The Arizona HOPCo Specialty Care Network is the only
URAC-accredited MSK clinically integrated network in the country.

Provider Access and Availability

Consumer Access to Service and Information

Network Adequacy

Payors that contract with the CIN can chose to use their own musculoskeletal network which includes the CIN physicians or to use the CIN network exclusively. When payors use their own musculoskeletal network, they attest in the CIN agreement that they meet all regulatory network adequacy standards. When a payor uses the CIN network exclusively, the CIN uses Quest Analytic Software to confirm compliance with CMS network adequacy standards.

Access and Availability

Providers will make provider services available to members on a 24-hour per day, 7 days a week, per week basis according to generally accepted standards of medical practice. Provider services include but are not limited to, office availability, telehealth services, urgent care hours, after-hours on-call service, and messaging to emergency services.

Appointment Availability

  • Urgent – within 24 hours
  • Sick – within 3 days
  • Well Care – within 30 days
  • In-office wait times not to exceed 30 minutes
Hours of operation are documented in the CIN rosters and posted on the CIN website.
The CIN will verify access and availability performance measures annually with the provider. The CIN will have the provider complete a Provider Office Visit Checklist. Annual results will be reported to the Clinical Quality Operations Committee. If a provider does not meet performance metrics, then CIN will provide education and monitor through a Corrective Action Plan (CAP). (See Provider Office Visit Checklist and CAP forms attached).

The CIN ensures the payor meets regulatory geo-access requirements in the payor agreements, found in the health plan CIN risk agreements that the health plan attests their network meets access and availability standard.

Emergency Services

Provider directs the patient to the emergency room as medically appropriate during regular business hours or after hours. The provider will complete annually in the Provider Office Checklist. 

Emergency Services are defined as follows:
Except as otherwise required by law or otherwise defined in the applicable Plan, those services necessary to treat a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) 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: (a) placing the health of the individual (or, with respect to a pregnant woman, her pregnancy or health or the health of her fetus) in serious jeopardy; (b) serious impairment to bodily functions; or (c) serious dysfunction of any bodily organ or part.

Provider/Group Provider Information

Prior to the Effective Date, and for each office/site in which Provider Services are rendered to Members, providers shall provide to the CIN a complete list of the group’s provider names, office, and/or service addresses, office hours, email addresses, telephone and facsimile numbers, areas of practice or specialty and tax identification numbers. Providers will notify the CIN, in writing, within thirty (30) business days of any change in this information, as well as any additions to the list of the group’s providers. Providers shall provide to CIN at least ninety (90) days prior notice termination, for any reason, of a group provider’s relationship with provider.

Provider Capacity

Provider shall provide at a minimum, annually a notice to CIN of any significant changes in the capacity of Group or Group Providers.

Closed Panel

Provider and CIN agree that a broad selection of physicians is important to Members. Accordingly, only upon at least ninety (90) days prior written notice with good cause acceptable to CIN, Provider or any Group Provider may prospectively decline to accept new members as patients. To prevent discrimination against the CIN or its Members, for such time as Provider or a Group Provider declines to accept new Members as patients, such Provider or Group Provider shall not accept patients as additional members from any insurer, entity, or organization which competes with the CIN.

Referrals and Utilization of Participating Provider. For all Plans, except as prohibited by law, Provider agrees to refer, and/or admit or arrange for admission of Members only to Participating Provider hospitals and facilities (including, but not limited, to surgery centers), and other Participating Providers directly contracted with CIN or payor unless the referral, and/or admission is either authorized in advance by the payor, or in cases of Emergency Services.

For the purpose of providing quality care to Members, Provider shall furnish to other physicians and providers treating a Member all relevant medical information, including treatments and diagnostic tests, related to such Member.

Non-Discrimination. Equitable Treatment of Members. Provider shall render Provider Services to Members with the same degree of care and skill as customarily provided to Provider’s patients who are not Members, according to generally accepted standards of medical practice. Provider and CIN agree that Members and non-Members should be treated equitably. Provider agrees not to discriminate against Members on the basis of race, ethnicity, gender, creed, ancestry, lawful occupation, age, religion, marital status, sexual orientation, mental or physical disability, medical history, color, national origin, place of residence, health status, claims experience, genetic information, source of payment for services whether as a private purchaser of the plan or as participants in publicly financed programs of health care services, cost or extent of Provider Services required, Medicare beneficiary status, or on any additional grounds prohibited by law or this policy.