February 2, 2026

Medicare Advantage Referral Updates & Clarifications from Blue Cross of Idaho

During the January 28^th webinar, BCI provided updates and clarifications to help our provider community better navigate the referral process. The referral grace period has been extended through May 1, 2026, giving providers additional time to create referrals while processes continues to be refined. Below is a list of key takeaways along with links to presentations and the full webinar recording with live Q&A. The Idaho Medical Association will continue to meet with BCI stakeholder to share feedback and concerns from our members.

• The following specialties and services have been added to the list of services that do not require a referral:
• OB/GYN
• Chiropractic services
• Audiology
• Neonatology
• Nutritionist services
• Podiatry
• Optometry
• Ophthalmology
• Optician services
• Home Health Agency services
• Services performed in an observation setting
• Specialists have been asked not to cancel patients if a referral is not yet in place. Instead, they should contact PRexternalreps@bcidaho.com or PRproviderrelations@bcidaho.com for assistance.
• A 7-day grace period is available for specialists to obtain a referral after seeing the patient once the May 1^st deadline has passed.
• CPT code 99213 is being used only as a placeholder for internal tracking of referrals. It is not related to billing for actual service.
• If both the provider and facility are in-network, only one referral is required for the in-network provider.
• Specialists cannot refer patients to other specialists. The patient must return to their PCP to obtain a new referral.
• Interventional Radiology many not be considered an excluded provider because it is typically a planned visit and is not viewed as a “hidden provider” under radiology. If Interventional Radiology services occur in an ER setting, they follow emergent care rules and are excluded from referral requirements.
• BCI is working toward enabling both specialists and PCPs to view referrals in progress within JIVA. Currently, only the submitting provider can see the referral in JIVA.

CLICK HERE for Gill Compliance handouts.

CLICK HERE for Blue Cross of Idaho handouts.

CLICK HERE for full webinar recording.

CMS - Improving the Clinical Laboratory Improvement Amendments (CLIA) Program

CMS has issued an important update for providers and laboratories performing CLIA-regulated testing. As part of CMS's ongoing efforts to modernize and streamline the CLIA process, paper CLIA fee coupons and paper CLIA certificates will be discontinued effective March 1, 2026. Moving forward, CMS will issue CLIA fee coupons and certificates electronically, and CLIA fees will be paid securely and efficiently through pay.gov, eliminating the need for mailed documents and paper checks.

If your lab has not transitioned to electronic CLIA notifications, you may miss fee notices or certification documents, which can result in delays or compliance issues. CMS will send CLIA fee coupons and certificates electronically only, so it's critical that your laboratory's email and contact information are current. This applies to all CLIA certificate types, including certificates of waiver.

Providers should take action now to confirm enrollment in electronic notifications and ensure internal staff know how CLIA fees will be received and paid going forward. Waiting until the deadline might create unnecessary disruptions and penalties.

For assistance in Idaho, contact the Department of Health and Welfare, Laboratory Improvement Program at: (208) 334-0528; FAX: (208) 334-4067, or Email: labimprovement@dhw.idaho.gov.

Additional information is available at https://healthandwelfare.idaho.gov/providers/idaho-laboratories-and-testing/clinical-lab-certification.

Medicaid Managed Care Listening Sessions

Save the Dates!

Medicare Wellness E/M Visits: Coding and Documentation Strategies

Join us on February 11th for this session from the 2026 IMA Education Series

In this educational session, we'll take a fresh look at Medicare Wellness visits and the documentation strategies that support both compliance and appropriate reimbursement. Gill Compliance Solutions will walk through practical guidance your providers and teams can apply right away, including:

• A review on Medicare Wellness Visit basics and documentation requirements
• Understanding bundled vs. unbundled services related to AWVs and IPPEs
• How to determine when a significantly, separately identifiable E/M service is appropriate
• Documentation strategies for multiple services performed during a wellness visit
• Tips to ensure practice revenue is not left on the table while staying compliant

Presented by: Nicole Benson, Audit Manager, BA, CPC CPMA, COSC

Date: February 11, 2026

Time: 12:15 - 1:15 (MST)

All registered attendees will earn 1 CEU credit for participation and completion of this education webinar

AMA Discounted 2026 Medical Coding Books: Order Yours Today!

The Idaho Medical Association is pleased to offer substantial discounts on resource materials for AMA and Optum360° books for your office. Order your CPT®, HCPCS, ICD-10, Code of Medical Ethics and other resource materials today! The discounted Coder's Bundle includes the 2026 CPT Professional Edition and the 2026 ICD-10-CM manual for one discounted price.

The 2026 Essential Reference Guide order form with the most popular choices is available HERE for your convenience.

Please note there is a $9.00 shipping and handling fee per book. We also offer a 20% shipping discount for orders of five or more books. Sales tax is calculated on merchandise only and prior to adding shipping fees.

Books will be shipped or hand delivered to you as soon as they are available. ICD-10 and CPT books are now on-hand and can be sent to your office today! Contact Rebecca (rebecca@idmed.org) at the IMA with any questions or call (208) 344-7888x101.

CPT® is a registered trademark of the American Medical Association.