The manual is organized into the following sections for your convenience. Click on a section title to view the content.
Provider Manuals
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2025 Networks and Benefit Plans for BCBSIL
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Provider Manual - Commercial
The Commercial Provider Manual is organized into the following sections for providers participating in PPO, Blue Choice PPOSM, HMO and the Blue High Performance Network® EPO. Click on a section title to view the content.
- Behavioral Health Program
- Billing and Reimbursement
- Coordinated Home Care
- Credentialing Standards
- Durable Medical Equipment
- Electronic Commerce
- Extended Care
- Fraud and Abuse
- HMO Claims Processing
- HMO Coordination of Benefits
- HMO Membership Information
- HMO Medical Service Agreement Highlight and Process Summary
- HMO Network Adequacy
- HMO Payment/Compensation to the IPA
- HMO Scope of Benefits
- HMO Utilization Management Plan
- Health Care Medical Management (This section includes Utilization Management and Prior Authorization.)
- Home Infusion Therapy
- Hospice
- MyBlue Plus POS
- NCQA Accreditation Requirements
- Pharmacy Management
- Quality Improvement
- Glossary of Terms
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Network Policies and Procedures
HMO Policy and Procedures
Health Care Delivery Policy and ProceduresPolicy Name Policy Number Review Date Accountable Care Organization (ACO) Dual Claimed Physician Policy and Procedure Admin 84 4/1/2023 BCBSIL Marketing Communications HLA Policy Procedure MC 2 2/1/2021 Blue Cross Blue Shield of Illinois Quality of Complaints & Occurrences Process Policy QI 30 4/1/2023 Blue Cross Blue Shield of Illinois Quality of Complaints & Occurrences Process Procedure QI 30A 4/1/2023 Member Communication RR 5 1/1/2022 Member Rights and Responsibilities RR 1 10/1/2022 Professional Liability Insurance Ref 5 12/1/2022 Provider Handling of Member Inquiries Complaints and Appeals Ref 1 11/14/2024 Provider Manual Admin 20 7/1/2022 Provider Standard Appeal Process UM 5 2/23/2023 Provider Urgent/Expedited Clinical Appeal Process UM 6 12/1/2022 Recovery of Provider Overpayments due BCBSIL Admin 3 10/24/2024 Reimbursement Admin 8 5/1/2022 -
Blue Cross Community Health PlansSM Manual
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Blue Cross Community MMAI (Medicare/Medicaid Plan)SM Manual
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Blue Cross Medicare Advantage (HMO)SM Delegated Provider Manual
Blue Cross Medicare Advantage HMO Delegated Manual
Medicare Advantage HMO Delegated Utilization Management and Population Health Management PlanMA HMO In-network Approval Letter
MA HMO In-network Approval Letter (Spanish)
MA HMO Medicare Re-Opening
MA HMO Medicare Re-Opening (Spanish)
MA HMO Notice of Denial of Medical Coverage
MA HMO Notice of Denial of Medical Coverage (Spanish)
MA HMO Notice of Dismissal of Coverage Request
MA HMO Notice of Dismissal of Coverage Request (Spanish)
MA HMO Notice of Medicare Non-Coverage
MA HMO Notice of Medicare Non-Coverage (Spanish)
MA HMO Notice of Non-discrimination
MA HMO Notice of Non-discrimination (Spanish)
MA HMO Out-of-network Letter
MA HMO Out-of-network Letter (Spanish)
MA HMO Right to Expedited Grievance
MA HMO Right to Expedited Grievance (Spanish) -
Blue Cross Medicare Advantage HMO Non-Delegated ModelSM Manual
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Blue Cross Medicare Advantage (PPO)SM Manual