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Claims Submission/Payment

Provider Administrative Policy

Provider Information
Policy Date
April 2007
Revised/June 2013


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.


Claims Submission/Payment

Claims submitted to Blue Cross of Idaho Medicare Advantage plans should use current Medicare billing guidelines and approved forms. Regardless of the format used, all submitted claims shall contain complete and accurate information relevant to claims processing including, without limitation:

  1. Member name
  2. Provider name, provider address and identification number
  3. Available information regarding third-party liability and other applicable underwriting or insurance coverage
  4. Relevant occurrence date
  5. Itemization of charges, date of service, principal diagnosis and procedure code and, if appropriate, secondary diagnoses and procedures, all of which shall utilize a standard coding system acceptable to Medicare Advantage plans

By submitting claims with the above information, Blue Cross of Idaho can expedite processing and payment of claims, and prevent the return of claims for required processing information.

Please notify Blue Cross of Idaho of any changes in your tax identification number as soon as possible. The Internal Revenue Service requires Blue Cross of Idaho to have current W-9s on all providers. Please fax completed W-9 forms to your provider relations representative (see MA PAP102).

Medicare Advantage must receive claims not later than 12 months from the date of service or as specified in the provider's contract.

Submit paper Claims to:
Blue Cross of Idaho/Medicare Advantage
P.O. Box 8406
Boise, ID 83707

You can submit claims electronically (see MA PAP214 ).

We make organization determinations (including denials and payments) on all claims within 60 days of receipt. 

The claims department will pay “clean” claims within 30 days. Please do not resubmit a claim piror to reviewing status of the claim on our website at

If a member has health insurance coverage under two or more plans and Medicare Advantage is the secondary payer, Blue Cross of Idaho will process the claim only if evidence of the primary payer’s payment is attached to the claim. The combined payments by the plans will not exceed the Medicare Advantage allowable.

Medicare Advantage follows Medicare guidelines to identify a primary insurance carrier.

Policy History

Date Action Reason
June 2013 Revised Changed language regarding review of claim status to reflect process changes.
October 2011 Revised added link to MA PAP102
August 2008 Revised Removed modifier information
May 2008 Revised Hospice change

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