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Contracting/Non-contracting Providers

Provider Administrative Policy

Policy Date
February 2008
Revised/May 2008
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.


Contracting/Non-contracting Providers

Blue Cross of Idaho works diligently on behalf of our Idaho members to develop contracting relationships with Idaho healthcare providers. The following information outlines the administrative relationship with Blue Cross and each type of provider.

Contracting Providers:

  • Must submit both primary and secondary claims on behalf of their patients.
  • Are directly reimbursed from Blue Cross of Idaho for covered services.
  • Must write off provider adjustments.
  • May submit claims electronically.
  • May only collect copayments, coinsurance, deductible and non-covered amounts from their patients.

Non-Contracting Providers:

  • Must submit claims on behalf of patients or provide completed claim forms for patients to submit the claim themselves.
  • Do not receive direct reimbursement for covered services from Blue Cross of Idaho.
  • Reimbursements made directly to the patient.
  • May submit claims electronically.

Medicare Supplements:

  • Reimbursement for Medicare supplements will follow Medicare assignment regardless of contracting status with Blue Cross of Idaho.
  • If you accept assignment on the Medicare claims you will be paid directly.
  • If you do not accept assignment on the Medicare claims the patient will be paid directly.

Policy History

Date Action Reason
May 2008 Revised Excluded providers removed from title

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