• BCBSIL Credentialing Submission document identifying network and contract information.
• The State of Illinois Health Care Professional Credentialing/Recredentialing and Business Data Gathering Form.
• BCBSIL Attestation signed and dated within 60 days of submission.
• BCBSIL Hospital Verification form completed by the Hospital.*
• HMO practitioners must submit a Medical Group Service Agreement if Medical Group affiliation has changed.

* Forward to the practitioner's primary admitting hospital the "BCBSIL request of Hospital Privileges" to be completed by the hospital staff.