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Our Quality Management Program promotes quality of care and service

October 5, 2017

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Independence is dedicated to providing access to a network of health care providers who provide a high standard of care and service for our members ? developing and maintaining strong relationships with the providers in our network and the communities we serve. Information about our Quality Management Program is accessible on our website, which includes a description of our Quality Management Program and an outline of program goals, objectives, and activities to improve clinical, network, and service quality.

Please review the following standards with your staff to ensure that your office maintains the required access, documentation, and quality of care expected of our network providers:

  • Access and availability standards. Independence standards ensure that our managed care networks are adequate to meet the needs of our members with respect to location and appointment accessibility for primary and specialty care, as well as urgent and emergency care, in accordance with applicable regulatory requirements.
  • Member rights and responsibilities. All Independence members have defined rights and responsibilities.
  • Privacy and confidentiality. Independence, our contractors, and our affiliates are required to protect the privacy and confidentiality of our members? personal and health information in accordance with state and federal regulatory requirements.
  • Utilization review. It is the policy of Independence that all utilization review decisions are based on the appropriateness of health care services and supplies, in accordance with Independence?s definition of medical necessity and the benefits available under the member?s coverage.
  • Medical record-keeping standards. Well-maintained medical records are critical to facilitate communication, continuity, coordination, and an effective plan of care. Accordingly, Independence standards require that medical records are maintained in a manner that is current, detailed, and organized as required by applicable regulatory requirements.

In addition, Independence annually seeks member input through the Consumer Assessment of Health Care Providers and Systems (CAHPS) survey. This direct mail/phone survey asks members about their experience with their doctors and the service they receive from their health plan. Our most recent survey indicated positive changes from the prior year including:

  • Members were more satisfied with how their doctors communicate:
    • – Their doctor is spending enough time with them during their visit.
    • – Their doctor listened to them carefully and showed respect for what they had to say.
  • Members gave higher ratings for their personal doctor and with the coordination of medical care between the doctors and facilities they received services from.
  • Members also indicated satisfaction in the ease of getting an appointment with specialists.

Information about our Quality Management Program and these standards can also be found in the Provider Manual for Participating Professional Providers (Provider Manual) and the Hospital Manual for Participating Hospitals, Ancillary Facilities, and Ancillary Providers (Hospital Manual), which are available through the NaviNet® web portal. Paper copies of the Provider Manual and Hospital Manual can be ordered by submitting an online request.

For more information about our Quality Management Program and our progress in meeting program goals, please visit our website or call Customer Service at 1-800-ASK-BLUE. Members can also request this information by calling Customer Service at the number listed on the back of their ID card.

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This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of Independence Blue Cross. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.
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Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.