred.

  • Appointment scheduling guidelines may vary by state. It is recommended that you confirm whether or not the state in which you’re providing services has any state-specific mandates.
  • Emergency Care appointments would be needed if a patient is experiencing excessive bleeding, pain or trauma
  • Providers are encouraged to schedule member appointments appropriately to avoid inconveniencing the members with long wait times in excess of 30 minutes. Members should be notified of anticipated wait times and given the option to reschedule their appointment.