CommercialReimbursementMedium impact
PAP423 - Inpatient Per Diem Payment Policy - Added lesser of applicability to per diem terms
Blue Cross of Idaho·ID · Critical Care, Emergency Medicine·Reimbursement
Effective date
Jul 1, 2025
We identified it
Jun 19, 2026
Summary
Blue Cross of Idaho updated their inpatient per diem payment policy in mid-2025 to apply 'lesser of' terms to per diem payments for acute care facilities. This means reimbursement will be the lower of either the contracted per diem rate or the provider's charges, applied at the claim line level except for NICU services which apply at the claim level.
Action Required
By July 1, 2025: Billing team must update charge capture and billing systems to ensure per diem claims reflect accurate charge amounts since reimbursement will now be subject to lesser of calculations. Review current charge structures for revenue codes 110-120, 191-199, 200, and 206 to ensure charges align with contracted per diem rates. For NICU services (revenue codes 0171-0174), ensure total claim charges are appropriately set as lesser of applies at claim level rather than line level.