Quality Measures Help Track Our Members’ Heart Health

Heart disease and stroke are among the leading causes of death in the U.S. We track measures related to our members’ blood pressure control and statin therapy. Learn steps to help identify and close care gaps.

Avoid Inappropriate Use of Antipsychotic Medication for Anxiety Disorders

Most antipsychotic medications aren’t approved for the treatment of anxiety disorders. We encourage prescribing providers to carefully assess symptoms, risks and benefits when considering medications for our members with anxiety disorders.

Postponed: Updates to Behavioral Health Substance Use Criteria for Utilization Management

We’ll continue to apply criteria from the American Society of Addiction Medicine’s third edition in our medical necessity reviews for substance use services for adults and adolescents.

Utilization Management Review Paused for Advanced Imaging Site of Care

Expanded utilization management reviews for Advanced Imaging site of care services are paused until further notice. This doesn’t impact prior authorization reviews for Advanced Imaging.

Annual Survey Monitors Our Members’ Health Care Experiences

Every year, some of our members receive the Consumer Assessment of Healthcare Providers and Systems survey. It asks them to rate their experiences with their health care providers and plans. Learn about survey topics for Medicare Advantage and Medicaid plans.

Earn Continuing Education Credit in Courses on Maternal Mental Health

You can access March of Dimes^® e‑learning modules on maternal mental health and perinatal loss at no cost through May 13, 2025.

Explore Learning Opportunities

We offer free webinars and workshops for providers who participate in our networks. Sign up now for orientations and webinars on contracting, credentialing and more.

Members of Blue Cross Community Health Plans^SM May Earn Rewards for Medical Services

Your patients with BCCHP^SM may earn cash rewards for completing certain medical services, including mammograms and diabetic eye exams. Learn about this year’s rewards program and how members can sign up.

Patients in the Qualified Medicare Beneficiary Program Should Not Be Billed

QMB patients are eligible for both Medicare and Medicaid. If you participate in Blue Cross Community MMAI (Medicare‑Medicaid Plan)^SM, you may not bill our members enrolled in the QMB program. Learn precautions to take to avoid billing these members.

Hospitals Must Provide Notice to Members Under Outpatient Observation for More Than 24 Hours

Hospitals and critical access hospitals are required to give the standardized Medicare Outpatient Observation Notice to members of Blue Cross Medicare Advantage^SM and MMAI plans who are under outpatient observation for more than 24 hours. The notice explains why the members aren’t inpatient and their cost‑sharing obligations.

Prepare for Directory Audits Required by the Illinois Health Care Access and Protection Act

Among other changes, Illinois House Bill 5395 (Public Act 103‑0650) requires that we audit all commercial and qualified health plan network directories every 90 days, beginning Jan. 1, 2025. The audit includes a new required field for appointment availability. Learn what this means for you and how you can prepare.

Prior Authorization Changes

We’re making updates to our standard pharmacy prior authorization programs. Changes affect members with prescription drug benefits administered by Prime Therapeutics. Learn more about what’s changing, effective March 1, 2025.

Pharmacy Program Quarterly Update – Part 2

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

Revised Policy Requires Appropriate Revenue and Procedure Codes on Outpatient Facility Claims

Effective April 14, 2025, we’ll revise Clinical Payment and Coding Policy CPCP018, which outlines revenue codes that require use of supporting Current Procedural Terminology (CPT^®) and Healthcare Common Procedure Coding System codes and National Drug Codes on outpatient facility claims. Learn what’s changing, including updates to bill types.