Reinforce Prenatal and Postpartum Care To Support Whole Health

We track quality measures related to our members’ care visits and depression screening during and after pregnancy. Review tips to close gaps in care.

Availity^® Authorizations To Accept Concurrent Reviews and Extensions for Behavioral Health Services

We’re expanding the capabilities of our utilization management tool integrated with Availity Essentials to further expedite behavioral health service approvals for commercial members. Learn how to attend a training.

See Our Behavioral Health Resources for Providers

Resources for providers across disciplines include clinical practice guidelines and information on quality measures, as well as introductory webinars offering continuing education credit at no cost to you.

See Prior Authorization Changes for Some Commercial and Government Programs Members

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

Watch for Claim Editing Changes for Evaluation and Management Services for Commercial Members

Effective July 1, 2026, we’ll enhance our claims editing and review process for office, inpatient and outpatient evaluation and management services for our members with commercial plans.

Two New Claims Editing Rules To Be Implemented in July 2026

On or after July 8, 2026, we’ll update the Lyric software database to better align provider coding with industry standards for accurate billing and proper reimbursement.

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 youth behavioral health.

Exact Sciences To Reach Out to Medicaid Members on Colorectal Cancer Screening and Care

We’re collaborating with Exact Sciences to reduce disparities in colorectal cancer detection and treatment for our members with Blue Cross Community Health Plans^SM.

Watch for Outreach from BigHeart Health To Schedule Preventive Services for Medicaid Members

The Illinois Department of Healthcare and Family Services has contracted with BigHeart Health to enroll members in a new preventive care program for Medicaid members. BigHeart Health may reach out to you to schedule wellness visits when gaps in care are identified.

Use Updated Hospital Forms for Medicare Members

The Centers for Medicare & Medicaid Services updated its Important Message from Medicare and Detailed Notice of Discharge. Learn how to access the forms.

Review Updates to IAMHP Universal Roster Template for Medicaid

Effective Feb. 1, 2026, the Illinois Association of Medicaid Health Plans released an updated Universal Roster template. New fields related to race, ethnicity and telehealth capabilities are required. We accept this roster for provider information verification and updates.

See Changes to Our Annual National Drug Code Fee Schedule, Impact and Timeline

We review our NDC Fee Schedule on an annual and periodic basis. Reimbursement rates for some medications may change because of this review.

Review Pharmacy Program Quarterly Update – Part 2

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.