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

If you are an Medicare or Medicare Supplement member, please register here.

New Options for Affordable Health Insurance

Contracting Home IV

 

  1. Contact your Provider Relations Representative to order your contract. (See PAP100)
  2. Submit the following items. Any missing items may result in the return of incomplete documents or a delay in processing.
    • Current state pharmacy license
    • Evidence of accreditation - Medicare Accreditation/Certification through the Accreditation Commission for Health Care (ACHC), the Community Health Accreditation Program (CHAP) or The Joint Commission (TJC) (attach a copy)
    • Malpractice/liablity insurance - minimum amounts of $1 million per occurrence, $3 million aggregate (attach a copy)
    • Provider information sheet 
    • W-9
    • Exhibit 1
    • Provider tax ID or ownership update (This is only required when a new contract on an existing provider is required due to a tax ID or ownership updated.)

 

Return to:

Fax:  208-387-6818

Email:  PR2PI@bcidaho.com