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Standards for Medicaid Appointment Scheduling

Sunshine Health wants to ensure appointments for medical and behavioral health services are available to all our members on a timely basis. The following Appointment Availability standards can also be found in the Provider Manual (PDF). Please ensure these standards are implemented by your organization.

After Hours Passing Standards:

  • Answering service or system that can contact a physician. Member should receive a response within 30 minutes.
  • Advice nurse with access to physician.
  • Office telephone that transfers calls to a cell phone; or any method that ensures 24-hour phone access for members.

Provider Office Wait Times

  • 30 minutes maximum

  • Urgent Visit: 48 Hours
  • Sick Visit: 7 days
  • Routine Wellness Exam: 30 days

  • Urgent Visit: 48 hours
  • Sick Visit: 7 days
  • Follow-Up After Physical Health Admission: 7 days
  • Ancillary Services: 14 days
  • Routine Prenatal Exam: Within 4 weeks until week 32; every 2 weeks until week 36; and every week after, up until delivery.
  • Routine Wellness Exam: 60 days

  • Non-life-threatening emergency: 6 hours
  • Urgent Visit: 48 hours
  • Initial Visit for Routine Care: 10 day
  • Follow-Up Routine Care: 30 days
  • Follow-Up after Behavioral Health Hospital Admission: 7 days (Scheduled prior to discharge)

Resources & Tips

Available 365 days a year.

Non-urgent sign language and language interpreter services

Confidential, free, 24/7/365 support from a trained counselor for mental health, substance use or suicidal crisis.

Telehealth Offerings

Scheduling around a 4-day work week? Alternate between staff members. Providers are encouraged to utilize their own telehealth platforms, if available.

Virtual mental health services;must be 13 years of age and up.

Pediatric clinicians available 24/7;must be under 18 years of age.

  • Visit the KidzDocNow website
  • Available to these members: Sunshine Health Medicaid (MMA); Children’s Medical Services (CMS) Health Plan; Child Welfare Specialty Plan (CWSP)

Virtual healthcare; available to all ages.