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:
- Select your facility or provider type.
- 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
- Select Update if:
- You are a current provider who needs to modify any information about your organization
|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|
|Behavioral health service extender
(LPC, LMSW, LAMFT, licensed psychologist extender)
|Certified registered nurse anesthetists||Contracting||Non-contracting||Update|
|Diagnostic imaging, independent||Contracting||Non-contracting||Update|
|Durable medical equipment||Contracting||Non-contracting||Update|
|Independent clinical laboratory||Contracting||Non-contracting||Update|
|Mental health (PhD, LCSW, LCPC, LMFT)||Contracting||Non-contracting||Update|
|Physician service extender
(PA, CSA, CST, COT, CRNFA, OPA-C)
|Registered dietician, independent||Contracting||Non-contracting||Update|
|Therapists (PT, OT, ST)||Contracting||Non-contracting||Update|