The Centers for Medicare & Medicaid Services and the state of Illinois have contracted with Blue Cross and Blue Shield of Illinois along with other Managed Care Organizations to implement Medicaid to all counties in Illinois. BCBSIL offers two plans: Blue Cross Community Health PlansSM and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM.
Our Illinois Medicaid networks include independently contracted providers (physicians, hospitals, skilled nursing facilities, ancillary providers, managed long-term services and support, and other health care providers) through which eligible members may obtain covered services.
Networks and Benefit Plans
Blue Cross Community Health Plans
BCCHP is a program developed and administered by BCBSIL to support delivery of integrated and quality managed care services to enrollees, such as seniors/persons with disabilities, families and children (including special needs children), and adults qualifying for the Illinois Department of Healthcare and Family Services Medical Program under the Affordable Care Act.
Blue Cross Community MMAI (Medicare-Medicaid Plan)
MMAI is a demonstration plan developed to better serve individuals eligible for both Medicare and Medicaid. MMAI combines Medicare and Medicaid funding under a blended payment agreement to provide integrated, comprehensive care to benefit dual-eligible enrollees.
For more details about our Illinois Medicaid plans including names, network summary and geographic areas, see the Government Programs Networks and Benefit Products.
Join the BCCHP and MMAI Network
To join our Medicaid network, follow the process for Contracting.
Credentialing
The state of Illinois is responsible for credentialing and recredentialing of physicians and certain other providers who participate in the BCCHP and MMAI Medicaid plans.
To be eligible to participate, providers must be enrolled and credentialed through the Illinois Medicaid Program Advanced Cloud Technology system. For more information, visit the IMPACT website. Providers with general questions about IMPACT or provider enrollment may email IMPACT Help or call 877-782-5565 (select option #1).
Pre-service Requirements
- It’s important to refer to the applicable Provider Manual to ensure you are aware of your responsibilities as a network provider.
- Always check eligibility and benefits first. This step will help you determine coverage, prior authorization requirements and other information.
- Visit the Utilization Management section for an overview of the Prior Authorization process. This section also includes a Support Materials (Government Programs) page for quick access to an Illinois Medicaid prior authorization requirements summary and procedure code list.
- Go to the Medical Policy page for active and pending policies.
Claims
The fastest way to conduct business with BCBSIL throughout the entire claims process is via Electronic Data Interchange (EDI). Refer to the Claim Submission section for an introduction to filing claims with BCBSIL. Government Programs claims must be submitted within 180 days of the date of service and/or discharge date.
Provider Training Requirements and Resources
It is a CMS and/or State of Illinois requirement for BCBSIL to make available provider training on specified topics related to BCCHP and MMAI. Learn more