Independence is dedicated to maintaining the highest standard of care and
service for our members, providers, and
the communities we serve. Information about our Quality Management Program is
accessible on our
website. The website includes a description of our Quality
Management Program,
including 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 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.
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 or by calling the Provider Supply Line at
1-800-858-4728.
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 request the same information by calling Customer Service.
NaviNet is a registered trademark of NaviNet, Inc., an
independent company.