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PAP 356

Key Performance Indicators for Ancillary Providers Contracted Under a Physician Clinic Contract

Provider Administrative Policy

Ancillary Provider
Policy Date
May 2013
Revised/March 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


Key Performance Indicators for Ancillary Providers Contracted Under a Physician Clinic Contract

Blue Cross of Idaho is committed to helping improve the quality of care and services available to our members by promoting effective and efficient use of healthcare resources. One way we do this is by aligning provider reimbursement with measures that reduce administrative or medical costs for our policy holders.

Independently contracted audiology, dietician, mental health (psychologist, licensed clinical social workers, licensed clinical professional counselors and licensed marriage family therapists) optometrists, physician therapists, occupational therapists and speech therapists, "ancillary providers", are subject to the key performance indicators in their contract.

For ancillary providers covered under a physician clinic contract, the ancillary provider will be assigned to the same fee schedule level as the physician clinic in the following manner:

  1. If clinic receives the premium fee schedule level we will assign the ancillary provider to the premium ancillary provider fee schedule.
  2. If the clinic receives the enhanced or standard fee schedule level the ancillary provider will be assigned to the standard ancillary provider fee schedule.

Please refer to the specific clinic contract for the definitions of the key performance indicator measures.

Policy History

Date Action Reason
March 2014 Revised Due to annual ammendments

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