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Precertification for certain services to be delegated to Tandigm Health

July 21, 2017

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Concurrent with Independence?s transition to a new medical management system for processing authorization requests during the third quarter of 2017, precertification for certain services will be delegated to Tandigm Health (Tandigm), a population health services organization serving many primary care practices in the Philadelphia area.

When a provider submits an authorization request through the new Authorizations transaction on the NaviNet® web portal for a service delegated to Tandigm, a notification will display to advise the provider of the delegation and that they may then be contacted by Tandigm for additional information related to the request. The delegation of services applies to members who have a Tandigm primary care physician. This will not change the initial precertification request process through NaviNet.

Delegated services

The following services will be delegated to Tandigm for precertification and/or concurrent review:

  • inpatient elective admissions;
  • long-term acute care (LTAC) and acute rehabilitation;
  • skilled nursing facility (SNF) admissions;
  • selected outpatient procedures (carticel, cochlear implant, bariatric, and uvulopalatopharyngoplasty);
  • reconstructive and potentially cosmetic procedures;
  • elective (nonemergency) ground, air, and sea ambulance transport;
  • all home health services, excluding infusion therapy;
  • prosthetics/orthotics and durable medical equipment, except continuous positive airway pressure;
  • medical foods;
  • out-of-capitation laboratory, radiology, and occupational and physical therapy;
  • continuity of care;
  • day rehabilitation;
  • hyperbaric oxygen therapy.

Effective August 14, 2017, requests for skilled nursing placement, acute rehabilitation, and LTAC admissions for Tandigm members will be managed by Tandigm. Impacted facilities (hospitals, SNFs, LTACs) can contact Tandigm directly by calling 1-844-TANDIGM, option 5, or by sending a fax to 215-238-2271. Independence discharge planning staff will also be able to direct facilities to Tandigm when requesting placement for Tandigm members. Continued stay/concurrent review for these admissions will be managed by Tandigm.

Stay informed

It will be important for providers who submit authorization requests to stay current with ongoing announcements related to this system transition to ensure your organization is prepared when the changes are implemented.

Additional information regarding this transition will be communicated through Partners in Health UpdateSM and on Independence NaviNet Plan Central.

NaviNet is a registered trademark of NaviNet, Inc., an independent company.

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