Provider Network Consultant Assignments
Our Provider Network Consultants (PNCs) serve as the liaison between BCBSIL and our independently contracted provider community, developing and maintaining working relationships with their assigned providers. Among other services, your assigned PNC can:
- Help keep you up-to-date on BCBSIL products, programs and initiatives
- Alert you of training opportunities for providers
- Assist you with adhering to financial requirements and contractual compliance
We have four PNC teams. Each team is dedicated to a different provider category, as follows:
Ancillary PNCs for skilled nursing facilities, home health agencies, hospice, home infusion therapy, durable medical equipment (DME), orthotics and prosthetics, dialysis centers and private duty nursing agencies
Institutional PNCs for hospitals, surgical centers, hospital-owned and billed professional groups, substance abuse and other freestanding facilities
HMO Medical Group (MG) and Independent Practice Associations (IPAs) PNCs for MG/IPAs in the HMO Illinois and BlueAdvantageSM HMO networks
Professional PNCs for contracting physicians and other health care practitioners and provider groups
Select the appropriate PNC team name below to obtain contact information for your assigned PNC or PNC team:
Ancillary providers include skilled nursing facilities, home health agencies, hospice, home infusion therapy, DME, orthotics and prosthetics, dialysis centers and private duty nursing agencies.
BCBSIL contracts with more than 2,000 ancillary providers in Illinois and northwest Indiana. Our Ancillary Provider Network Consultant (PNC) team focuses specifically on the services provided by skilled nursing facilities, home health agencies, hospice, home infusion therapy, DME, orthotics and prosthetics, dialysis centers and private duty nursing agencies.
Meet your Ancillary PNC:
The following Ancillary PNCs are available to meet with your staff regarding BCBSIL policies and procedures, billing, and contractual issues:
- Jean Gavina, 312-653-2331
- Elaine Williams, 312-653-4305
You may also direct your requests and inquiries to our general email box at email@example.com, or leave a message at 312-653-4820.
HMO Provider Network Consultants (PNCs) serve as the liaisons between BCBSIL and the HMO Medical Groups/Independent Practice Associations (MG/IPAs) in the HMO Illinois and BlueAdvantage HMO networks.
Each PNC must keep their assigned MG/IPA up-to-date on HMO product and process changes, BCBSIL news that may affect the providers affiliated with their group; PNCs also help ensure contract compliance. HMO PNCs also serve as an internal voice for the MGs/IPAs regarding the administration and delivery of managed health care, such as quality improvement and utilization management programs, the implementation of legislative requirements, and preventive care and wellness initiatives.
Our experienced staff of Institutional Provider Network Consultants (PNCs) is dedicated to maintaining the strong working relationships we have with our more than 250 contracted hospitals in Illinois and northwest Indiana. This includes hospital-owned and billed professional groups, substance abuse and other freestanding facilities.
The Provider Network Relations staff also includes a team of PNCs dedicated to providing assistance to our more than 100 contracted surgical centers Illinois and Northwest Indiana. These surgi-centers include freestanding, outpatient, ambulatory surgery facilities that provide highly specialized, often same-day surgical services to meet the needs of BCBSIL members.
Your assigned Institutional PNC specializes in initiatives, programs, regulations and claim processing concerns most relevant to facility providers. In addition to keeping you informed of BCBSIL news and updates, your PNC is available to visit your office as needed and can assist you by investigating billing issues, compiling data and developing solutions.
To find the name of your assigned hospital or surgi-center PNC, along with their contact information, refer to the Institutional Provider Network Consultant List. Please note that this listing includes several tabs for your convenience.
Our dedicated team of Professional PNCs provides service to more than 25,000 contracting physicians and medical groups throughout Illinois and northwest Indiana.
With a thorough knowledge of the PPO product, your assigned PNC specializes in investigating issues, producing data and developing solutions. If needed, your PNC can visit your office to help address any special needs or concerns.
- Professional PNC assignments are determined by territory according to county. The city of Chicago area is broken down further with assignments by zip code.
- The team also includes a designated Billing Services Representative, who provides specialized training for all Billing Services in the Chicago Metro area.
To find the name of your PNC, along with their contact information, refer to the Professional Provider Network Consultant List.
Refer to the Professional Provider Resource Guide for additional information.