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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
under Standards of Care in the Resources for Patient Management
section. The website includes
a description of our Quality Management Program, including program goals,
objectives, and activities to improve
clinical, network, and service quality.
- 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 the
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.
Please review the standards listed above with your office staff to ensure
that your office maintains the required
access, documentation, and quality care expected of our network providers.
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 contact 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.
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