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Provider Administrative Policy

Section
Blue Cross of Idaho Information
Policy Date
November 2007
Status/Date
Revised/Februay 2014
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

Contact Information

Provider Contact Center for Commercial and Medicare Advantage

Hours:  8 a.m. - 5 p.m./ MT, (Monday, Tuesday, Thursday, Friday)
              8:30 a.m. - 5 p.m. MT (Wednesday)

Interactive voice response (IVR) provides instant answers 24/7 to your questions about claim status, eligibility, deductible status and prior authorization. The IVR system does not provide FEP BlueCard claim status information.

Type of Business Local Direct Toll Free
Pre-service benefits for Commercial, FEP, Dental and Medicare Advantage Lines of Business 208-286-3656 866-482-2250
For the Hearing Impaired TTY 800-223-3131 TDD 800-377-1363

Medicare Medicaid Coordinated Plan True Blue Dual Special Needs Plan Hours: 8 a.m. - 9 p.m., MT seven days a week

Member Line Dual Special Needs Plan: 888-495-2583
Waiver Providers Support Line: 866-588-6174                          

Post Service Claims

Submit secure on-line inquiries for post-service claims on the secure provider portal on our website www.bcidaho.com, using one of the two options below:

Option 1

  1. Log onto our secure website, www.bcidaho.com 
  2. Select Eligibility and Claims
  3. Select Claims, then search for the claim in question and view your claim
  4. If you have a question, select Provider Contact Center
  5. After typing your question, select Continue

With option 1, the form auto populates the appropriate member, provider and claim information. Simply type your question in the notes field. The system will securely deliver your submission to a Customer Service Agent following HIPAA compliancy guidelines.

Option 2

  1. Log onto our secure website, www.bcidaho.com
  2. Select Contact Us
  3. Select General Information under the Email heading
  4. Select a Question Category for the drop-down list. Select I have a different question, when unable to locate the claim on the website
  5. Complete the required fields marked with a red asterisk
  6. Select Submit Question

With option 2, the form auto populates your contact information based on your user name and password. The system securely delivers your submission to a Customer Service Agent following HIPAA compliancy guidelines.

Credentialing/Re-credentialing Local Toll-Free Fax
208-387-6860 800-627-6655 Ext. 6830 208-286-3584

Mailing Address
Blue Cross of Idaho
P.O. Box 7408
Boise, ID 83707

Automated System
Blue Cross of Idaho has an automated system that allows you to enter the extension of a provider relations representative or access a department directory by calling: 208-286-3602 or 866-283-5723

When the system asks for a specific extension, use the following contact information based on your geographic area:

Internal Provider Relation Representatives
If you have questions regarding coding or contracting, you may contact one of the following provider relations representatives.

Benewah, Bonner, Boundary, Clearwater, Idaho,
Kootenai, Latah, Lewis, Nez Perce and Shoshone Counties,
North Idaho, Washington and Montana

Leah Hulse CPC

E: PR8326@bcidaho.com
P: 208-286-3602 Ext. 8326
866-283-5723 Ext. 8326
F: 208-286-3575

Adams, Boise Canyon, Elmore, Gem, Owyhee,
Payette, Valley and Washington Counties,
St. Alphonsus Health Systems Statewide and Oregon

Pam Roach CPC

E: PR7541@bcidaho.com
P: 208-286-3602 Ext. 8306
866-283-5723 Ext. 8306
F: 208-286-3556

Ada County and St. Lukes Health Systems Statewide

Heidi Lowman

E: PR7560@bcidaho.com
P: 208-286-3602 Ext. 8304
866-283-5723 Ext. 8304
F: 208-286-3558

Bannock, Bear Lake, Bingham, Blaine, Bonneville, Butte,
Camas, Caribou, Cassia, Clark, Custer, Franklin, Freemont,
Gooding, Jefferson, Jerome, Lemhi, Lincoln, Madison,
Minidoka, Oneida, Power, Teton and Twin Falls Counties,
South Central, Southeastern and Eastern Idaho, HCA,
Nevada, Utah and Wyoming

Jenn Lucy

E: PR7205@bcidaho.com
P: 208-286-3602 Ext. 8310
866-283-5723 Ext. 8310
F: 208-286-3560


 

Provider Communications
One to One for Healthcare Provider Newsletters, Administrative Policies for Commercial, Dental and Medicare Advantage, Provider Alerts and Provider Web site communications.

Melissa Johnston                                                                    E: PR8317@bcidaho.com
P: 208-286-3602 Ext. 8317
866-283-5723 Ext. 8317
F: 208-286-3592

 

 

 Provider Appeals Representative

Medicare Advantage            Natalie Cook CPC, CPC-H

E: 
PR6650@bcidaho.com
P:  208-286-3602 Ext. 8312     
      866-283-5723 Ext. 8312
F:  208-286-3559
Commercial and Dental Debbie Gossage CPC

E: 
PR6987@bcidaho.com
P:  208-286-3602 Ext. 8311
      866-283-5723 Ext. 8311
F:  208-286-3559
Commercial and Dental                                                                    

Kathy Root CPC

E:  PR8315@bcidaho.com
P:  208-286-3602 Ext. 8315
      866-283-5723 Ext. 8315
F:  208-286-3581


External Provider Relation Representatives
For questions about EDI Plus, Blue Cross of Idaho's free clearing house and secure provider portal Web site training you may contact one of the following:

Adams, Benewah, Bonner, Boundary, Clearwater,
Idaho, Kootenai,
Latah, Lewis, Nez Perce, Shoshone,
Valley and Washington Counties, North Idaho,
Montana, Oregon and Washington

Kathy Brock CPC-P


E:
PR7329@bcidaho.com
P: 208-286-3602 Ext. 8307
    866-283-5723 Ext. 8307
F: 208-286-3561

South, South-Central Idaho and Nevada - The cities
of Eagle, Garden City, Kuna, Meridian, Star and the following
counties:
Blaine, Butte, Camas, Cassia, Custer, Elmore, Gooding,
Jerome, Lemhi, Lincoln, Minidoka, Owyhee and Twin Falls

Diane Mortensen CPC

E:
PR7450@bcidaho.com
P: 208-286-3602 Ext. 8308
    866-283-5723 Ext. 8308
F: 208-286-3562

Treasure Valley West - City of Boise, all Ada County St. Lukes
Health Systems and the following counties: Boise, Canyon,
Gem and Payette Counties
Jamie Hunihan

E:
PR6668@bcidaho.com
P: 208-286-3602 Ext. 8309
    866-283-5723 Ext. 8309
F: 208-286-3563
Eastern Idaho, Wyoming and Utah - Bannock, Bear Lake,
Bingham, Bonneville, Caribou, Clark, Franklin, Fremont,
Jefferson, Madison, Oneida, Power and Teton

Angie McCormick

E: PR7032@bcidaho.com
P: 208-286-3602 Ext. 7032
    866-283-5723 Ext. 7032
F: 208-331-7502



Electronic Billing
For questions about electronic billing errors and your Error and Acceptance Report, contact the help desk via Email: edihelpdesk@bcidaho.com.

Prior Authorization Contacts:

  Local Toll-Free Fax
Behavioral Health Management 208-331-7535 800-743-1871 208-387-6840
Medical Management 208-331-7535 800-743-1871 208-331-7344
Inpatient/Home Health/Hospice 208-331-7535 800-743-1871 208-331-7326
Case Management 208-331-8872 800-627-1187 Ext.8872  
Disease Management 208-387-6924 800-627-6655 Ext. 6924  
Pharmacy Management 208-387-6666 800-627-6655 Ext. 6666 208-387-6969
Quality Management 208-331-7327 800-274-4018 Ext. 7327  

AIM - American Imaging Management
Non-emergent MRI/MRA, CT, PET and nuclear cardiology scans require authorization by the ordering physicians prior to scheduling the appointment. You can obtain prior authorizations for these services through AIM located within the provider portal at bcidaho.com, or by calling AIM's toll-free number at 866-714-1105. Failure to obtain prior authorization could cause a claim denial or delay.

AMI - Alternative Medicine Integration
Phone: 
855-432-2667
Email:  mmarek@amibestmed.com
Hours:  9 a.m. - 5 p.m. MT, Monday - Friday


Policy History

Date Action Reason
February 2014 Revised Updated External Reps regional coverag
January 2014 Revised Updated Credentialing's Fax number
June 2013 Revised Update Relations Representatives Regions
May 2013 Revised Update process for post-service claims
January 2013 Revised Added note to Internal and External Reps, added pre-service and post-service
August 2012 Revised Removed phone number for EDI
June 2012 Revised Updated AMI's email address
January 2012 Revised Removed NIHN contact information
October 2011 Revised Updated Internal/External Reps Regional Areas
September 2011 Revised Updated email address for Provider Contact Center
June 2011 Revised Added new contact information
October 2010 Revised Added mailing address, updated Provider Relation positions
August 2010 Revised Phone number revisions
January 2010 Revised BPA, Home Health/Hospice, FEP 24-hour, and NIHN phone number revisions
October 2009 Revised Behavioral Health, Inpatient/Home Health/Hospice, AIM numbers added
July 2009 Revised FEP phone number removed, BPA number for all but NIHN removed, extensions updated
March 2009 Revised Customer Service hours changed, phone number added
November 2009 Revised Phone number revisions
August 2008 Revised Email inquiries and contact headings
May 2008 Revised Employee and phone number revisions

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