Standards and Requirements

Blue Cross and Blue Shield of Illinois is committed to providing you with the resources you need to collaborate with us in providing excellent service to your BCBSIL patients. This section of the website is designed to provide you with manuals, documents, procedures, policies and regulations so that you have the information at your fingertips to administer BCBSIL health insurance products, policies and procedures.

BCBSIL Provider Manual

The BCBSIL Provider Manuals are comprehensive guides for professional and facility providers. These manuals set forth the policies, procedures and requirements necessary for participation in the BCBSIL contracting provider networks. Learn more

BlueCard Program

BlueCard is a national program that enables members of one Blue Cross and Blue Shield Plan to obtain health care services while traveling or living in another BCBS Plan’s service area. Learn more

Consolidated Appropriations Act & Transparency in Coverage

The Consolidated Appropriations Act (CAA) of 2021 and the Transparency in Coverage Final Rule went into effect on Jan. 1, 2022. Learn more

Clinical Payment and Coding Policies

Clinical payment and coding policies are based on criteria developed by specialized professional societies, national guidelines (e.g. Milliman Care Guidelines (MCG) and the CMS Provider Reimbursement Manual. Learn more

Medical Policy

Providers should be knowledgeable about BCBSIL Medical Policies. These Medical Policies serve as guidelines for health care benefit coverage decisions, which may vary according to the different products and benefit plans offered by BCBSIL. Learn more

Medical Policy/Pre-certification: Out-of-area Members

To view out-of-area Blue Plan's medical policy or general pre-certification/pre-authorization information. Learn more

Medicare Advantage PFFS

If you provide care to a Medicare Advantage Private Fee-for-Service (PFFS) member from an out-of-area Blue Cross and Blue Shield Plan, you may use this tool to view the Terms and Conditions of the member's plan. Learn more

Risk Adjustment

Risk Adjustment seeks to level the playing field by discouraging adverse selection of members. Learn more