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Accidental Injury Questionnaire


Provider Administrative Policy

Section
Claims Submission
Policy Date
February 2008
Status/Date
Revised/November 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

Accidental Injury Questionnaire

We use accidental injury questionnaires (AIQs) to help identify third-party liability when one of our members is involved in an accident. Blue Cross of Idaho will automatically send an AIQ to a member

We use accidental injury questionnaires (AIQs) to help identify third-party liability when one of our members is involved in an accident.  Blue Cross of Idaho will automatically send an AIQ to a member for claims submitted with any accident diagnosis (V71.3-V71.4 and 800.00-999.9) and a dollar amount over $500. If applicable, we will deny the affected claims until your patient returns the AIQ.

 

You may use the secure provider portal at bcidaho.com to supply accident information to Blue Cross of Idaho by accessing the Accidental Injury Questionnaire under the Forms link.  You may also print the AIQ for your patient to sign in your office. Please include the patient name and Blue Cross of Idaho identification number and your provider name in the upper, right corner of the form. The patient's AIQ file will include the information you provide, your claim and other claims associated with the patient's accident.

 We will return any incomplete AIQs to the member for missing information.

NOTE:  Winco members require a different AIQ form. The members signature is required or the form will be considered incomplete and returned to the member.

Winco AIQ Form

Accidental Injury Questionnaire (online)


Policy History

Date Action Reason
November 2012 Revised Updated Winco language and link to Winco AIQ and AIQ online forms
November 2010 Revised WinCo AIQ added

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