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PAP422 - Dialysis Billing for Non-Contracting Providers - Included Gemstone OON claim payment processing rules
Effective date
Not stated in the notice
Identified
Jun 19, 2026
Summary
Blue Cross of Idaho updated PAP422 in January 2024 to clarify that out-of-network (OON) dialysis claims processed through the Gemstone claims system will be paid directly to the provider, whereas Legacy system claims are paid to the member. This change affects claim payment routing for non-contracting dialysis facilities and requires billing teams to understand which claims system processes their claims to direct reimbursement appropriately.
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What to do
Action · 5 steps
01Billing team must immediately.
02Determine whether your dialysis facility's claims are processed through the Legacy or Gemstone claims system by contacting Blue Cross of Idaho.
03If processed through Gemstone, update internal records and patient communications to reflect that OON reimbursement will be paid directly to the provider (not the patient).
04If processed through Legacy, note that payments will be directed to members absent a specific case agreement with the payer.
05Update billing workflows and denial management processes to route follow-up based on correct payment recipient.
If missed: Failure to understand payment routing may result in delayed receipt of reimbursement or incorrect collection attempts against members.
Codes mentioned
9099990993
Original notice
PAP422 - Dialysis Billing for Non-Contracting Providers - Included Gemstone OON claim payment processing rules
providers.bcidaho.com · Always check the source before changing claims.