Claims Submissions and Reimbursement

Clinical Laboratory Claims

Horizon BCBSNJ members should use participating laboratories to be covered at the highest level of benefits and incur the lowest out-of-pocket expense. Horizon HMO members (including Medicare Advantage and Horizon NJ Health members) must use LabCorp or AtlantiCare Clinical Laboratories to be eligible for benefits. Horizon POS (including NJ DIRECT) and Horizon Direct Access members should use LabCorp or AtlantiCare Clinical Laboratories to receive in-network benefits. If members choose to receive out-of-network services they should use a participating PPO laboratory or a participating hospital outpatient laboratory to incur lower out-of-pocket expenses. Participating managed care and PPO laboratory locations can be viewed on our online Provider Directory at <www.HorizonBlue.com>. Improved cash flow by eliminating mail time and check float. Elimination of bank fees for check deposits. Please note: EFT will only be used by Horizon BCBSNJ to make deposits into your designated accounts. We will not withdraw any amounts from these designated accounts. Enrolling in EFT requires that you receive online Explanation of Payments (EOPs) in place of paper statements. To sign up for EFT, registered users of NaviNet may: Visit www.NaviNet.net and sign in by entering your User Name and Password. Select Horizon BCBSNJ within the Plan Central dropdown menu. Click Claim Management. Click EFT Registration. We will perform two test deposits into the bank account you indicate. Once you confirm that the tests were successful, it takes only two to four business days before EFTs begin. If you have questions about EFT or EFT registration, please call our e-Service Helpdesk at 1-888-777-5075. You can also e-mail questions to the e-Service Helpdesk at <Provider_Portal@HorizonBlue.com>. If you are not registered with NaviNet, visit www.NaviNet.net and click Sign up. If you have questions about NaviNet registration, please call NaviNet Customer Care at 1-888-482-8057. Please note that payments generated from our dental claim processing system will still be made via paper check, even for those who sign up for EFT. We will keep you apprised of our progress toward generating EFTs from our dental claim processing system in our Blue Review newsletter.

Electronic Funds Transfer

Horizon BCBSNJ requires all participating physicians and other health care professionals to register for Electronic Funds Transfer (EFT) upon joining our networks. We require all participating physicians and other health care professionals to be enrolled in EFT no later than April 15, 2012. To meet this compliance date, we encourage initiating EFT registration no later than March 30, 2012. Horizon BCBSNJ reserves the right to re-evaluate the participation status of physicians and other health care professionals who do not comply with this requirement. The benefits of EFT include: Elimination of paper checks to track and deposit. Reduction in paperwork and administrative costs. Reduction in the opportunity for error/theft. Quicker reimbursement into one or more designated bank accounts.

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Reimbursement Requests for Under- and Overpayments
The New Jersey state law, known as the Health Claims Authorization, Processing and Payment Act (HCAPPA), effective July 11, 2006, affects physicians, other health care professionals and facilities. This law applies to all insured New Jersey group and individual business. HCAPPA requirements do not apply to certain lines of business, such as self-funded business, including Administrative Services Only (ASO) accounts such as the New Jersey State Health Benefits Program (SHBP) and School Employees Health Benefits Program (SEHBP). Overpayment Health insurers may only seek reimbursement for overpayment of a claim from a physician or health care professional within 18 months after the date the first payment on the claim was made. There can only be one reimbursement sought for overpayment of a particular claim. All claims paid on or after July 11, 2006 are subject to this requirement. However, recapture of an overpayment, beyond the 18-month period, is permitted if there is evidence of fraud, a physician or health care professional with a pattern of inappropriate billing submits the claim, or the claim is subject to COB. Recapture of overpayments by a health insurer may be offset against a physicians future claims if a notice of account receivable is provided at least 45 calendar days in advance of the recapture, and all appeal rights under HCAPPA are exhausted. An offset will be stayed pending an internal appeal and state-sponsored binding arbitration. However, with prior written consent, Horizon BCBSNJ will honor requests for the recapture prior to the expiration of the 45-day period. If a physician or health care professional prefers to make payment directly to Horizon BCBSNJ rather than permit an offset against future claims, the 45-day notice letter will include an address to remit payment. Horizon BCBSNJ may extend the notice period up to 90 days. The decision to offer an extended notice period will be made on a case-by-case basis. Please note that Horizon BCBSNJ will not recapture an overpayment until the expiration of the notice period (except with a physicians or health care professionals prior written consent, or if a physician or health care professional remits payment directly to Horizon BCBSNJ). Both the paper voucher and the electronic (HIPAA standard 835 transaction) version of the voucher, if applicable, will reflect the adjustment as soon as it is recorded. In the event that Horizon BCBSNJ has determined that an overpayment is the result of fraud and has reported the matter to the Office of the Insurance Fraud Prosecutor, HCAPPA allows a recapture of that overpayment to occur without the 45-day notice period. Underpayment Under HCAPPA, no physician or other health care professional may seek reimbursement from a member/patient or health insurer for underpayment of a claim submitted later than 18 months from the date the first payment on the claim was made, except if the claim is the subject of an HCAPPA appeal submitted or the claim is subject to continual claims submission. No physician or other health care professional may seek more than one reimbursement for underpayment of a particular claim.

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PCP Billable Services
In addition to capitation, PCPs may bill for some special services. You will receive fee-for-service reimbursement for these services. To make information more accessible to our Primary Care Physicians (PCPs), we have made current lists of billable services available on our website. Billable services for capitated PCPs identifies the special services and immunizations that capitated PCPs may bill for and receive fee-for-service reimbursement, in addition to their capitation payment. Billable services for fee-for-service PCPs identifies the eligible services that a fee-for-service PCP* may bill for and receive reimbursement. Visit www.HorizonBlue.com/Providers to view, print or download these lists. Mouse over Forms and Vouchers and click Provider Reference Materials. Click Reimbursement and Billing. Click PCP Billable Lists. If you have questions about these lists, please contact your Professional Relations Representative. * PCPs who have fewer than 250 members on their panel are reimbursed fee for service for all eligible services. Your panel size at the end of the year will determine your reimbursement (fee-for-service or capitation) for the following year. For example, if your panel has 249 members or fewer at the end of the year, you will become a fee-for-service PCP throughout the following year, regardless of any fluctuation in your panel size during the year. Your reimbursement method will be re-evaluated at the end of each year.

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Out-of-network requests for all Horizon HMO or Horizon EPO members. For Horizon POS members, prior authorization is required for a hospital-based activity or if a service request is for the in-network level of benefits for a service that would otherwise be covered at the out-of-network level (in addition to the services described in this list). Outpatient testing, including but not limited to: Psychological/developmental/ neuropsychological testing. Neurobehavioral status exam. Pain management. Out-of-network hemodialysis for Horizon HMO members. Physical therapy. Private duty nursing. Sinus surgery, rhinoplasty and rhytidectomy. Specialty pharmaceuticals such as Botox, IVIG, Flolan. Transplant services except corneal transplants. Trigger point injections. UPPP (Uvulopalatopharyngoplasty). Vein stripping/sclerotherapy. STAT lab testing in the outpatient department of a hospital requires prior authorization. Routine laboratory tests must be performed by LabCorp or AtlantiCare Clinical Laboratories. Listing current at time of printing.

Online Prior Authorization Lists

Lists of services and supplies requiring prior authorization are available on our website. Accessing this information online will save you time by eliminating the need to call Physician Services to confirm whether or not prior authorization is required for particular services. To access our prior authorization lists, go to www.HorizonBlue.com/Providers and: Mouse over Forms and Vouchers and click Provider Reference Materials. Click Utilization Management. Click the link under the Prior Authorization Lists heading. Click the product or group in question to review the appropriate prior authorization list.

Obtaining Authorization
To obtain authorization, please call our Utilization Management Department at 1-800-664-BLUE (2583). Please note that retroactive authorizations will not be granted. As a participating physician or other health care professional, it is your responsibility to make sure all authorization procedures are followed. If authorization is needed for services you are referring for or rendering and no authorization is obtained, claim payment may be limited or denied, and if denied the member may not be billed for the service.

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Horizon Medicare Advantage Products
We are an approved Medicare Advantage (MA) Organization and offer three products for our Medicare beneficiaries. Members may choose Horizon Medicare Blue Value or Horizon Medicare Blue Access in place of Medicare Parts A and B. These products are offered to individuals and group account members. New Jersey residents who are eligible for both Medicare and Medicaid coverage may, begining January 1, 2012, choose to enroll in our new Special Needs Plan (SNP), Horizon Medicare Blue TotalCare (HMO-SNP). Horizon Medicare Blue Value (HMO) This HMO plan requires members to choose a Primary Care Physician (PCP). Members receive benefits at an in-network level only. Referrals are needed for additional services. Members enrolled in this plan use the Horizon Managed Care Network. Members can select one of the following to convert Medicare Advantage to Medicare Advantage with Prescription Drug coverage Horizon Medicare Blue Value w/Rx Standard (HMO). Horizon Medicare Blue Value w/Rx Enhanced (HMO). Horizon Medicare Blue Access (HMO-POS) This point of service plan gives members the option of selecting a PCP. However, if a PCP is not selected, the member incurs higher copayments. Members can receive benefits at in- and out-of-network levels. No referrals are needed for additional services. Members enrolled in this plan use the Horizon Managed Care Network. Members can select one of the following to convert Medicare Advantage to Medicare Advantage with Prescription Drug coverage: Horizon Medicare Blue Access w/Rx Standard (HMO-POS). Horizon Medicare Blue Access w/Rx Enhanced (HMO-POS). Horizon Medicare Blue TotalCare (HMO-SNP) This Special Needs Plan (SNP) is available to New Jersey residents who are eligible for both Medicare and Medicaid coverage effective January 1, 2012. This $0 premium plan is designed to provide more focused and specialized health care to plan eligibles. This plan provides benefits for all medically necessary and preventive care services covered under Medicare Part A, Medicare Part B and Medicaid. This plan also provides benefits for prescription drugs and medications eligible under Medicare Part B, Medicare Part D and Medicaid. Well Care Our Medicare Advantage products cover services coded as preventive, such as prostate screening and gynecological exams (subject to plan limitations). These services can be obtained without a referral receipt from the PCP when provided by participating physicians and other health care professionals. Chiropractic Care Our Medicare Advantage members may go directly to participating chiropractors for manual manipulation of the spine to correct subluxation that can be demonstrated by X-ray. This means they do not require a referral receipt from their PCP to visit a participating chiropractor. Members are also eligible for an unlimited amount of chiropractic visits per year. X-rays ordered by chiropractors are not covered. Prior Authorization is required for chiropractic services provided to members enrolled in our Horizon Medicare Advantage TotalCare (HMO-SNP) plan. Case Management New members are asked to complete and return a health assessment questionnaire within one month of enrolling in any of our Medicare Advantage products. Members identified as high risk are assigned a case manager to help you coordinate the members care. Copayments and Coinsurance Our Medicare Advantage members may have

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various office visit copayments. In other health care settings, coinsurance may be required. Copayment amounts and coinsurance percentages, if applicable, are printed on the members ID card. Note: Members enrolled in our Horizon Medicare Advantage TotalCare (HMO-SNP) plan have no cost sharing responsibilities for any services they receive. Dual Eligibles CMS has issued new requirements for Dual Eligibles (members who are enrolled in both a Horizon BCBSNJ Medicare Advantage [MA] program and in the states Medicaid program as a full-benefit dual eligible or Qualified Medicare Beneficiary [QMB]) and to all dual eligible categories for which the state provides coverage and chooses to protect beneficiaries from the cost sharing for Medicare Part A and Part B services. Effective January 1, 2010, Horizon BCBSNJ participating physicians and other health care professionals may not seek to collect copayments or other cost sharing from Dual Eligible enrollees who are enrolled in Horizon BCBSNJs Medicare Advantage plans when the state is responsible for paying those amounts. Participating physicians and other health care professionals may bill the appropriate state source for those amounts. Please also see page 102 for important information about appeals for Dual Eligible members enrolled in our Horizon Medicare Advantage TotalCare (HMO-SNP) plan. Emergency and Urgent Care Definitions For our Medicare Advantage products, a medical emergency is a medical condition manifesting itself by acute symptoms of sufficient severity (including, but not limited to, severe pain) such that a prudent layperson, with an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in: (a) Serious jeopardy to the health of the individual or, in the case of a pregnant woman, the health of the woman or her unborn child, (b) Serious impairment of bodily functions, or (c) Serious dysfunction of any bodily organ or part. Emergency services include a medical emergency screening examination and inpatient and outpatient services that are needed to stabilize an emergency medical condition. For our Medicare Advantage products, urgently needed services are those services required to prevent a serious deterioration of a covered persons health that results from an unforeseen illness, injury or condition that requires care within 24 hours. Medical Record Retention Physicians and other health care professionals are required to maintain medical records for a minimum of 10 years for all Medicare Advantage members. Medical Necessity Determinations The medical necessity review and determination process for Horizon Medicare Advantage products is different than that of other managed care products. If you or the member disagrees with a coverage determination we have made, the decision may be appealed. We have up to 14 days to determine whether an initial request for a service is medically appropriate and covered. If additional clinical information is required, we may have up to an additional 14 days to make a determination. In some cases, the standard pre-service review process could endanger the life or health of the member. As a participating physician or other health care professional, you may request an expedited 72-hour pre-service determination for a Medicare Advantage patient if, in your opinion, the health or the ability of your patient to function could be harmed by waiting for a medical necessity determination. Expedited determinations may be requested by calling 1-800-664-BLUE (2583).

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Non-expedited determinations may be requested in writing to: Horizon Medicare Advantage Utilization Management Department Appeals Coordinator Three Penn Plaza East, PP-14J Newark, NJ 07105-2200 Fax: 1-877-798-5903 Medicare Part D Prescription Drug Determinations Requests for a coverage determination will be responded to within 24 hours for an expedited request (or sooner if the members health requires us to) or within 72 hours for a non-expedited coverage determination. Part D drug coverage determinations include: Prior authorization determinations for those drugs that require prior authorization. Requests that we cover a Part D drug that is not on the plans List of Covered Drugs (Formulary). Requests that we waive a restriction on the plans coverage for a drug, including: - Being required to use the generic version of a drug instead of the brand name drug. - Being required to try a different drug first before we will agree to cover the drug you are asking for. (This is sometimes called step therapy.) - Quantity limits. For some drugs, there are restrictions on the amount of the drug you can have. Requests that we pay for a prescription drug the member already purchased (a coverage decision about payment). Expedited Medicare Part D drug determinations may be requested by calling 1-866-884-9477. Non-expedited Medicare Part D drug determinations may be requested in writing to: Caremark Medicare Appeals Department MC 109 PO Box 52000 Phoenix, AZ 85072-2000 Fax: 1-866-884-9475 Horizon Medicare Advantage Member Appeals Members have the right to appeal any decision regarding payment by us or our denial of coverage based on medical necessity. Appeals may be requested verbally or in writing. Based on the medical circumstances of the case, a Horizon BCBSNJ physician reviewer will determine if the request qualifies as an expedited appeal, however, the member, physician or other authorized representative acting on behalf of the member may request an expedited appeal based on the medical circumstances of the case. Medical records and your professional opinion should be included to support the appeal. If coverage of services is denied, you must inform your Medicare Advantage patient of their appeal rights. At each patient encounter with a Medicare Advantage enrollee, you must notify the enrollee of their right to receive, upon request, a detailed written notice from the Medicare Advantage organization regarding the enrollees benefits. You may issue the appeal rights directly to the member in your office at the time of the denial, or contact Member Services and we will issue the appeal rights to the member. Details about how to pursue various appeals and appeal levels will be communicated in writing as part of each coverage determination and/or appeal determination notification. Medical appeals for Medicare Services Generally, we have 60 days to process an appeal pertaining to post-service denial of claim payment (appeal for payment) and 30 days to process an appeal pertaining to denial of a requested service (pre-service appeal for service). Expedited appeals are processed within 72 hours.

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Please note that a completed Appointment of Representative (AOR) form or other court-appointed document indicating the members consent may be required for a physician to pursue post-service appeals on behalf of the member. To file an expedited appeal, the member may call Member Services at 1-800-365-2223. To request an appeal in writing, members should write to or fax: Horizon Medicare Advantage Appeals Coordinator Three Penn Plaza East, PP-02P Newark, NJ 07105-2200 Pre-service appeal requests may be faxed to 1-856-638-3143. Post-service appeals (appeals for payment) may be faxed to 1-973-466-4090. Medicare Part D Prescription appeals Generally we have up to seven days to process an appeal pertaining to a post-service denial of coverage decision or claim for a Medicare Part D prescription drug and up to 72 hours to process an appeal pertaining to a coverage decision of a Medicare Part D prescription drug the member has not yet received. Expedited appeals are processed within 24 hours. To file an expedited Medicare Part D appeal, the member may call 1-866-884-9477. To request a Medicare Part D prescription drug appeal in writing, members should write to or fax: Caremark Medicare Appeals Department MC 109 PO Box 52000 Phoenix, AZ 85072-2000 Fax expedited (24-hours) or standard (72 hour) appeal requests to 1-866-884-9475. Other Appeals for Horizon Medicare Advantage TotalCare (HMO-SNP) Because Horizon Medicare Advantage TotalCare (HMO-SNP) members have Medicare and receive assistance from Medicaid, appeals for these members may follow different processes depending on the service in question.Appeals for members enrolled in the Horizon Medicare Advantage TotalCare (HMO-SNP) plan, because these members have Medicare and get assistance from Medicaid, may follow different processes depending on the service in question. Appeals for Medicare benefits follows the same process as for all other Horizon BCBSNJ Medicare Advantage plans. Appeals for Medicaid benefits will follow the same process as for other non-Medicare related appeals. Please see the Utilization Management or Medical Appeals section beginning on page 82 of this manual for more information. Additional Appeal Rights for Medicaid Services Members enrolled in the Horizon Medicare Advantage TotalCare (HMO-SNP) plan also have the right to file for a Medicaid Fair Hearing. Medicaid Fair Hearings must be requested within 20 days of a Horizon BCBSNJ determination letter about a Medicaid service. Members have the right to represent themselves at the Medicaid Fair Hearing or to be represented by an attorney, friend or other spokesperson. Requests for Medicaid Fair Hearings must be made to: New Jersey Department of Human Services Division of Medical Assistance and Health Services Fair Hearing Services PO Box 712 Trenton, NJ 08625-0712 Advance Directives Advance directives allow patients to make sure their wishes are clearly known regarding the type of care a member would like to receive. They also allow the patient to appoint someone to make medical decisions for them if they are unable to speak for themselves. Advance directives are legally recognized documents and are an important part of a members medical record. During an audit, Horizon BCBSNJ representatives look for documentation that the physician asked their

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patient if they either have an advance directive or would like to create one. When treating your Medicare Advantage patients, ask them if they have completed their advance directives. If the patient responds that he or she has an advance directive, that documentation (along with an actual copy of the advance directive document itself) should be included as a prominent part of the medical record. Please also advise your patients who have advance directives already in place that they should make their designated health care proxy and their family members aware of the advance directive. If the patient responds that he or she has no desire to create an advance directive, that documentation should also be included as a prominent part of the medical record. There are three options available when patients are making an advance directives choice: Proxy Directive Proxy Directives, or durable power of attorney for health care, are used to designate a health care representative or health care proxy who is authorized to make medical decisions on the patients behalf, in the event he or she is unable to do so. Combined Directive A Combined Directive is a single document in which the patient names a proxy and documents specific treatment instructions used to guide treatment decisions. Instruction Directive Instruction Directives, also known as living wills, specifically express in writing the patients desires or instructions for treatment and indicate treatments the patient is not willing to accept. The state of New Jersey has advance directive forms available online, however, no particular form is required. For an advance directive to be legally recognized, it must be documented in writing, signed by the patient in front of two adult (age 18 or older) witnesses or by a Notary Public. In addition, the patient should be encouraged to make his or her desires known, not only to his or her health care proxy and physician, but also to his or her family members. For more information on advance directives, review the brochure Advance Directives for Health Care, published by the State of New Jersey Commission of Legal and Ethical Problems in the Delivery of Health Care. This brochure is available at <www.state.nj.us/health/healthfacilities/ documents/ltc/advance_directives.pdf>. Subcontractors and Medicare Participating offices that have entered into business arrangements with a subcontractor (i.e., clinical laboratory, radiology center, etc.) must ensure that all contracts with those entities include language that requires them to comply with all applicable Medicare laws and regulations. Nine-Digit Zip Codes Required CMS requires the use of nine-digit ZIP codes on all Medicare Advantage claim submissions in certain locations where a five-digit ZIP code spans more than one pricing area. The New Jersey and Pennsylvania towns that require the use of nine-digit ZIP codes are listed below. New Jersey 08512 Cranbury 08525 Hopewell 07735 Keyport 08530 Lambertville 07747 Matawan 08540 Princeton 08558 Skillman 08560 Titusville Pennsylvania 18042 Easton 18055 Hellertown 18951 Quakertown 18077 Riegelsville 19087 Wayne

To avoid delays in claim processing, we recommend that physicians and other health care professionals within these areas bill with the complete nine-digit ZIP code for all patients. If youre unsure of your nine-digit ZIP code, visit the United States Postal Services online Zip Code Lookup at <www.usps.com/zip4>.

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Policies, Procedures and General Guidelines

Copayments and Allowed Amounts
Copayment amounts vary from plan to plan. It is possible that a members copayment may turn out to be greater than our allowance for the services provided. You are permitted to collect the copayment indicated on the members ID card at the time of service, but if our allowed amount for the service you provided (indicated on the EOP you receive) is less than the copayment amount collected, you may need to refund the difference to the member.

When Not to Collect Office Visit Copayments

As mandated by the Patient Protection and Affordable Care Act (PPACA), preventive care services must be covered with no member cost sharing or dollar maximums. Please do not collect preventive care copayments from your Horizon BCBSNJ patients. Please note that PPACA allows group health plans offering custom benefits (plans in force on or before March 23, 2010 and continuing to be in force) to opt (for as long as that health plan continues to be in force) to retain a copayment for preventive care services.

Collection of Member Liability: Deductible and Coinsurance

At the time of service you may collect copayment amounts as indicated on the members ID card. Additionally, you are expected to bill members for the appropriate member liability (deductible and/or coinsurance), as indicated on the Explanation of Payment (EOP) you receive. Please wait until you receive the EOP before billing the member for these amounts. You are required to accept our allowance for eligible services as payment in full. To protect our members, Horizon BCBSNJ forbids participating physicians and other health care professionals from adding a collection fee, interest or other amount to the member liability until the member has had a reasonable opportunity (i.e., a minimum of 30 days) to pay. Please inform your patients in advance of your billing practices for the collection of member liability and of any fees or interest that you charge when member liabilities are not paid in a timely manner.

Reimbursement for Assistants at Surgery Services

We do not reimburse for assistants at surgery in surgical procedures if use of an assistant at surgery is not established as medically necessary and appropriate for that procedure. To avoid misunderstandings regarding reimbursement of assistants at surgery, we encourage you to check on reimbursable procedures at the time of authorization. You are responsible for ensuring that assistants at surgery (where medically necessary) are participating in our Horizon Managed Care Network. If a nonparticipating assistant at surgery is used, unless Horizon BCBSNJ has prior authorized the use of that nonparticipating assistant at surgery, then Horizon BCBSNJ will consider you responsible for the difference between the participating and nonparticipating rates and for ensuring that the member is not balanced billed over and above our allowed amount.

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Specialty access standards
Horizon Blue Cross Blue Shield of New Jersey has established access standards for our specialist physicians who participate in the managed care networks to ensure our members receive the timely and efficient care that they need. Our Quality Improvement Committee approved the Specialist Access Standards listed below. The standards may vary depending on the patients medical condition. In certain cases, your office may need to see a patient earlier than the timeframes listed below.

Type of Care Routine Care: Includes any condition or illness that does not require urgent attention or is not life-threatening, as well as routine gynecological care. Urgent Care: Includes medically necessary care for an unexpected illness or injury. Emergent Care: Includes care for a medical condition manifesting itself by acute symptoms of sufficient severity including, but not limited to, severe pain; psychiatric disturbances and/or symptoms of substance abuse such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in placing the health of the individual (or, with the respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy; serious impairment to bodily functions or serious dysfunction of a bodily organ or part. After-hours Care

Access Standards Physician shall offer the member a scheduled appointment as soon as possible, but not to exceed three weeks of the request. Physician shall offer the member a scheduled appointment within 24 hours of the request. Physician shall respond to the members call immediately and advise as to the best course of action. This may include sending the member to an emergency facility.

Physician shall have a mechanism to respond to the members call for urgent or emergent care that ensures calls in these circumstances are returned within 30 minutes. No member shall wait more than 30 minutes for a scheduled appointment. If the waiting time is expected to exceed the 30-minute standard, the office shall offer the member the choice of waiting or rescheduling the appointment.

Office Waiting Time

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