December 18, 2020
This notice has been revised to reflect that all specialty care categories listed are subject to the differential as referenced for the specified members.
Effective Jan. 1, 2021, City of Chicago members (three-character prefix CTY and group numbers 195500, 195502) will have a Blue Distinction® Center (BDC) component for the specialty care categories listed below:
- Bariatric (Weight-loss) Surgery
- Cardiac Care
- Knee and Hip Replacement
- Spine Surgery
- Transplants
For the City of Chicago members specified above, services in these BDC specialty care categories must be performed at a BDC facility as these services carry a benefit differential. Services are covered at 90% after deductible at a BDC designated facility. There is no coverage unless services are rendered at a BDC facility regardless if a provider is contracted as PPO.
Providers checking eligibility and benefits via the Availity® Provider Portal can expect return results that include informational BDC messaging for the specialty care categories when the patient’s policy has a Blue Distinction component. The Availity benefit response will include applicable coverage for the service selected. BDC benefit differentials can be confirmed by calling the Customer Service number on the member’s Blue Cross and Blue Shield of Illinois (BCBSIL) ID card.*
BDCs offer quality care, treatment expertise and better overall patient results. A Blue Distinction® Center+ (BDC+) offers more affordable care in addition to quality, care, cost, treatment expertise and better overall patient results.
For More Information
Find facilities recognized for expertise in bariatric surgery, cardiac care, knee and hip replacement, maternity, spine surgery and transplants on the Blue Cross and Blue Shield Association (BCBSA) Blue Distinction® Specialty Care page.
Refer to the Availity General Eligibility and Benefits User Guide for navigational help. If you need further help or training, contact our Provider Education Consultants.
*Note: For HMO members, Medical Groups/Primary Care Providers should review BCBSIL’s HMO Scope of Benefits for appropriate benefit/referral guidelines for BDC facilities.
This information in this notice is not applicable to Medicare Advantage or Illinois Medicaid members.
A Local Blue Plan may require additional criteria for providers located in its own service area; for details, contact your Local Blue Plan. Blue Distinction® National criteria for BDC and BDC+ are displayed on the BCBSA website. Individual outcomes may vary. Neither BCBSA nor any Blue Plans are responsible for non-covered charges or other losses or damages resulting from Blue Distinction or other provider finder information or care received from Blue Distinction or other providers.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.
The information in this article is being provided for educational purposes only and is not the provision of medical care or advice. Physicians and other health care providers are to their own best medical judgment based upon all available information and the condition of the patient in determining the best course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.