CommercialReimbursementMedium impact
PAP422 - Dialysis Billing for Non-Contracting Providers - Included Gemstone OON claim payment processing rules
Blue Cross of Idaho·ID · Nephrology·Reimbursement
Effective date
Jan 1, 2025
We identified it
Jun 19, 2026
Summary
Blue Cross of Idaho updated their dialysis billing policy for non-contracting providers to include new Gemstone claim system payment processing rules. Out-of-network dialysis claims processed in the Gemstone system will now be paid directly to the provider, while Legacy system claims continue to be paid to the member.
Action Required
Immediately: Billing team must verify which Blue Cross of Idaho claim processing system (Legacy vs Gemstone) applies to your practice. For out-of-network dialysis claims in Gemstone system, update payment expectations as payments will now come directly to provider instead of member. Update accounts receivable procedures accordingly.