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.
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.
Providers and facilities can use InstaMed to receive fully reconciled remittance advice and claims settlement payments electronically for services provided to Independence Administrators plan members.
To appeal a claim, download the Provider Claim Appeals Form.
To request a reimbursement for an implant, download the Implant Reimbursement Request Form.
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.
Upcoming EDI Gateway transitionOver the next year, Independence Administrators will transition Electronic Data Interchange (EDI) transactions from our current EDI vendor 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 gateway.transition@ibx.com.
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.
As part of our transition to a next generation platform, we are transitioning EDI transactions from our current EDI vendor 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.
If you have any questions, please contact the SDS support team Monday – Friday, 8 a.m. – 5 p.m. ET at stream.support@sdata.us or 855-297-4436.
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.
To appeal a claim, download the Provider Claim Appeals Form.
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.
Select Formulary
Premium 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.
*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.
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:
Submit prior authorization requests by fax using the forms listed below:
Commercial prior authorization forms
Select formulary
Premium formulary
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.
Find out how Independence Administrators reviews the requested treatment settings for certain specialty drugs that are eligible for coverage under the medical benefit.
Learn how Independence Administrators reviews treatment regimens for certain specialty drugs to ensure they adhere to safe prescribing limits.
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 via Practice Management on the PEAR portal or by calling 1-888-234-2393. Required precertification must be obtained to avoid reduced payment or non-payment for the service or medication.
