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MA PAP204

Compensation


Provider Administrative Policy

Section
Provider Information
Policy Date
July 2007
Status/Date
Revised/September 2012

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.

Policy

Compensation

TRUE BLUE ® HMO

Providers should collect any applicable copayments due at the time of service. A member"s identification card lists copayment/coinsurance amounts. The provider will not seek to collect, accept payment from or bill members, except copayments/coinsurance, for the provision of covered services over and above that paid for by the Medicare Advantage plan.

Submission of a claim for reimbursement shall be the provider’s representation that, in the provider’s best judgment, the charges represented are only for medically necessary covered services.

Please be aware, many services may not require a copayment, including flu shots, hepatitis B or pneumococcal vaccines, or other preventive services.

Please note:  True Blue HMO Special Needs Plan members (full dual eligibility for Medicare and Medicaid) may have no copayment as indicated on their member identification card, except for copayments for Part D medications.

SECURE BLUE SM   PPO

The provider will not seek to collect, accept payment from or bill members, except copayments and coinsurance, for the provision of covered services over and above that paid for by the Medicare Advantage plan.

Submission of a claim for reimbursement shall be the provider’s representation that, in the provider’s best judgment, the charges represented are only for medically necessary covered services.

Please be aware, many services may not require a copayment, including flu shots, hepatitis B or pneumococcal vaccines or other preventive services. 

Medicare updates allowables quarterly. Please see MAPAP227 for additional information regarding allowances. Blue Cross of Idaho makes its portion of the reimbursement directly to the provider of service. Providers should collect copayments or coinsurance from the member at the time of service.  If a provider mistakenly collects more from the member than the designated cost share amount, the provider must refund the difference to the member.  Blue Cross of Idaho complies with Medicare's prompt claims payment rules.


Policy History

Date Action Reason
September 2012 Revised Added link to MAPAP227
January 2012 Revised Removed references to Flexi Blue
January 2010 Revised 2010 Summary of Benefits and Benefits at a Glance
March 2009 Revised 2009 Summary of Benefits and Benefits at a Glance
November 2008 Revised Language clarification
August 2008 Revised Language clarification
May 2008 Revised Language clarification

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