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If you are an Individual or Family Member under age 65, please register here.

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New Options for Affordable Health Insurance

Provider Forms for New and Existing Providers

New providers with Blue Cross of Idaho may elect to be either contracting or non-contracting.

  • Contracting Providers - must meet Blue Cross of Idaho licensing, accreditation and/or credentialing criteria and have a signed contract with Blue Cross of Idaho. Blue Cross of Idaho pays contracting providers directly for covered services.
  • Non-contracting Providers - must meet Blue Cross of Idaho licensing and/or accreditation standards but doesn't require a signed contract with Blue Cross of Idaho. Blue Cross of Idaho pays our members directly for covered services provided by non-contracting providers.

Note:  Non-covered providers do not meet Blue Cross of Idaho's licensing and/or accreditation standards. Blue Cross of Idaho may deny services as non-covered and the charges become member liability (See PAP247). 

To access documentation for new providers or to update information on an existing provider, follow the steps below:

  1. Select your facility or provider type.
  2. Select Contracting Provider or Non-Contracting Provider if:
    • You are a new provider or clinic with Blue Cross of Idaho
    • You are adding existing providers to a new organization/tax identification number
  3. Select Update if: 
    • You are a current provider who needs to modify any information about your organization
      • New address or phone number
      • New locations (If provider practices at multiple sites under the same tax ID)
      • Terminations
      • Panel change
      • Tax ID or change in ownership (For additional information, please call your Provider Relations Representative (see PAP100 or DPAP100). 

 

  Facility  - Claims submission on a UB04  
Free standing hospice Contracting Non-contracting Update
Free standing dialysis facility Contracting Non-contracting Update
Hospitals (acute, rehabilitation, specialty care)            Contracting Non-contracting Update
Skilled nursing facility (SNF) Contracting Non-contracting Update
 

Professional - Claims submission on a CMS 1500 (medical) or
                        ADA claim form (Dental)
 
Ambulatory surgical center Contracting Non-contracting Update
Audiologists Contracting Non-contracting Update
Behavioral health service extender
(LPC, LMSW, LAMFT, licensed psychologist extender)
Contracting Non-contracting Update
Certified registered nurse anesthetists Contracting Non-contracting Update
Chiropractor Contracting Non-contracting Update
Dentist Contracting Non-contracting Update
Diagnostic imaging, independent Contracting Non-contracting Update
Durable medical equipment Contracting Non-contracting Update
Home health Contracting Non-contracting Update
Home IV Contracting Non-contracting Update
Independent ambulance Contracting Non-contracting Update
Independent clinical laboratory Contracting Non-contracting Update
Mental health (PhD, LCSW, LCPC, LMFT) Contracting Non-contracting Update
Nurse practitioner Contracting Non-contracting Update
Optometrist Contracting Non-contracting Update
Physician Contracting Non-contracting Update
Physician service extender
(PA, CSA, CST, COT, CRNFA, OPA-C)
Contracting Non-contracting Update
Registered dietician, independent Contracting Non-contracting Update
Sleep laboratory Contracting Non-contracting Update
Therapists (PT, OT, ST) Contracting Non-contracting Update