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Provider Administrative Policy

Commercial Managed Care
Policy Date
December 2006
Reviewed/May 2008
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



Providers are required to collect any applicable copayments, deductibles or coinsurance due. Review your contract for prohibited collection information. Blue Cross of Idaho strives to pay electronic claims within 30 days of receipt and paper claims within 45 days of receipt, with the exception of BlueCard.®

Copayment amounts are listed on the member’s identification card for standard PPO and managed care plans. The provider will not seek to collect, accept payment from or bill any member any amounts, except copayments, deductibles or coinsurance, for the provision of covered services over and above that paid for by Blue Cross of Idaho. No copayments should be collected for flu shots or covered immunizations with the exception of flu shot clinics. If flu shot rosters are used, reimbursement will be made to the member (see PAP244 ).

Submission of a claim to Blue Cross for reimbursement shall be the provider’s representation that, in the provider’s best judgment; the charges represented by such claim are only for medically necessary services.

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