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New Options for Affordable Health Insurance

DPAP 110

Incomplete Provider Contracts


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

Incomplete Provider Contracts

Purpose:  Blue Cross of Idaho works diligently on behalf of our members to develop contracting relationships with Idaho dental providers. Blue Cross of Idaho has specific contract criteria established for all provider specialties. The contract criterion is in place to assure that our contracting providers meet acceptable provider licensing, accreditation, and/or dental standards to provide the highest quality of care and services to our members.

Policy:  To expedite the contracting process, we ask that providers complete and provide all necessary information for the contracts on the initial submission or it will delay the contract implementation process. We will generally implement complete provider contracts within 15 business days after we receive them.

Blue Cross of Idaho will ask providers for missing or incomplete information that is necessary to implement provider contracts three times. Blue Cross of Idaho will document the date and contact method used to try to obtain any missing information and retain incomplete provider contracts for a period of thirty days. After that time, Blue Cross of Idaho will destroy the incomplete contracts and include the documentation of the attempts to obtain the contract information in the provider file.

Listed below are some of the most common reasons for a delay in the processing of provider contracts.

Missing Information

  • Provider license
  • DEA certificate
  • Proof of liability/professional insurance
  • NPI provider ID
  • W-9 tax information
  • Dentist Profile Form

Incomplete Information

  • Attachments not completed
  • Contract not signed
  • Person that signed contract does not have authority to do so
  • Invalid provider for type of contract

Please fax provider contact information to:  208-286-3575.


Policy History

Date Action Reason