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December 2016 Texas Medicaid Provider Procedures Manual

Medicaid Managed Care Handbook : 2 Overview of Medicaid Managed Care : 2.4 PCP/Main Dentist Guidelines for Medicaid Managed Care Clients : 2.4.4 Continuous Access : 2.4.4.1 After-Hours Guidelines

2.4.4.1
PCPs and main dentists are required to have at least one of the following arrangements in place to provide 24‑hour, 7‑day a week access for managed care clients:
The office telephone is answered after-hours by an answering service, which meets language requirements of the major population groups and which can contact the PCP, main dentist, or another designated provider. All calls answered by an answering service must be returned within 30 minutes.
The office telephone is answered after normal business hours by a recording in the language of each of the major population groups served, directing the patient to call another number to reach the PCP, main dentist, or another provider designated by the PCP or main dentist. Someone must be available to answer the designated provider’s telephone. Another recording is not acceptable.
The office telephone is transferred after office hours to another location where someone will answer the telephone and be able to contact the PCP, main dentist, or another designated medical practitioner, who can return the call within 30 minutes.

Texas Medicaid & Healthcare Partnership
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