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Ambetter Provider Standards for Appointment Scheduling

Ambetter from Sunshine Health (Marketplace) 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. Please ensure these standards are implemented by your organization.

All Providers (from 5 p.m. to 8 a.m. and all weekends and holidays).

  • 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.

30 minutes maximum

  • Urgent Visit: 24 hours
  • Pediatric Sick Visit: 24 hours
  • Adult Sick Visit: 48 hours
  • Routine Visit: 30 business days

  • Routine Visit: 30 business days

  • Non-life-threatening emergency: 6 hours
  • Urgent Visit: 48 hours

Resources & Tips

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

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

Virtual healthcare; available to all ages.