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Pre-existing Information Request


Provider Administrative Policy

Section
Claims Submission
Policy Date
December 2006
Status/Date
Revised/September 2012
Provider Type(s)
All Providers  

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

Pre-existing Information Request

When Blue Cross of Idaho requests information for a pre-existing condition on a Blue Cross of Idaho member or BlueCard out of area claim, a request for medical records or a form will be sent to the provider that requires the provider to supply the requested information and return to Blue Cross of Idaho. If this information is not received or is insufficient, a second request will be sent. The requested information must be returned within 10 working days. Once received, the information will be forwarded to the appropriate plan for review or reviewed locally for Blue Cross of Idaho members.

If the form or information is not received:

  • BlueCard claims - The claim will remain open for a minimum of 10 business days after the initial pre-existing information is requested by the Home Plan; or longer at the discrestion of the Home Plan.
  • Blue Cross of Idaho - the claim will remain open for a total of 25 days from the receipt of the claim. If information is not received by the 25th day the claim will be denied.

Sample Form for Additional Information


Policy History

Date Action Reason
September 2012 Revised 1st bullet updated number of days claim to remain open

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