Timely Access to Care

Newport Dental Plan shall provide or arrange for the provision of health care services in a timely manner appropriate for the nature of the enrollee’s condition consistent with good professional practice. The Plan shall ensure that providers offer enrollees appointments for covered dental services in accordance with the following requirements:

• Urgent appointments within the dental plan network shall be offered within 72 hours of the time of request for appointment, if consistent with the enrollee’s individual needs and as required by professionally recognized standards of dental practice. Urgent care means health care for a condition that requires prompt attention
• Nonurgent appointments shall be offered within 36 business days of the request for appointment.
• Preventive care dental appointments shall be offered within 40 business days of the request for appointment. Preventive care means health care provided for the prevention and early detection of disease, illness, injury, or another health condition.

Interpreter services shall be coordinated with scheduled appointments for health care services at the time of the appointment without imposing delay on the scheduling of the appointment.

When it is necessary for a provider or an enrollee to reschedule an appointment, the appointment shall be promptly rescheduled in a manner that is appropriate for the enrollee’s health care needs, and ensure continuity of care consistent with good professional practice.