How Are We Creating the Future of Health Care? Together.
The future of health care is extremely complex and constantly changing. This resource is designed to give health care providers easy access to timely, accurate information, allowing you to focus on what’s most important — your patients’ health.
Have you registered for the PEAR portal?
Our transition to the Provider Engagement, Analytics & Reporting (PEAR) portal is complete! The PEAR portal offers participating providers a single point of entry to multiple digital tools, including PEAR Practice Management, PEAR Comprehensive Visit, and PEAR Analytics & Reporting.
Streamline Requests with iEXCHANGE®
Providers can streamline inpatient and outpatient precertification requests and treatment updates using iEXCHANGE, a convenient, HIPAA-compliant online service offered through MEDecision, Inc. Precertification can also be requested by calling the phone number on the plan member’s ID card.
Call 1-888-444-4617 to contact the iEXCHANGE Help Desk or Request a Free Webinar.
AmeriHealth Administrators, a leading independent national third party administrator, provides medical management services for Independence Administrators.Provider Access
The peer-to-peer process streamlines workflows, improves cost-efficiencies, and complies with accreditation requirements. To participate in the peer-to-peer process, please complete the Peer-to-peer Request Form.
Over the next year, Independence Administrators will transition Electronic Data Interchange (EDI) transactions from the Highmark EDI Gateway to Smart Data Solutions (SDS) Stream Clearinghouse.
This is an initial step of our transition to a next generation platform that will help us operate more efficiently and deliver new and innovative products and services. Learn more.
If you have any questions, please email us at firstname.lastname@example.org.
Electronic Data Interchange (EDI)
Submit claims and obtain important documents online through our Electronic Data Interchange (EDI) services. Submission by EDI can increase accuracy of claims processing and the speed of claim payments.
Platform transition news
As part of our transition to a next generation platform, we are transitioning EDI transactions from the Highmark EDI Gateway to Smart Data Solutions (SDS) Stream Clearinghouse. The transition will be done in phases starting in November 2023. Our goal is to transition all Trading Partners to SDS by the end of second quarter 2024.
For existing trading partners to SDS
SDS will contact existing trading partners when it is time to begin the transition process.
For new trading partners to SDS
Visit the new Trading Partner Information Center for an overview of the registration process and to review the Trading Partner Registration Guide. You will receive a verification code from SDS when it is time to start your transition.
For trading partners that have not yet completed the transition
Highmark, Inc. (Highmark) currently provides the Highmark EDI Gateway to handle EDI transactions on behalf of Independence Administrators. Please use the information below for assistance until your transition to SDS is complete.
The Trading Partner Business Center is Highmark’s online resource that provides tools and documentation for conducting EDI business.
Prescription Drug Information
Independence Administrators’ prescription drug plans are administered by an independent pharmacy benefits management company. Before prescribing a medication, you should work with the plan member to determine if the drug is included on the formulary.
Members who have prescription drug coverage through Independence Administrators are covered under one of several formulary-based prescription drug benefit programs. These programs are designed to provide physicians with a range of prescribing options while maintaining cost-effectiveness for Independence Administrators members.
- Prescription Drug Program Select Formulary (Prior Authorization Required)
- Prescription Drug Program Select Formulary
The Premium Formulary differs from the standard drug formulary in that it excludes 80 medications, which all have clinical alternatives included in the Premium Formulary. The Premium Formulary is managed and maintained by our pharmacy benefits manager.
- Premium formulary guide
- Latest formulary changes
- Premium formulary utilization management updates
- Procedures that support safe subscribing
- Premium formulary exclusion list
- Premium formulary prior authorization list
- Premium formulary step therapy list
- Premium formulary quantity limit list
- HDHP preventive drug list
- HCR preventive drug list
- HCR preventive $0 HIV PrEP
*Some specialty medications, such as infusion drugs or drugs administered by the physician in the office, may be covered by the plan member’s medical benefits plan and may require precertification.
Prior authorization is required for certain prescribed formulary drugs in order for such drugs to be covered. A request form must be completed for all medications that require prior authorization.
Submitting a prior authorization request
To simplify your experience with prior authorization and save time, please submit your prior authorization request to the pharmacy benefits manager through any of the following online portals:
Prior authorization via fax
Submit prior authorization requests by fax using the forms listed below:
Commercial prior authorization forms
- General fax form
- Acute migraine agents
- CNS stimulants — high cumulative dose
- Immune modulating therapy
- Opioid management — Buprenorphine/naloxone (Bunavail®/Suboxone®/Zubsolv®) and Buprenorphine (Subutex®)
- Opioid Management — Morphine Milligram Equivalent (MME) > 90 mg/day, Long-acting opioids, Short-acting opioids for short term Use, and Quantity
- Opioid Management — Short-acting opioids for continuation beyond 30 days
- Cost-share exception policy for preventative medications and women’s preventive services
- Select formulary exception prior authorization request form
- Dispense as written (DAW) override request form
- General fax form
- Health care reform copay waiver request form
Pharmacy Benefits Manager
Direct Ship Drug Program
Independence Administrators offers a Direct Ship Drug Program to our in-network physicians. Under this program, physicians can order certain specialty drugs that are given in the office and are eligible for coverage under the plan member's medical benefit when medical necessity criteria are met.
Most Cost-Effective Setting Program
Find out how Independence Administrators reviews the requested treatment settings for certain specialty drugs that are eligible for coverage under the medical benefit.
Dosage and Frequency Program
Learn how Independence Administrators reviews treatment regimens for certain specialty drugs to ensure they adhere to safe prescribing limits.
Medical Management Services
Independence Administrators uses various policies including Independence Blue Cross medical policy and InterQual® criteria. Visit the Independence Blue Cross medical policy page for more information.
AmeriHealth Administrators, an independent company, performs medical management services on behalf of Independence Administrators. You can obtain a copy of a specific policy by calling the clinical services department at 1-888-234-2393.
Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.
Certain procedures and prescription drugs require precertification before they are performed or administered. You can request precertification online using iEXCHANGE or call the phone number on the plan member’s ID card. Required precertification must be obtained to avoid reduced payment or non-payment for the service or medication.
Call the number on your patient’s ID card or log into iEXCHANGE®
Information for and interview requests from members of the media.
Submit an Inquiry
Claims, benefits, & eligibility
Call the toll-free service phone number on your patient’s ID card.
Submit an Inquiry
Pharmacy Benefits Manager
Behavioral health services
Please call the phone number listed on the patient’s Independence Administrators ID card.
We’ve adopted more nimble, advanced technologies so we can offer more comprehensive services, greater flexibility, enhanced interoperability, and improved health data management. What does that mean to you? More options.Learn More
If patients are facing a serious illness or medical condition, Independence Administrators' case management program might be right for them. This free, confidential program provides support, guidance, and coordinated care for complex health concerns.Learn More