Medicare AdvantageAdministrativeHigh impact
One-to-One for Healthcare Professionals - Fall Edition
Blue Cross of Idaho·ID·Medical Policy
Effective date
Jan 1, 2024
We identified it
Jun 19, 2026
Summary
Blue Cross of Idaho's Fall newsletter contains multiple updates including HEDIS Transitions of Care documentation requirements, CarelonRx name change to CarelonRx Pharmacy, and major claims processing system updates moving members to new Gemstone system with different ID formats and remittance processes.
Action Required
By January 1, 2024: Billing team must update e-prescribing systems to search for 'CarelonRx Pharmacy' instead of 'CarelonRx Mail'. Prepare for new member ID formats (9 digits starting with 101) and Plan Group IDs starting with 3 for government programs and 2 for individual plans. Update remittance processing to handle up to 11 different remittance advices between Legacy and Gemstone systems. Providers must enhance documentation for HEDIS Transitions of Care including timestamped admission notifications, discharge information receipt, patient engagement within 30 days, and medication reconciliation within 31 days post-discharge.