Access & availability standards
AmeriHealth New Jersey (AmeriHealth) is committed to maintaining an adequate network of primary and specialty care providers to meet the needs and preferences of its members. To ensure access and availability to care, AmeriHealth has established standards for the number and distribution of providers in our networks as well as timeliness of care. Each year, AmeriHealth assesses how effectively our networks ensure appropriate access and availability of care to our members.
Our access and availability standards, which participating providers should adhere to, are summarized below:
In the event of an emergency, or immediate need, members should call 911 or go to the nearest emergency room.
For non-life-threatening urgent care needs, an urgent care center, retail health clinic, or telemedicine visit may be an appropriate alternative for care if a primary care provider is unavailable. Members can use the Find a Doctor tool or visit MDLive›s website to learn more about these alternatives.
|Access Type||Appointment Availability Within|
(4 weeks for routine physical)
Office hours, patient scheduling, & waiting times
Practices are encouraged to have at least one weekend day or evening session per week.
The maximum number of patients scheduled per hour per physician should not exceed four for primary care providers or most specialists.
Waiting times in the office should not exceed 30 minutes from the time of the scheduled appointment.
Providers should respond to after-hours urgent/emergency problems within 30 minutes. Coverage must be provided 24 hours per day, 7 days per week for our members. Providers who use answering machines for after-hour services are required to include:
- Urgent/emergent instructions as the first point of instruction
- Information on contacting a covering provider
- Telephone number for after-hours physician access
Providers can view the Provider Manual for Participating Professional Providers, available through the NaviNet® web portal (NaviNet Open), for additional information on appointment availability requirements, the minimum number of office hours per week and the maximum number of patients scheduled per hour per provider by practice and provider type.