BlueChoice Select is a PPO product. Members are offered the choice to seek care within the network and receive the highest level of benefits or to go out-of-network and incur a lower level of benefits.

Referrals
Written referrals are not required, but when a referral is necessary, providers in the BlueChoice Select network must make every effort to refer the member to in-network BlueChoice Select providers, hospitals, and other medical facilities for services.

In instances where a referral is made to an out-of-network provider and/or to an entity with whom the contracting provider has a business interest, the member must be notified of the same in writing at the time of the referral. Referrals to out-of-network providers could result in reduced benefits for the member.

Reimbursement
Reimbursement is based on fee-for-service in accordance with the BlueChoice Select Schedule of Maximum Allowances (SMA).

Additionally, Primary Care Physicians (PCPs) and Primary Specialist Physicians (PSPs) are assigned a payment tier based on the following criteria:

• Achievement of clinically appropriate, cost effective, health care
• Utilization
• Compliance with program requirement

Member Payments
Providers should bill BCBSIL prior to collecting any fees other than copayments from the member. After the claim is adjudicated, providers may bill the member for any deductibles, coinsurance, or non-covered services.

Providers may not balance bill the member for any fees over the allowable charge.

Credentialing Requirements
All providers applying for participation in the BlueChoice Select network must complete a credentialing process prior to acceptance.

For more information on how to register and complete the online credentialing application, visit the Credentialing Process section

Eligible Providers:

Primary Care Physicians

• Family/General Practice
• Internal Medicine
• Pediatric Medicine
• Obstetrics/Gynecological Medicine
• Certified Nurse Midwife

Participating specialist providers include all PPO specialties with the exception of the following:

• Anesthesiologist
• Certified Nurse Specialist (CNS)
• Certified Registered Nurse Anesthetist (CRNA)
• Certified Surgical Assistant (CSA)
• Durable Medical Equipment (DME)
• Emergency Room
• Home infusion
• Independent Lab
• Licensed Clinical Professional Counselor (LCPC)
• Licensed Clinical Social Worker (LCSW)
• Licensed Marriage Family Therapist (LMFT)
• Nurse Midwife
• Optometrist
• Orthotic and Prosthetic
• Pathologist
• Psychiatrist
• Psychologist
• Radiologist
• Registered Nurse First Assistant (RNFA)
• Rural Health Clinics

BlueChoice Select Service Area:
The BlueChoice Select network service area includes the following counties in Illinois:

• Cook
• DuPage
• Kane
• Kankakee
• Lake
• McHenry
• Will
• Lake County Indiana

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