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Hospital Based Professional Services

Provider Administrative Policy

Policy Date
November 2007
Revised/May 2008
Provider Type(s)


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.


Hospital Based Professional Services

Hospital-based professional services must be submitted on a CMS-1500 form with procedure codes and/or HCPCS codes and ICD-9 diagnosis codes. These include, but are not limited to, claims for services submitted by the hospital for emergency room physicians, radiologists, pathologists and mental health providers.

Claims for physician services should include the individual provider's NPI in field 24J of the CMS-1500 form. Refer to PAP203 for billing number requirements. If you have any questions about provider numbers, please contact your provider relations representative.

Policy History

Date Action Reason
May 2008 Revised Language clarification

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