See Our BlueCard^® Program Checklist for Out‑of‑Area Member Claims

As part of our BlueCard program, you may see members with Blue Cross and Blue Shield Plans from other states. Review our checklist for filing out‑of‑area member claims.

CERIS Is Conducting Post‑Payment Commercial Claim Reviews

As of May 1, 2026, CERIS is conducting post‑payment audits of select commercial member claims to ensure accurate coding and appropriate Diagnosis Related Group assignment based on clinical documentation.

New Claims Editing Rules To Be Implemented in July 2026

On or after July 15, 2026, we’ll update the Lyric software database to better align provider coding with industry standards.

Claim Review To Expand for Many Commercial Members

On or after Sept. 1, 2026, we’ll expand prepayment review of some commercial inpatient and outpatient claims with a threshold of $50,000 or more.

See Prior Authorization Changes for Some Government Program Members

We’ve updated prior authorization requirements for certain government plans to reflect new, replaced or removed codes.

Review Quality Measures for Diabetes Care

Regular screenings, tests and office visits can play an important role in helping our members manage diabetes.

Encourage Pediatric Well‑Child Visits and Immunizations

Regular well‑child visits are an opportunity to track our members’ development and provide recommended immunizations. See documentation tips and resources.

Assess Childhood and Adolescent Weight and Counseling for Nutrition and Activity

It’s recommended that primary care providers and OB‑GYNs document body mass index percentile and nutrition and physical activity counseling provided during visits.

Explore Learning Opportunities

We offer free webinars and workshops for providers who participate in our networks. View the schedule and sign up for training sessions, including a new course on coding for diabetes mellitus.

Screen Medicaid Members for Lead Exposure Before Their Second Birthday

You can help close potential gaps in care by conducting required blood lead screening at well child visits. Learn about screening requirements and resources.

Provide Records To Support Risk Adjustment Data Validation Audits

Medicare Advantage providers may receive medical record requests from Blue Cross and Blue Shield of Illinois and our vendor Advantmed for Centers for Medicare & Medicaid Services’ Risk Adjustment Data Validation audits.

Post‑Visit Survey Supports Members’ Experiences

Our Medicare Advantage members may receive a survey about their experiences with their primary care providers after routine or sick visits. See what topics the survey covers.

Report Health Care Fraud and Abuse

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

Take Note of Change in Onboarding Process for New Providers

Effective Aug. 1, 2026, providers seeking to join our networks must submit a W‑9 with legal and DBA names and official IRS documentation when applying. Current in‑network providers aren’t affected unless they’ve had an organizational change requiring an updated W‑9.

Verify Your Directory Information Every 90 Days

Our members and other providers rely on our provider directory for accurate information about your practice. As a contracted provider, your directory data must be verified at least every 90 days, even if it hasn’t changed.

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 June 15, 2026.

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.

Learn About Updates to Reimbursement Policies

We regularly add and modify reimbursement policies, formerly known as clinical payment and coding policies, as part of our ongoing policy review. See which policies were updated.

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.