Access & Availability Annual Provider Survey
Primary Care Providers
Provider Name
*
Organization NPI
*
Location Address
*
If there are multiple addresses, please indicate below if the answers are for all addresses or just one.
Is this survey for one location or all locations?
*
Just one listed above
All contracted locations
Are you accepting new patients at this time?
*
Yes
No
Do you provide telehealth services? (Video and/or phone)
*
Yes
No
Is a regular, routine care visit is available within 30 business days?
*
Yes
No
Is a regular, routine care visit available within 7 - 10 business days?
*
Yes
No
Can a member get a routine care appointment within 48 hours?
*
Yes
No
If a member has an urgent health issue, can they get an appointment within 24 hours?
*
Yes
No
If a member calls with a life-threatening emergency, are they are instructed to call 9-1-1 and/or go to the nearest emergency room?
*
Yes
No
For calls received outside of business hours, are members are instructed on how to access emergency care, how to access an on-call provider, and/or provided instructions for calling back regarding regular, routine care?
*
Yes
No
Once a member checks in, is the average wait time for a routine care appointment less than 15 minutes?
*
Yes
No
Submit
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