December 2021

Watch for a Letter on Fighting Fraud, Waste and Abuse

Every year, analysts and investigators for Blue Cross and Blue Shield of Illinois (BCBSIL) review claims data, industry trends and investigative results to identify potential areas of fraud and waste.  We share this information with you in letters mailed to your office. The current letters show instances of potential billing abuse surrounding COVID-19 testing and vaccinations. The letters will remind you to comply with BCBSIL’s policies and requirements.

For more information on policies, please refer to the Standards and Requirements section of our Provider website.

If you encounter potential fraud, waste, and/or abuse, please file a report online or call our Fraud Hotline at 800-543-0867. All online reports and calls are confidential, and you may remain anonymous. For more information, visit our Fraud and Abuse page.

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider, nor is the information presented intended to replace or supersede any requirements set forth in your contract with BCBSIL. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.