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. We
strive to develop and maintain strong relationships with the providers in our
network and the communities we serve. One of the ways we do this is through our
Quality Management Program. Our website includes a description of the Quality
Management Program and an outline of program goals, objectives, and activities
to improve clinical, network, and service quality.
Program standards
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 adequately meet the needs of our members.
Appointment location and accessibility for primary and specialty care, as well
as urgent and emergency care, must be 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. This is 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.
Information about our Quality Management Program and the standards above can
also be found in the Provider Manual for Participating Professional
Providers and the Hospital Manual for Participating Hospitals, Ancillary
Facilities, and Ancillary Providers, which are available through the
NaviNet? web portal. Paper copies of the manuals 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.
NaviNet is a registered trademark of NaviNet, Inc., an
independent company.