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September 2025 Top of Mind

LA: Are you providing the required timely care to members?

As an Optum behavioral health network provider, you’re the first step in connecting UnitedHealthcare Community Plan of Louisiana members with timely mental health care and resources.

Review the contractually required standards for appointment access to ensure you’re meeting them: 

Care Type Appointment Availability Standard
Non-urgent routine care 14 days
Urgent, non-emergency care 48 hours
Psychiatric inpatient hospital (emergency involuntary) 4 hours
Psychiatric inpatient hospital (voluntary) 24 hours
Psychiatric inpatient hospital (emergency involuntary) 24 hours
ASAM levels 3.3, 3.5 and 3.7 10 business days
Withdrawal management 24 hours when medically necessary
Psychiatric residential treatment facility (PRTF) 20 calendar days
Emergent, crisis or emergency behavioral health services Must be available at all times and appointments within 1 hour of request
Outpatient behavioral health or substance abuse care after inpatient discharge Within 7 days of acute inpatient discharge

 

Additional Optum appointment standards

  • Appointment wait time: Patient appointment wait time in your office should be 45 minutes or less – including waiting room and consultation room wait times
  • Provider delays: Members should be alerted immediately to any provider delays
    • If the provider is anticipated to be longer than 90 minutes, members should be offered a new appointment time
    • Rescheduled appointments should consider the member’s health care needs and follow continuity of care best practices
  • Walk-in appointments: Providers should see members seeking walk-in appointments for non-urgent needs, if possible. If patients can’t be seen, they should be scheduled for a future appointment consistent with written scheduling procedures.
  • Appointment access compliance and after-hours coverage: We routinely monitor member complaints and assess phone logs for appointment availability to ensure compliance and continuous improvement
  • Referrals: If you are unable to accept a referral, please ask the member to contact us at 1-866-675-1607 to obtain a new referral

Questions? 

You can find the Louisiana Medicaid appointment access standards in the Louisiana Medicaid Provider Network Manual (pages 31-33).

You may also email networkse@optum.com or contact your Provider Relations Advocate.


 

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