Discuss Oral Hygiene as Part of Preventive Care for Children With Medicaid

Oral health screening is required as part of the Early and Periodic Screening, Diagnostic and Treatment program. View EPSDT reminders, quality measures and tips to consider.

Illinois House Bill Aims To Increase In‑Network Options for Behavioral Health Services

Effective Jan. 1, 2027, Illinois House Bill 1085 (Public Act 104‑0446) aims to increase in‑network participation by mental health and substance use disorder providers to give Illinoisans more in‑network options.

We’re Removing Option To Request Recommended Clinical Review for Medical Necessity

To improve the efficiency of our utilization management program, we’ll begin removing recommended clinical review as an optional review for our commercial members, starting Jan. 1, 2027.

Watch for New Digital Interfaces To Simplify Prior Authorization Requests

Starting Jan. 1, 2027, we’ll offer application programming interfaces to simplify prior authorization requests and give you quicker access to your patients’ information.

Access Medicare Advantage Prior Authorization Decision Letters via Availity^® Essentials

Beginning Oct. 8, 2026, you’ll be able to view and securely download prior authorization decision letters for members with Medicare Advantage plans through the Provider Correspondence Viewer within Payer Spaces.

Update: Waiver for Out‑of‑State Care Beyond Contiguous Counties Ends Jan. 1, 2027

Beginning Jan. 1, 2027, the service waiver program will end for members with Blue Choice Preferred PPO^SM and MyBlue Plus POS^SM plans purchased on or off the marketplace exchange.

See Prior Authorization Changes for Some Commercial and Government Program Members

We’ve updated prior authorization requirements for some commercial non‑HMO members and government plans to reflect new, replaced or removed codes.

Encourage Routine Screening To Detect Breast Cancer Early

Breast cancer screening should begin at age 40 and continue every other year until age 74, according to the U.S. Preventive Services Task Force. See tips to close screening gaps.

Support Care Coordination After Hospital Discharges

When our members receive inpatient hospital care, hospital care teams can help coordinate care with primary care providers by sharing discharge summaries. View tips to support care coordination.

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.

Use Medicaid ID Instead of Subscriber ID for Members With BCCHP^SM

Effective Jan. 1, 2027, the recipient identification number will be required on Medicaid claims and other health care transactions for members with Blue Cross Community Health Plans^SM. See details on transitioning to use of the RIN.

Use New Online Forms To Request and Submit Commercial Provider Rosters

To streamline roster submissions for your practice, we’ve created new online forms for commercial providers to request and submit rosters and make roster inquiries. Learn how to access them.

Watch for New Edge Benefit Plan Members in 2027

Beginning Jan. 1, 2027, you may see members of our new Edge benefit plans, powered by Easify^SM. Edge plans are copay‑only PPO plans with tiered benefits based on which providers our members choose.

Remind Blue High Performance Network^® Members To See In‑Network Providers

You can help ensure members receive their full benefits and avoid unexpected out‑of‑pocket costs by recommending other in‑network BlueHPN^® providers. Learn how to identify these members.

Review Procedure Code and Fee Schedule Updates

On Jan. 1, 2027, we’ll implement Current Procedural Terminology (CPT^®) and Healthcare Common Procedure Coding System procedure code additions, deletions and revisions.

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.