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PAP354

Independent Air/Ground Ambulance Billing


Provider Administrative Policy

Section
Ancillary Provider
Policy Date
August 2010
Status/Date
Revised/May 2013
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

Independent Air/Ground Ambulance Billing

Independent air/ground ambulance providers (participating or non-participating) need to submit claims on a CMS1500 claim form.  Box 32 needs to include information about site of pickup/delivery. 

Services for Blue Cross of Idaho Members

  • Independent air/ground ambulance providers must be licensed and have a service address in the state of Idaho.
  • If pickup and delivery sites are both in the state of Idaho, submit your claims to Blue Cross of Idaho.
  • If contracting with Blue Cross of Idaho and service address is located in a contiguous county, submit your claims to Blue Cross of Idaho.

Services for FEP Members

  • If pickup and delivery sites are both in the state of Idaho, submit your claims to Blue Cross of Idaho (Cities south of Riggins submit to Blue Cross of Idaho, north of Riggins submit to Regence Blue Shield of Idaho).
  • If the site of pickup is in Idaho and site of delivery is in another state, submit your claims to Blue Cross of Idaho unless you hold a provider contract with the plan in the state of delivery and not Blue Cross of Idaho. (Cities south of Riggins submit to Blue Cross of Idaho, north of Riggins submit to Regence Blue Shield of Idaho)
  • If the site of pickup is out of state and site of delivery is in Idaho, submit your claims to the Blue Cross/Blue Shield plan at the site of pickup unless a provider contract is held with Blue Cross of Idaho and not the other states' plan.

Services for Blue Card Members

  • Ambulance providers based/coordinated in the State of Idaho, and the site of services are in Idaho, submit claims to Blue Cross of Idaho regardless of contracting status.
  • Ambulance providers based/coordinated in the State of Idaho and the pick-up/delivery site crosses the state line, submit claims to Blue Cross of Idaho.

Exception: When all of the following conditions are met ambulance providers must submit their claims to the local Plan, the Plan in the state in which the ambulance provider's headquarters are located or where the services were coordinated:

  • The ambulance provider has no service location within the State of Idaho, and
  • Where services are not coordinated by a provider within the State of Idaho, for services fully or partially rendered in Idaho. 

 


Policy History

Date Action Reason
May 2013 Revised Updated BlueCard section, language clarification under Exception:

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