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New Options for Affordable Health Insurance

PAP 803

BlueCard Medicaid and State Children's Health Policies


Provider Administrative Policy

Section
BlueCard
Policy Date
December 2011
Status/Date
New/December 2011
Provider Type(s)
All Providers  

Disclaimer

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.

Policy

BlueCard Medicaid and State Children's Health Policies

In several states, the Blue Cross/Blue Shield plans act as the administrators of that state's Medicaid program. When a provider accepts an out of state Medicaid patient, their claims will price in accordance with the member's state policy and fee schedules, including cost sharing and member held harmless policies. The out of state Medicaid rates supersede the Blue Cross of Idaho allowances established in the provider contract.

BlueCard ID Cards for Medicaid and State Children's Insurance Programs administered as part of a state's Medicaid Program may not include the designated blank suitcase logo. The member's ID card contains the prefix with the member's subscriber ID with filing instructions on the back of the card. Providers should file all claims with their local BlueCross or BlueShield licensee.

Providers are able to determine the type of coverage when checking eligibility by calling 800-676-2583 or logging onto our secure provider portal at bcidaho.com. Since the allowances for Medicaid and State Children's Health Policies differ from standard contract allowances, Blue Cross of Idaho strongly recommends verifying coverage and eligibility before rendering services. In situations where a member has already exhausted a benefit, providers are responsible for writing the full balance off.

If you are seeing an out of area Medicaid member, you may review the individual state(s) Medicaid websites to obtain allowances. 


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