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Provider Administrative Policy

Provider Information
Policy Date
April 2007
Reviewed/May 2008


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.



The provider or designated covering provider agrees to provide coverage for medically necessary services 24-hours a day, 7 days a week  for Medicare Advantage members or to direct members to the setting most appropriate for treatment. The provider agrees to establish call-share arrangements with another provider to ensure 24-hour availability.

If changes are made in call-share arrangements, please notify Blue Cross of Idaho Provider Relations (see MA PAP102) to ensure claims from covering providers are processed correctly. If the provider office uses an electronic answering machine, the message for the caller should include: name and phone number of the on-call physician with instructions to contact that physician.

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