Contracting



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To apply for the Blue Cross and Blue Shield of Illinois products and to request an application choose your product below.

 

Note: You must provide services in Illinois or Lake County, Indiana in order to apply.




Blue Choice PPO is a product with a specific network of participating providers. Members who obtain care within the Blue Choice PPO network will receive the highest level of benefits. Members also have the option of obtaining care from with in the PPO network or going out-of-network. In either case the member will incur a lower level of benefits.

 

Referrals
Written referrals are not required, but when a referral is necessary, providers in the Blue Choice PPO network must make every effort to refer the member to in-network Blue Choice PPO 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 Blue Choice PPO Schedule of Maximum Allowances (SMA).

 

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 Blue Choice PPO 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

Primary Specialist Physician List 

 

Blue Choice PPO Service Area 

The Blue Choice PPO network service area includes the following counties in Illinois and Indiana:


BCBSIL does not contract directly with providers for our HMO products.

Providers who would like to participate in our HMO network must contact a BCBSIL contracting HMO Medical Group or IPA in their area.

 

View HMO Medical Group/IPA listing 


Our PPO professional network is made up of professional providers that agree to fees set by BCBSIL as the maximum cost for their services.

 

You must provide services in Illinois or Lake County, Indiana in order to apply.

 

Referrals
Written referrals are not required, but when a referral is necessary, the PPO provider must make every effort to refer the member to in-network PPO 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

Payment for services is according to the PPO Schedule of Maximum Allowances (SMA).

 

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.

 

Credentialing Requirements
All providers applying for participation in the PPO 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.

 

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

 

The PPO Professional Networks includes the following eligible provider types:

  • Advanced Nurse Practitioner (APN)

  • Applied Behavior Analyst (ABA) - network participation pending
  • Audiologist (AUD)
  • Certified Nurse Midwife (CNM)
  • Certified Nurse Practitioner (CNP)
  • Certified Registered Nurse Anesthetist (CRNA)
  • Certified Surgical Assistant (CSA)
  • Chiropractor (DC)
  • Clinical Psychologist
  • Developmental Therapist - network participation pending
  • Independent Lab
  • Licensed Clinical Nurse Specialist (LCNS)
  • Licensed Clinical Professional Counselors (LCPC)
  • Licensed Clinical Social Worker (LCSW)
  • Licensed Marriage and Family Therapist LMFT)
  • Optometrist (OD)
  • Osteopath (DO)
  • Physician (MD)
  • Physician Assistant (PA)
  • Podiatrist (DPM)
  • Registered Nurse First Assistant (RNFA)
  • Registered Surgical Assistant (RSA)
  • Sleep Medicine Centers
  • Surgical Assistant Certified (SAC)
  • Therapist (Physical-PT, Speech-ST, Occupational-OT) 

Note: If you are an Ancillary Provider (DME, Orthotic Supplier, Prosthetic Supplier or Home Infusion) and wish to contract with BCBSIL, email your request to ancillarynetworks@bcbsil.com or call 312-653-4820.

 

Request PPO Application