7.2.4 Pay Provider Authorization
Prior to submitting a Claim, the Provider must obtain the Member's consent and authorization to submit a Claim to Pacific Blue Cross. Downloading the Pay Provider Authorization Form and obtaining the Member's consent and signature before providing Equipment or Services to a Member may help reduce delays or the need to later reverse or cancel Claims.
Record Retention Requirements
Retention Period
The signed Pay Provider Authorization Form must be kept on file for a minimum of five (5) years from the date a Claim is submitted on the Member's behalf.
Production Timeline
The signed Pay Provider Authorization Form must be made available to Pacific Blue Cross within twenty-one (21) days of request.
Non-Compliance Consequences
During the course of an Audit, if the signed Pay Provider Authorization Form is not available, then Pacific Blue Cross may, by notice to Provider, deem that money paid by Pacific Blue Cross to such Provider was an Ineligible Expense and such Provider will be required to pay the full amount of such Ineligible Expense to Pacific Blue Cross.
Download Form
Download the Pay Provider Authorization Form