​​​​​COVID-19 (Coronavirus): Temporary suspension of certain prior authorizations

May 4, 2021

This article was revised on May 4, 2021, to update the effective dates.

Independence will suspend prior authorizations requirements for acute in-network inpatient admissions from the emergency department for patients with a COVID-19 diagnosis.

Member:

Admissions:

Effective:

Commercial members

From: in-network emergency department

To: in-network hospital

March 31, 2020, through May 31, 2021, or the end of the federal Public Health Emergency (whichever comes first).

Medicare Advantage members

From: in- or out-of-network emergency department 

To: in-network hospital

March 31, 2020, through May 31, 2021, or the end of the federal Public Health Emergency (whichever comes first).

CHIP members

From: in- or out-of-network emergency department 

To: in-network hospital​

Through whichever date comes last:

  • the end of the Pennsylvania state Public Health Emergency (May 28, 2021)
  • the end of the federal Public Health Emergency (July 20, 2021)

Independence resumed prior authorizations requirements for patients with and without a COVID-19 diagnosis as of April 1, 2021, for:

  • Transfers from acute in-network inpatient facilities to in-network post-acute facilities (long-term acute care hospitals, inpatient rehabilitation, skilled nursing facilities).

  • Transfers from acute in-network inpatient facilities to other in-network i​npatient facilities and in-network ambulance transport.

Independence will continue to assess the situation based on COVID-19 activity and share updates with our provider community.

Independence is committed to providing our members with access to the care they need during the COVID-19 pandemic. We encourage all Independence members and providers to visit our dedicated COVID-19 webpage regularly for the latest news and updates. We will continue to evaluate member needs as the situation changes.

Utilization management

Facilities must continue to notify Independence's Utilization Management (UM) department within contractual time frames, but no longer than two business days from admission to an acute or post-acute facility.

The UM and Care Management departments will collaborate with facilities to gather clinical information and to assist in the coordination of transitions of care for members.

Independence retains the right to audit medical records, as warranted.