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Standards of Care
The Independence Blue Cross Quality Management program monitors and objectively evaluates standards and quality of care for our members.
The Quality Management Program:
- provides tools and information to assist network providers in developing and maintaining a high standard of care;
- manages partnerships with network providers;
- monitors and evaluates the care our members receive;
- suggests improvements to medical policies;
- oversees provider credentialing;
- oversees various processes for hearing grievances and appeals;
- collects member suggestions for quality initiatives;
- monitors aspects of care based on the demographics of members served (i.e., age, sex, and health status);
- investigates and tracks potential quality-of-care concerns through the recredentialing, grievance and appeal, and peer review processes.
We communicate member safety initiatives through newsletters and mailings to increase awareness and reduce medical and medication errors.
We take all member feedback seriously. We thoroughly investigate and aim to resolve all quality-of-care and quality-of-service issues. Any member may file a concern or complaint in writing or by calling Customer Service at the number listed on back of his or her ID card.
Continuity and coordination of care
We assess coordination and continuity of care against three criteria:
- how well care is coordinated among medical providers who are treating the same patient;
- how well medical and behavioral care are coordinated;
- when a provider leaves a network, how well we ensure that his or her patients under active treatment have continuous access to care.
When a member is receiving an active course of treatment and his or her practitioner leaves the health plan, the member may be eligible for continued access to the practice for a time period mandated by specific state regulations. The health plan will notify the member in writing that his or her provider has left the network and assist the member in arranging the continuation of care and selection of a new practitioner.
Information about our Quality Improvement program is available to members and providers. Upon request, we’ll provide a description of our program and a report on progress.
Provider requests, call 1-800-227-3119 for HMO or 1-800-332-2566 for PPO. Member requests, call the Member Services number listed on back of the ID card.
Additional information can be found in our Provider News Center.