Medicare AdvantageAdministrativeMedium impact
PAP1007 - Emerency and Urgent Care Services for Tailored Network and Access Plans - Language updates
Blue Cross of Idaho·ID · Emergency Medicine, Family Medicine, Internal Medicine +2 more·Medical Policy
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Blue Cross of Idaho updated PAP1007 with language clarifications for emergency and urgent care services under Tailored Network and Access Plans. The policy confirms no prior authorization is required for emergency services and specifies that urgent care services must use place of service code 20 on CMS-1500 forms regardless of diagnosis.
Action Required
Immediately: Billing team must ensure all urgent care services are billed using place of service code 20 on CMS-1500 forms, regardless of the diagnosis billed with the evaluation and management (E/M) code. Update billing system rules and staff training to reflect this requirement for Blue Cross of Idaho Tailored Network and Access Plans.