Supporting Healthy Hearts

February is American Heart Month. We’re spotlighting awareness for our members who may not know that heart disease and stroke are among the leading causes of death in the U.S. We encourage you to talk with our members about reducing and managing their risks for these conditions.

BCCHP^SM and MMAI Providers: Join Our Community Stakeholder Committee

We’re hosting quarterly Community Stakeholder Committee meetings to find ways to better serve our Blue Cross Community Health Plans^SM and Blue Cross Community MMAI (Medicare-Medicaid Plan)^SM members. We’d like to invite you to join us for our next committee meeting on Feb. 15, 2024. Read more on News and Updates.

What You Can Do To Help Improve CAHPS^® Survey Results

Blue Cross and Blue Shield of Illinois conducts an annual Consumer Assessment of Healthcare Providers and Systems survey for BCCHP and MMAI members. The aim of the survey is to monitor the members’ experience and their satisfaction with BCBSIL and its contracted providers and medical groups.

Collection of HEDIS^® Records for FEP^® Members Begins This Month

Providers who care for our Federal Employee Program^® members may receive medical record requests from BCBSIL or our medical record retrieval vendor through April 2024.

Utilization Management: Avoid Delays and Denials

Our utilization management program helps ensure our members get the right care, at the right time, in the right setting. There are optional recommended clinical reviews and required prior authorization reviews that are conducted before services are rendered.

Prior Authorization Code Updates for Some Commercial and Government Programs Members, Effective April 1, 2024

BCBSIL is changing prior authorization requirements that may apply to some commercial non-HMO and government programs (Blue Cross Medicare Advantage (PPO)^SM, BCCHP and MMAI) members. Refer to the News and Updates for a summary of commercial and government programs changes and code updates.

Pharmacy Program Updates: Prior Authorization Changes Effective April 1, 2024

The pharmacy PA program encourages safe, cost effective medication use by allowing coverage when certain conditions are met. A clinical team of physicians and pharmacists develops and approves the clinical programs and criteria for medications that are appropriate for PA by reviewing U.S. FDA-approved labeling, scientific literature and nationally recognized guidelines. Read more on News and Updates.

Appropriate Use of Opioids Program Retired in January 2024

The Appropriate Use of Opioids program was retired on Jan. 1, 2024. BCBSIL will continue to promote safe and effective use of prescription opioids through an approach that more closely aligns with the Centers for Disease Control and Prevention 2022 Guidelines for Prescribing Opioids for Pain, which emphasize flexibility and individualized care. Read more on News and Updates.

Managing Our Members’ Antidepressant Medication

We encourage you to talk with our members about getting help for depression, if needed. A depression screening tool can help clarify whether depressive symptoms indicate major depressive disorder. 

Provider Learning Opportunities

BCBSIL offers free webinars and workshops for the independently contracted providers who work with us. A preview of upcoming training sessions is included in this month’s issue.

Has your information changed? Let us know! 

When seeking health care services, our members often rely upon the information in our online Provider Finder^®. Prospective patients can use this online tool to confirm if your practice is a contracted in-network provider for their health care benefit plan.

Reminder: CPT^® Codes May Change

As a reminder, Current Procedural Terminology codes may change throughout the year due to changes (new, replaced or removed codes) implemented by the American Medical Association.

ClaimsXten™ Quarterly Reminder: Updates Effective April 15, 2024

BCBSIL will implement its first quarter code updates for the ClaimsXten auditing tool on or after April 15, 2024.