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As of October 17, 2017, Independence transitioned to a new medical management system for processing authorization requests. Concurrent with this transition, precertification for certain services has been 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 he or she 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 (PCP). This does not change the initial precertification request process through NaviNet.
Delegated services
The following services are delegated to Tandigm for precertification and/or concurrent review for members who have a Tandigm PCP:
- inpatient elective admissions;
- long-term acute care (LTAC) and acute rehabilitation;
- skilled nursing facility (SNF) admissions;
- select 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.
As a reminder, as of August 14, 2017, requests for skilled nursing placement, acute rehabilitation, and LTAC admissions for Tandigm members are 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 can also direct facilities to Tandigm when requesting placement for Tandigm members. Continued stay/concurrent review for these admissions is managed by Tandigm.
Resources available
Please review our Transition to a new medical management system: Frequently asked questions (FAQ) or NaviNet Authorizations transaction: FAQ to help answer any questions you may have about this change. These FAQs can be found in the Frequently Asked Questions section of Independence NaviNet Plan Central under Administrative Tools & Resources. Note: The FAQs will be updated as more information becomes available.
NaviNet is a registered trademark of NaviNet, Inc., an independent company.
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