ExchangeAdministrativeMedium impact
PAP1005 - Tailored Network and Access Plan Referral - Clarified role of referral centers.
Blue Cross of Idaho·ID·Medical Policy
We identified it
Jun 19, 2026
Summary
Blue Cross of Idaho clarified that referral centers can make recommendations for gap referral approvals but final determinations of medical necessity remain with Blue Cross of Idaho. This affects tailored network and access plans where gap referrals are required for out-of-network care.
Action Required
Immediately: Update staff training materials and workflows to reflect that referral centers can only make recommendations for gap referrals, not final approval decisions. Ensure billing team understands that Blue Cross of Idaho retains final authority on medical necessity determinations. Continue following existing gap referral submission processes through the Provider Portal at providers.bcidaho.com.