PROVIDER APPOINTMENT STANDARDS FOR SCHEDULING

Date: 10/14/25

A message for Ambetter providers. Please share with your administrative team.

To ensure our members receive services for medical and behavioral health appointments in a timely manner, below are the Appointment Availability Standards we ask our providers to implement accordingly. These can also be found in the Ambetter Provider Manual.

After Hours – All Providers

• After Hours (Passing Standards)
• Answering service or system that will page physician
• Answering system with option to page physician
• Advice nurse with access to physician
• Answering service that will page the provider after a message is left

PRIMARY CARE & PEDIATRIC

• Urgent Care: Within 24 hours of member’s call
• Non-Urgent/Sick Care: Within 48 hours
• Routine: Within 15 business days of request

SPECIALIST

• Urgent Care: Within 24 hours
• Routine: Within 30 business days

OBGYN

• Urgent Care: Within 24 hours
• Routine: Within 30 business days

BEHAVIORAL HEALTH

• Non-Life-Threatening Psychiatric Emergency: Within 6 hours
• Urgent: Within 48 hours 
• Routine (Initial Assessment): Within 10 business days
• Routine Follow Up Care: Within 10 business days

If you have questions about this bulletin or other provider resources, please contact your Provider Relations Representative or call us at the numbers below:

Ambetter from Sunflower Health Plan (Marketplace): 1-844-518-9505 (TTY 711)