Aug. 21, 2024
Effective Jan. 1, 2025, Blue Choice PPO will be nationally available. This means you may see members from other Blues plans who have access to the Blue Choice PPO network in Illinois.
What’s changing: You must participate in the Blue Choice PPO network to be reimbursed as an in-network provider for members of Blue Cross and Blue Shield of Illinois and other Blues plans with Blue Choice PPO.
Reimbursement: We’ll reimburse services for members with Blue Choice PPO at the Blue Choice PPO levels per your contract terms. If you’re not contracted with the Blue Choice PPO network, you’ll receive out-of-network reimbursement for care of these members. Blue Choice PPO isn’t available in Lawrence and Wabash counties.
How to file claims: Follow your normal process for filing claims. For members of other Blues plans, follow the BlueCard® Program process as usual. Electronic claim submission is your fastest path to payment.
How to recognize members with Blue Choice PPO: The network name will be on the front of the member’s ID card. Look for the PPO suitcase symbol to identify members of the BlueCard Program.
Check eligibility and benefits first through Availity® Essentials or your preferred vendor for all members with Blue Cross and Blue Shield before every scheduled appointment.
Questions? Call the customer service number on the member’s ID card.
Checking eligibility and/or benefit information and/or obtaining prior authorization is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage, including, but not limited to, exclusions and limitations applicable on the date services were rendered. If you have any questions, call the number on the member’s ID card.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding third party vendors and the products or services they offer.