September 2020
Reminder: Some Specialties Do Not Need Credentialing
Credentialing is the process by which Blue Cross and Blue Shield of Illinois (BCBSIL) reviews and validates the professional qualifications of physicians and certain other providers who apply for participation in our commercial HMO, PPO, Blue Choice PPOSM, Blue Cross Medicare Advantage (PPO)SM and Blue Cross Medicare Advantage (HMO)SM networks, ensuring they meet our professional standards.
As a reminder, the specialties listed below do not require credentialing to be part of the BCBSIL networks. All other specialists must be credentialed.
| Anesthesiology | Licensed Massage Therapy (LMT) | Radiation Tech |
| Critical Care Medicine | Neurodevelopmental Disabilities | Radiology |
| Dentistry | Certified Registered Nurse Anesthetist (CRNA) | Registered Nurse (RN) |
| Emergency Medicine | Occupational Therapy | Registered Nurse First Assistant (RNFA) |
| Hospice and Palliative Medicine | Oral Pathology | Registered Surgical Tech |
| Hospital Based Provider Type AB | Pathology | Retail Health Provider |
| Hospitalist Provider Type HP | Pediatric Intensive Care | Speech Pathology (Therapy) |
| Licensed Practical Nurse (LPN) | Periodontics | Surgical Assistant |
| Licensed Professional Counselor (LPC) | Phlebology | |
| Licensed Social Worker (LSW) | Physical Therapy |
The State of Illinois is responsible for credentialing and recredentialing of physicians and certain other providers that participate in the Blue Cross Community Health PlansSM (BCCHPSM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM Medicaid plans. To be eligible to participate, the physician and certain other providers must be enrolled/credentialed through the Illinois Medicaid Program Advanced Cloud Technology (IMPACT) system.
For more information, visit our Credentialing page.
Please note that the fact that a provider participates in a BCBSIL network is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have any questions, call the number on the member’s ID card.