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.

Learn more

Visit the Provider News Center

Faster Reimbursement

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.

Visit InstaMed

Claim Appeals and Reimbursements

To appeal a claim, download the Provider Claim Appeals Form.

Download

To request a reimbursement for an implant, download the Implant Reimbursement Request Form.

Download

Peer-to-peer Requests

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.

Peer-to-peer Request Form

Provider Claim Appeals

To appeal a claim, download the Provider Claim Appeals Form.

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.

Drug formularies

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

• Prescription Drug Program Select Formulary (Prior Authorization Required)
• Prescription Drug Program Select Formulary updates (Prior Authorization Required) as of 1/1/2025
• Prescription Drug Program Select Formulary
• Prescription Drug Program Select Formulary updates as of 1/1/2025

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.

• 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:

• CoverMyMeds^®
• Surescripts^®

Prior authorization via fax

Submit prior authorization requests by fax using the forms listed below:
Commercial prior authorization forms

Select formulary

• 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

Premium formulary

• Dispense as written (DAW) override request form
• General fax form
• Health care reform copay waiver request form

Pharmacy Benefits Manager

Call 1-888-678-7013

1-888-671-5285 (fax)

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.

Direct Ship Program

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.

Learn more

Dosage and Frequency Program

Learn how Independence Administrators reviews treatment regimens for certain specialty drugs to ensure they adhere to safe prescribing limits.

Learn more

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.

Precertification

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.

• Precertification List (effective 7/1/2024)
• Precertification List (effective 1/1/2024)

Provider Contact Information

Provider finder

Find an Independence Administrator Network Provider.
1-888-356-7899
Find Providers

Precertification

Call the number on your patient’s ID card or log into the PEAR portal.
Log In

Media

Information for and interview requests from members of the media.
Submit an Inquiry

Provider services

Reach provider services, care management, and clinical pharmacy services.
1-888-356-7899
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

1-888-678-7013 (phone)
1-888-671-5285 (fax)

Behavioral health services

Please call the phone number listed on the patient’s Independence Administrators ID card.