[
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. ]