See Updates to Behavioral Health Clinical Practice Guidelines

The guidelines are based on established evidence‑based standards and support decision‑making processes in member care.

Review Changes to Air and Ground Medical Transportation

Effective Jan. 1, 2026, Alacura Medical Transportation Management will manage prior authorization, recommended clinical review and retrospective claim review for commercial non‑HMO air and ground medical transportation claims. See how to contact Alacura when transport is needed.

See Prior Authorization Changes for Commercial and Government Plans

Effective Jan. 1, 2026, prior authorization requirements for certain commercial and government plans are changing to reflect new, replaced or removed codes.

Explore Learning Opportunities

We offer free webinars and workshops for providers who participate in our networks. View the schedule and sign up for sessions.

Blue Cross Community MMAI (Medicare‑Medicaid Plan)^SM Ending

Beginning Jan. 1, 2026, the MMAI plan will no longer be offered to our members. You can follow existing processes for submission of MMAI claims with dates of service through Dec. 31, 2025.

We’re Enhancing Reviews for Medicaid Claims

Effective Jan. 5, 2026, we’ll enhance our claims editing and review process to ensure accurate billing of claims for members with Blue Cross Community Health Plans^SM.

Use Medicaid ID When Submitting Claims for Members With BCCHP^SM

No later than Feb. 1, 2026, for members with BCCHP, you should begin filing claims using the Medicaid recipient identification number instead of the subscriber ID for Blue Cross and Blue Shield of Illinois. See where to find the RIN and other details.

View Reminders on Illinois Medicaid Hospital 30‑Day Readmission Review and Dispute Processes

Claims for subsequent hospital admissions that are determined to be readmissions may be denied unless exception criteria are met. For denial disputes, medical records for both hospitalizations are required. See resources for more information.

Use Updated Form To Submit Medicaid Claims Inquiry or Dispute Requests

If you provide care to our members with BCCHP, please use our updated form when submitting a claims inquiry or dispute request.

Watch for Enhancements to Utilization Management Processes for Illinois Medicaid

Beginning in early 2026, you’ll experience a new online process when initiating prior authorization requests through Availity^® Essentials for members with BCCHP. Preview what’s changing and how it will improve efficiencies.

Keep Your Record ID Active To Prevent Network Termination

If you haven’t filed a claim with your billing or rendering National Provider Identifier and Tax Identification Number with a date of service within 24 months, we may cancel your corresponding record ID, and you may be terminated from our networks. Learn how to keep your record ID active with us.

Review Pharmacy Program Quarterly Update – Part 1

Changes were made to our drug lists and utilization management program. Learn about these and other pharmacy program updates.

See the Latest Pharmacy Prior Authorization Changes

We’re updating our standard pharmacy prior authorization programs. Changes affect members with prescription drug benefits administered by Prime Therapeutics^®. Review what’s changing as of Jan. 1, 2026.

We’re Renaming Clinical Payment and Coding Policies to Reimbursement Policies

Starting Jan. 1, 2026, the policies will have a new name. They’ll continue to be a resource for general information on billing and coding.

Learn About Updates to Clinical Payment and Coding Policies

We regularly add and modify CPCPs as part of our ongoing policy review. See which policies were updated and when.

Review Active and Pending Medical Policies

Approved new or revised medical policies and their effective dates are usually posted on our website the first and 15th of each month. You can view all active and pending policies, as well as draft medical policies, and provide comments on draft policies. These policies may impact your reimbursement and your patients’ benefits.