Medicare AdvantageAdministrativeMedium impact
MAPAP400 - Timely and Quality Care - Updated language on women’s health care.
Blue Cross of Idaho·ID · OB-GYN, Family Medicine, Internal Medicine·Medical Policy
Effective date
Oct 1, 2025
We identified it
Jun 19, 2026
Summary
Blue Cross of Idaho updated their Medicare Advantage policy MAPAP400 to revise language regarding women's health care self-referral rights. The policy confirms that Medicare Advantage members can self-refer to contracting gynecologists for women's health care services without requiring a PCP referral.
Action Required
Immediately: Front desk staff and billing team should verify that Medicare Advantage members can schedule gynecology appointments without PCP referrals. Update scheduling protocols to allow direct gynecology appointments for Blue Cross of Idaho Medicare Advantage members. Ensure billing staff are aware that these self-referred visits should process normally without prior authorization requirements.