Independence Blue Cross does not use specific quality measures, member experience measures, or cost-related measures to select practitioners or hospitals to participate in the network.
Designated sites disclaimer:
HMO/POS members are required to use sites designated by their PCP for services, which could include radiology, physical therapy and lab. Members need to speak to the PCP about their designated sites.
Data name, gender, specialty, practice locations (medical group affiliations), languages spoken, accepting new patients, and hospital affiliations are submitted by the provider during the credentialing process. Your Health Plan verifies board certification through the American Board of Medical Specialties (ABMS) website upon credentialing and every three years during the re-credentialing process. Your Health Plan also requests providers to review all of this data for accuracy and updates this data at that time if changes are reported by providers. Additionally, your Health Plan updates all data, except practice locations (medical group affiliations), every three years during the re-credentialing process. Providers will update their practice location information when a change occurs and may update all other data at any time. A limitation includes provider self-reported changes that may not be reported to the Health Plan. Your Health Plan refers members to a telephone number or website address for the most up-to date information on the provider or to ask a question regarding participating practitioners/providers.
Explanation of displayed items:
- Specialty The field or purpose of a health care provider.
- Medical Group Affiliations: A list of all medical groups with which he provider is affiliated.
- Languages Spoken: Languages other than English that are spoken by the provider.
- Hospital Affiliations: Hospitals where the care provider has clinical privileges.
- Board Certifications: Board certification, which is achieved through testing and peer evaluation, demonstrates a physician's expertise in a particular specialty and/or subspecialty of medical practice. This information may change between re-credentialing cycles.
- Accepting New Patients: The medical group is open the new patients.
Your Health Plan validates the Name (name of the hospital), Location (location(s) affiliated with the facility) and phone number (contact information of the locations) of the hospital with whom it contracts. The initial assessment is conducted upon the hospital joining the network, and then every 3 years through the reassessment process. This validation is done as per the assessment/reassessment form that is completed and attested by the hospital. Although, the health plan does not verify the demographic information on an on-going basis, it does validate the information when submitted by the hospital during the term of the contracting period and during the re-contracting/reassessment process. Directories are updated within 30 calendar days of when new information is identified through reassessment, the roster process and from provider self-reported changes. A limitation includes provider self-reported changes that may not be reported to the Health Plan. Your Health Plan refers members to a telephone number or website address for the most up-to date information on the provider network or to ask a question regarding participating practitioners/providers.
Accreditation is granted when a hospital has met the requirements from an assessment against nationally recognized guidelines. Your Health Plan validates the accreditation status with an appropriately recognized accrediting body (i.e., Joint Commission, AOA, DNV, HFAP, CIHQ or CARF) for regional hospitals with whom it contracts. The initial assessment is done upon the hospital joining the network, and then every 3 years through the reassessment process. Although, the health plan does not validate the accreditation status on an on-going basis, it does verify self-reported changes as and when submitted by the hospital. You may find the accreditation status of a hospital on the following web sites: The Joint Commission, AOA, DNV, HFAP, CIHQ, CARF.
Your Health Plan makes the quality and patient experience data available to you from recognized sources which includes hospital ratings results from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey sent to a randomized list of patients over 18 years old within six weeks after leaving the hospital. The survey asks what patients think about important measures of care. The Centers for Medicare & Medicaid Services (CMS) is responsible for overseeing the survey and makes the results available to the public. A limitation includes if patients neglect to participate in the survey and results are subjective. Results are updated quarterly and reflect the most recent four quarters of data. More information is available at http://www.hcahpsonline.org. Your health plan also monitors and reviews quality data and indicators for hospitals including but not limited to complaints and occurrences on an ongoing basis.