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Incomplete Provider Contracts


Provider Administrative Policy

Section
Information
Policy Date
November 2010
Status/Date
Revised/November 2012
Provider Type(s)
N/A  

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

Incomplete Provider Contracts

Blue Cross of Idaho works on behalf of our members to develop contracting relationships with Idaho healthcare providers. We have specific contract criteria established for all provider specialties to ensure that our contracting providers meet acceptable provider licensing, accreditation, and/or medical standards to provide the highest quality of care and services.

To expedite our contracting process, we ask that providers provide all necessary contract information on the initial submission including credentialing applications where applicable. Incomplete information will delay the contract implementation process.

Blue Cross of Idaho implements completed provider contracts following the completion of the credentialing process. We ask providers for missing or incomplete information three times and document each contact attempt. We then retain incomplete provider contracts for a period of ninety days. After ninety days, Blue Cross of Idaho destroys incomplete contracts and includes record of the documentation requests in the provider file.

Below are common reasons for provider contract processing delays. 

Missing Information 

  • Credentialing application
  • Provider license (i.e., physician, lab, DME)
  • Accreditation certificate
  • Proof of liability/professional insurance
  • Medicare number
  • CLIA certificate
  • NPI provider identification
  • Tax identification number or W-9
  • Surety bond for DMEPOS providers
  • Provider information sheet (PIS)

Incomplete Information  

  • Incomplete credentialing application or supporting documentation
  • Incomplete attachments
  • Unsigned contract
  • Clinic name inconsistencies throughout the contract
  • Unauthorized signature on contract
  • Invalid provider for type of contract
  • Current contract version

Fax provider contract information to: 208-387-6818


Policy History

Date Action Reason
November 2012 Revised Removed language of 15 days

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