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Clinic Criteria for Multiple Fee Schedules in a Single Contract

Provider Administrative Policy

Policy Date
August 2010
Revised/October 2012
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.


Clinic Criteria for Multiple Fee Schedules in a Single Contract

Clinics need to meet the following criteria for Blue Cross of Idaho to offer single contracts that contain both the multiple conversion factor rate attachment and the single conversion factor rate attachment:

  1. Clinics must have three or more specialty types represented.
  2. 50 percent or more of the total clinic physicians must be primary care.
  3. Clinics must indicate fee schedule selection when submitting paperwork to add a new provider, or the single conversion factor fee schedule will be assigned by default. 

Policy History

Date Action Reason
October 2012 Revised Bullet #3 updated.

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