MEDICAID |
|
Encourage Pregnant Members With BCCHPSM To Sign Up for Special Beginnings® Program
If you’re treating a pregnant member with Blue Cross Community Health PlansSM, encourage them to participate in our maternity care management program for education and support.
|
|
|
|
|
Home Health and Homemaker Waiver Providers Must Register With HHAeXchange
Contracted Home Health and Homemaker Waiver providers must register with HHAeXchange, Illinois’ Electronic Visit Verification vendor.
|
|
|
|
|
Managed Long‑Term Services and Supports Transition
Effective Jan. 1, 2027, MLTSS services will transition from the HealthChoice Illinois program to Prepaid Inpatient Health Plans operated by a Fully Integrated Dual Eligible Special Needs Plan sponsor. As part of this transition, Blue Cross and Blue Shield of Illinois will no longer provide coverage for MLTSS members, effective Jan. 1, 2027.
|
|
|
|
|
View Reminders and Quick Tips for Medicaid Authorizations
In April, we launched Medicaid Authorizations, a new application accessible in Availity Essentials. You can use it to check requirements in real time and move directly into the submission process for Medicaid prior authorization requests handled by BCBSIL.
|
|
|
|
|
Reminder: We’re Conducting Postpayment Reviews on Medicaid Claims
Effective Oct. 2, 2026, we began conducting postpayment reviews of Medicaid member claims to help identify billing inconsistencies and ensure coding accuracy and reimbursement policy alignment.
|
|
|
 |
| |
MEDICARE |
|
Reminder: Digital Access to Medicare Advantage Prior Authorization Decision Letters
Beginning Dec. 11, 2026, prior authorization approval letters for Medicare Advantage members will no longer be mailed via the U.S. Postal Service. You can view and securely download prior authorization decision letters for these members through the PCV application in Availity Essentials.
|
|
|
|
|
|
| |
NETWORK PARTICIPATION |
|
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 ID 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 Our Building Guidelines for Laboratory Claims
Help make sure your claims are processed on time by following the guidelines for billing independent clinical laboratory services.
|
|
|
|
|
|
| |
PHARMACY |
|
Changes Coming to the Medical Drug Benefit Program
Effective Jan. 1, 2027, we will update coverage for specific prescription drugs administered by a health care provider in a clinical setting.
|
|
|
|
|
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, 2027.
|
|
|
|
|
Review Pharmacy Program Quarterly Updates – Part 2
We’ve made changes to our drug lists and utilization management program. Learn about these and other pharmacy program updates.
|
|
|
|
|
|
| |
STANDARDS AND REQUIREMENTS |
|
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.
|
|
|
|
|
|
|
 |
Verify Your Directory Details Every 90 Days
Your directory information must be verified every 90 days, even if it hasn’t changed since you last verified it. Learn more.
|
|
|
 |
Contact Us
Contact information for Provider Relations Representatives and other resources is on our website.
|
|
|
|
|
|
 By clicking this link, you will go to a website/app (“site”). The site may be offered by a vendor or an independent third party. The site may also contain non-Medicare related information. Some sites may require you to agree to their terms of use and privacy policy.
|
Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation,
a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
|
300 E. Randolph Street, Chicago, IL 60601
© 2026 Health Care Service Corporation. All Rights Reserved.
Legal and Privacy | Unsubscribe
|
|
|
