Medicaid

The Centers for Medicare & Medicaid Services and the State of Illinois have contracted with Blue Cross and Blue Shield of Illinois and other Managed Care Organizations to implement Medicaid to all counties in Illinois. BCBSIL offers two plans: 

  • Blue Cross Community Health PlansSM 
  • 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

    BCCHPSM is a program developed and administered by BCBSIL to support delivery of integrated and quality managed care services to Medicaid enrollees. Enrollees qualify for the Illinois Department of Healthcare and Family Services Medical Program under the Affordable Care Act and include:

    • Seniors
    • Persons with disabilities
    • Families and children
    • Special needs children
    • Adults

     

    Blue Cross Community MMAI (Medicare-Medicaid Plan)

    MMAI is a 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 Government Programs Networks and Benefit Products. 

  • Join Our Medicaid 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 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). 

  • Utilization Management
    Use our tools and resources noted below to determine coverage and find important information on our service authorization program.

     

    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 third party vendors and the products or services they offer. 

  • Claims

    The fastest way to conduct business with BCBSIL is via electronic data interchange. See claim submission for an introduction to filing claims. Claims for BCCHP and MMAI must be submitted within 180 days of the date of service or discharge date.

  • Training Requirements

    It is a Centers for Medicare & Medicaid Services and/or State of Illinois requirement for Blue Cross and Blue Shield of Illinois to make available provider training on specified topics related to Blue Cross Community Health PlansSM and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM. Completion of training is mandatory for all MMAI and Medicaid contracted providers.

    Required Training Modules

    The following training modules have been prepared for you by BCBSIL (select a topic to complete each training module online).

    Note: After exiting out of the module, a new window will appear, and a training completion certificate will generate automatically. Once generated, the certificate can be saved or printed. A copy of the certificate will also be sent to the email address provided on the Guestbook registration form. Please be advised, the generation of the certificate is not acceptable in lieu of attesting. The certificate is for your records only. To properly attest and notify us that the training has been completed, please utilize the electronic attestation linked below.

    Completion of  training is mandatory for all BCCHP and MMAI contracted providers and staff who interact with patients. 

    ADA Site Compliance Survey

    Additionally, to determine compliance with the Americans with Disabilities Act, CMS accessibility and language requirements, professional providers are required to complete the BCBSIL survey for their primary office location annually and facility providers are required to complete the survey for each location annually. 

    Take our survey.

    *Alternative option for compliance training completion: You may complete the online attestation of training completion which certifies that your practice has completed the annual BCCHP and MMAI compliance training from another government contracted Managed Care Organization. If you cannot complete the electronic attestation, you can locate a paper copy under the forms section.

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