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PAP215

Provider Liability


Provider Administrative Policy

Section
Claims Submission
Policy Date
December 2006
Status/Date
Revised/October 2009
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

Provider Liability

Blue Cross of Idaho may deny a claim for various reasons including, but not limited to, incorrect coding, bundling, inappropriate use of modifiers, determinations of services, supplies and procedures that are investigational or not medically necessary under the terms of the member and/or provider contracts and Blue Cross of Idaho medical policies.  If this occurs and the provider is a contracting provider, the claim will deny as provider liability. 

Notice of Non-covered Services
A notice of non-covered services, advance beneficiary notice (ABN), must be completed for a contracting provider to bill a member for a non-covered service.  See PAP248 for additional information regarding the specific requirements of the ABN.


Policy History

Date Action Reason
October 2009 Revised Link to PAP248 added

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