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Provider Information Changes

Provider Administrative Policy

Claims Submission
Policy Date
February 2008
Revised/October 2014
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


Provider Information Changes

You must present Blue Cross of Idaho with written documentation when making the following changes:

  • *Change in ownership or tax identification change, (please include a copy of the updated W-9).
  • Change of address or additional service location
  • Change of phone and/or fax number
  • Change of clinic or provider name
  • *Provider joining practice
  • Provider leaving practice
  • Change of sponsoring provider if you are a nurse practitioner (NP) or a physician assistant (PA) working under the supervision/sponsorship of a physician
  • Change in status when physicians accept new members. This may include opening or closing of new patient panel. 30-day advance written notice is required before the change goes into effect
  • Change in patient limitation such as an age or gender limitation
  • Changes in provider specialty.
    • Please note:  Members will receive notification to select a new primary care provider if specialty is changed from primary care to a specialist.

*Contact your provider relations representative (see PAP100) to determine what supporting documentation you will need.

Include the effective date of change (we will not make retrospective changes but we can process future effective dates). When your request for change specifies a past date, the change will take effect on the date we enter the information into our system. If the change is in the future, the future date is the effective date.
Please Note:  If numerous Blue Cross of Idaho legacy numbers have been assigned to your providers at different addresses and a provider is moving from one legacy location to another, a provider information sheet is necessary to add the provider to the new address/legacy number. Written notification is still required terminating the provider from the old address.
Please let us know if claims with dates of service prior to the tax identification change fall under a previous tax identification number so we can issue new provider numbers.
If your tax identification change represents a change of ownership, your contracts and credentialing with Blue Cross of Idaho may not be valid. Please contact your provider relations representative (listed in PAP100) prior to ownership changes to assure your contracting status remains in place.

W-9 Form

Provider Information Sheet

Provider Request for Update Form

Policy History

Date Action Reason
October 2014 Revised Change in specialty added as a bullet
April 2013 Revised Added language regarding patien panel and patient limitations.
November 2012 Revised Removed language regarding 15 days set up
July 2012 Revised Revised language added link to Provider Request for Update Form
June 2012 Revised Updated changes that require written documentation
January 2012 Revised Removed NIHN language.
November 2010 Revised Added service extender information
August 2010 Revised Mass fax information added
August 2008 Revised Language clarification
May 2008 Revised Title change

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