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.
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.
Payment for services is according to the PPO Schedule of Maximum Allowances (SMA).
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.
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)
- Audiologist (AUD)
- Board Certified Behavioral Analyst (BCBA)
- Certified Nurse Midwife (CNM)
- Certified Nurse Practitioner (CNP)
- Certified Registered Nurse Anesthetist (CRNA)
- Certified Surgical Assistant (CSA)
- Chiropractor (DC)
- Clinical Psychologist
- Developmental Therapist
- Doctors of Naprapaths
- Independent Lab
- Licensed Acupuncturists
- Licensed Clinical Nurse Specialist (LCNS)
- Licensed Clinical Professional Counselors (LCPC)
- Licensed Clinical Social Worker (LCSW)
- Licensed Marriage and Family Therapist LMFT)
- Optometrist (OD)
- Oral Maxillofacial Surgeon
- Osteopath (DO)
- Physician (MD)
- Physician Assistant (PA)
- Podiatrist (DPM)
- Registered Dietitians
- 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 Ancillary Networks or call 312-653-4820.
Provider Onboarding Form