As a participating provider, you have agreed to comply with Independence Blue Cross's Quality Management Program to support optimal health outcomes and satisfaction with care for our members. Please review our standards of care with your staff related to:
Our member safety and wellness initiatives promote efficient utilization of services, facilitate coordination of care, promote adherence to the plan of care, and help to improve outcomes.
- Complex case management. Members with complex medical conditions may be eligible for case management. You can refer members online or by calling 1-800-313-8628.
- Drug utilization review. Targeted reports are generated annually related to prescribing and care coordination practices. Reports are sent via mail to your practice, if applicable.
- Occurrence investigation. Our clinical staff, with Medical Director oversight, review all reported occurrences for quality issues. Medical records may be requested for a detailed analysis and, if necessary, a corrective action plan from the facility or provider.
- Blue Distinction® Specialty Care. Blue Distinction® Centers and Blue Distinction Centers+ are recognized through this program when they meet stringent, objective national criteria for excellence in outcomes. For more information about criteria, visit the BCBSA website.
Learn more about our Quality Management Program by visiting our website; reading the Quality Management section of the Provider or Hospital Manual; or calling Customer Service at 1-800-ASK-BLUE (1-800-275-2583).