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DPAP 204

Provider Information Changes

Provider Administrative Policy

Claims Submission
Policy Date
January 2012
Revised/October 2014
Provider Type(s)
All Providers  


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).



Provider Information Changes

You must present Blue Cross of Idaho with written documentation via email, fax, or regular mail when making the following changes:

  • Change of address
  • Change of phone and/or fax number
  • Change of clinic or provider name
  • Provider leaving practice

Include the effective date of change (we will not make retrospective changes but we can process future effective dates). When your request for change specifies a past date, the change will take effect on the date we enter the information into our system. If the change is in the future, the future date is the effective date.

Please Note:  If we assigned numerous Blue Cross of Idaho legacy numbers to your providers at different addresses, and a provider moves from one legacy location to another, a dentist profile form is necessary to add the provider to the new address/legacy number. Written notification is still required terminating the provider from the old address. Contact your dental provider relations representative (see DPAP100) to determine the paperwork you will need if you have:

  • Providers joining your practice
  • Change in ownership or tax identification number of a solo practice or clinic (please include a copy of the updated W-9 form).

Please let us know if claims with dates of service prior to the tax identification change fall under a previous tax identification number so that we can issue new provider numbers.

 If your tax identification change represents a change of ownership, your contracts with Blue Cross of Idaho may not be valid. Please contact your dental provider relations representative (see DPAP100) prior to ownership changes to assure your contracting status remains in place.

Policy History

Date Action Reason
October 2014 Revised Removed processing timeframe

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