CommercialReimbursementMedium impact
PAP2002 - Maximum Allowances for Unlisted Codes - New
Blue Cross of Idaho·ID·Medical Policy
Effective date
Nov 1, 2022
We identified it
Jun 19, 2026
Summary
Blue Cross of Idaho has established a new reimbursement policy for unlisted billing codes. When no maximum allowance is available, covered services will be reimbursed at 67% of the provider's billed charges for Traditional, PPO and Commercial Managed Care coverage.
Action Required
Immediately: Billing team should review all unlisted codes currently being billed to Blue Cross of Idaho. Update billing procedures to expect 67% reimbursement of billed charges when no maximum allowance is established. Consider adjusting charge amounts for unlisted codes accordingly to ensure adequate reimbursement.