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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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