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Provider Administrative Policy

Commercial Managed Care
Policy Date
April 2007
Reviewed/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.



The primary care physician (PCP) agrees to provide 24-hour, seven day per week coverage for members. The PCP, or his or her designated covering provider(s), will be available on a 24-hour basis to provide care personally, or to direct members to the setting most appropriate for treatment. The provider agrees to establish call-share arrangements with another contracting provider whenever possible.

If changes are made in call-share arrangements, please notify the provider relations department to assure that claims from covering providers are processed correctly (see PAP100 ). If electronic answering machines are used, messages should include name and phone number of the on-call physician, with instructions to contact that physician.

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