All PlansAdministrativeMedium impact
PAP281 - Provider External Auditors - Deleted incorrect information for Provider appeals from our vendors.
Blue Cross of Idaho·ID·Medical Policy
Effective date
Feb 1, 2026
We identified it
Jun 19, 2026
Summary
Blue Cross of Idaho revised their Provider External Auditors policy (PAP281) to remove incorrect information about provider appeals from their vendors. The policy clarifies that when vendors conduct medical record reviews and issue determinations, providers must follow the vendor's established inquiry and appeal process, not Blue Cross of Idaho's direct process.
Action Required
Immediately: Billing and appeals teams must ensure all appeals related to vendor-performed audits (coding validation, DRG validation, documentation adequacy reviews) are submitted directly to the respective vendor using their established appeal process, not to Blue Cross of Idaho. Reference the Provider Vendors section of the secure Provider Portal for current vendor contact information. Update internal appeal workflow procedures to reflect this vendor-specific requirement.