BlueChoice is a managed care, point-of-service benefit plan, offering members the choice to seek care within the BlueChoice network and receive the highest level of benefits or to self refer and go out-of-network and incur a lower level of benefits. BlueChoice Select is an open-access product that utilizes the BlueChoice network, but allows members to self direct their care without a referral.

BlueChoice members select a participating Primary Care Physician (PCP) who provides services and coordinates all health care needs with Participating Specialist Physicians (PSP) and other BlueChoice providers, hospitals, and ancillary facilities.

Reimbursement is based on fee-for-service in accordance with the BlueChoice Schedule of Maximum Allowances (SMA). Additionally, PCPs and PSPs are assigned a payment tier based on the following criteria:

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

Providers should bill BCBSIL prior to collecting any fees other than co-payments for the patient. After receiving the payment and Provider Claim Summary (PCS), providers may bill the member for any deductibles, coinsurance, or non-covered services. Providers may not balance bill the patient for any fees over the allowable charge.

Eligible Providers:

Primary Care Physicians

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

Participating Specialist Providers:

Request Application.