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New Options for Affordable Health Insurance

DPAP 104

Contracting/Non-contracting Providers


Provider Administrative Policy

Section
Information
Policy Date
January 2012
Status/Date
New/January 2012
Provider Type(s)
All Providers  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Blue Cross of Idaho works diligently on behalf of our members to develop contracting relationships with Idaho dental providers and Blue Cross Blue Shield dental affiliates (national Dental Grid).

 


Policy

Contracting/Non-contracting Providers

Blue Cross of Idaho works diligently on behalf of our members to develop contracting relationships with Idaho dental providers and Blue Cross Blue Shield dental affiliates (national Dental Grid). The following information outlines the administrative relationship with Blue Cross of Idaho and each type of provider.

Contracting Providers:

  • May submit claims electronically.
  • Must submit both primary and secondary claims on behalf of their patients.
  • Are directly reimbursed from Blue Cross of Idaho for covered services.
  • Must write off provider adjustments.
  • May only collect copayments, coinsurance, deductible and non-covered amounts from their patients.

Non-Contracting Providers:

  • May submit claims electronically.
  • May submit claims on behalf of patients or provide completed claim forms for patients to submit the claim themselves.

 


Policy History

Date Action Reason