Quality Measures Track Diabetes Care

Regular screenings, tests and office visits can help our members manage diabetes. Review tips on how to close care gaps.

Illinois Senate Bill 3538 Requires Coverage of Mental Health Counseling for First Responders

Effective June 1, 2025, some of our members employed by counties, municipalities and fire protection districts may have coverage for mental health counseling services at no cost as required by Illinois SB 3538. View details and reminders on how to confirm member benefits.

Review Claims Reminders for Behavioral Health Services

We monitor behavioral health claims for disallowed billing practices. See guidance on billing for services provided by trainees under supervision.

Update: Watch for Changes to Behavioral Health Clinical Review Criteria for Substance Use

We’ll implement updates to the clinical criteria we use in medical necessity reviews of substance use services for adults.

Access BlueApprovR^SM in Availity^® Authorizations

The BlueApprovR utilization management tool will be integrated with Availity Authorizations in Availity Essentials. The new configuration will continue to expedite approvals for behavioral health services. Review how to submit and access prior authorization requests.

Review Prior Authorization Changes for Commercial Members

Effective July 1, 2025, prior authorization requirements for certain commercial 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, including training on parent and guardian mental health.

We’re Making Claims Processing Changes for Blue Cross Community Health Plans^SM

Effective July 1, 2025, how you submit claims for members with BCCHP^SM will change. Review what’s new for electronic claims and paper claims with attachments.

Attend a Webinar to Prepare for Medicaid Prior Authorization Vendor Transition

Effective Aug. 1, 2025, Carelon Medical Benefits Management will replace EviCore healthcare for some prior authorization requests for our members with BCCHP. Sign up for a webinar on how to register with Carelon and navigate its portal.

Report Health Care Fraud, Waste and Abuse

We encourage providers to report potential incidents. Review how to file a confidential report online or by phone or mail.

Providers with Unused Record IDs May Be Terminated from Networks

If you haven’t filed a claim with us under your record ID with a date of service within 24 months, we may cancel your record ID. Review how to keep record IDs active.

New Home Delivery Pharmacy Service to Fill Members’ Injectable GLP‑1 Prescriptions

Express Scripts^® Pharmacy will transition home delivery prescriptions for covered, injectable GLP‑1 drugs to a new specialized pharmacy. Effective June 15, 2025, EnGuide Pharmacy will dispense these prescriptions. Learn what’s changing.

Learn About Medicaid Drug List Changes

The state of Illinois made coverage changes to the drug list used by our Medicaid members who have prescription drug benefits through BCCHP, effective March 13, 2025. View details and related resources.

Review 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 what’s changing, effective June 15, 2025.

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.

Review New Coding Policy for Global Obstetrical Maternity Services

We have new coding guidance in our Clinical Payment and Coding Policy, CPCP044 Global Obstetrical/OB Maternity Services, effective Aug. 19, 2025.

Review Medical Policy Updates

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.