​Independence has developed a new form to facilitate precertification (authorization) for admission to a long-term acute care (LTAC) facility. Providers must fax this form and supporting documentation to the LTAC precertification team at 215-238-2538.

Supporting documentation includes:

• a physician-written order for LTAC transfer
• the last five days of physician progress notes
• a complete list of all current medications including IV antibiotic end date(s)
• the most recent test results and related consults (CT scan, X-rays, ultrasound, etc.)
• Ventilator Weaning Requests – ventilator flow sheets with the last four days of weaning trials

The LTAC precertification form is also available on our forms page.

To meet our goal, we monitor the continuity and coordination of care that members receive. We ask that providers understand and adhere to precertification requirements so that together we can achieve optimal patient outcomes.

Learn more

If you have questions about the authorization process, please call Provider Services at 1-800-ASK-BLUE (1-800-275-2583).