Supporting timely access to care: Resources for California HMO providers

REQUIREMENTS: Immediately: (1) Review and ensure front desk/scheduling staff understand California DMHC appointment access standards for medical and behavioral health services based on urgency levels (emergent, urgent, routine, preventive). (2) Update scheduling systems and protocols to document appointment request dates and measure wait times in compliance with DMHC methodology. (3) Establish workflow for when medically necessary care is unavailable within required timeframes: determine financial responsibility via Division of Financial Responsibility (DOFR), then submit Network Exception Request form to Cigna at fax 800.558.3710 if Cigna is financially responsible. (4) Train staff that language assistance services are available free to members—direct them to call the number on their Cigna ID card. (5) Ensure providers participate in the annual Provider Appointment Availability Survey (PAAS) when contacted; accurate and timely responses are required for compliance monitoring. (6) Contact Access2Care@Cigna.com with questions. Note: Failure to meet timely access standards or participate in PAAS surveys may trigger compliance violations and potential contract penalties under Cigna Healthcare provider agreements.