ExchangeAdministrativeMedium impact
Review appointment availability for Exchange plan members
UnitedHealthcare·AL, AZ, FL, IN, IA, KS, LA, MI, MS, MO, NE, NC, OH, OK, SC, TN, TX, WI, WY · General Practice, Psychiatry·Network News
We identified it
Aug 2, 2026
Summary
UnitedHealthcare has implemented CMS-mandated appointment wait time standards for Individual Exchange plan members in 19 states. Participating providers must ensure appointment availability within 10 business days for behavioral health, 15 for primary care, and 30 for specialty care. Practices must monitor scheduling compliance and document capacity barriers if standards cannot be met.
Action Required
Immediately: Front desk and scheduling staff must review current appointment availability in practice management system for all Exchange plan member appointments. By ongoing compliance: (1) Scheduling team must monitor next available appointment dates against CMS standards (behavioral health 10 business days, primary care 15 business days, specialty care 30 business days); (2) Adjust scheduling templates and appointment capacity if wait times exceed standards; (3) Document all operational or capacity-related barriers and corrective actions taken; (4) Billing/compliance team should flag any Exchange plan members who cannot be scheduled within required timeframes for provider escalation. Failure to maintain compliance may result in UnitedHealthcare taking corrective actions and potential loss of network adequacy compliance status, affecting contract status.