Medicare AdvantageAdministrativeMedium impact
MAPAP229 - Post-Service Inquiries and Appeals - Language clarified
Blue Cross of Idaho·ID·Medical Policy
We identified it
Jun 19, 2026
Summary
Blue Cross of Idaho clarified language in their Medicare Advantage post-service inquiries and appeals process policy. The policy outlines the three-level review process (inquiry, first-level appeal, second-level appeal) and specifies that claims denied for medical necessity reasons requiring medical records cannot use the online inquiry process and must go directly to the formal appeals process.
Action Required
Immediately: Staff must understand that claims denied for medical necessity reasons requiring medical records cannot be submitted through the online post-service inquiry process and must go directly to formal appeals using the Contracting Provider Appeal Form with medical records. Update workflow to identify these denial types and route them to the appropriate appeals process instead of online inquiries.