Provider Network Consultant Assignments

Our Provider Network Consultants (PNCs) serve as the liaison between BCBSIL and our independently contracted provider community, developing and maintaining working relationships with their assigned providers. Among other services, your assigned PNC can:

  • Help keep you up-to-date on BCBSIL products, programs and initiatives
  • Alert you of training opportunities
  • Assist you with adhering to financial requirements and contractual compliance

We have several PNC teams. Each team is dedicated to a different provider category, as follows:

Commercial Ancillary PNCs for skilled nursing facilities, home health agencies, hospice, home infusion therapy, durable medical equipment (DME), orthotics and prosthetics and dialysis centers

Government Programs PNCs for Illinois Medicaid – Blue Cross Community Health Plans (BCCHP)SM, Blue Cross Community MMAI (Medicare-Medicaid) PlanSM and Medicare Advantage – Blue Cross Medicare Advantage (HMO)SM (MA HMO) and Blue Cross Medicare Advantage (PPO)SM (MA PPO) networks

Institutional PNCs for hospitals, surgical centers, hospital-owned and billed professional groups, substance abuse and other freestanding facilities

HMO Medical Group (MG) and Independent Practice Association (IPA) PNCs for MG/IPAs in the HMO Illinois®, Blue Advantage HMOSM, Blue Precision HMOSM, BlueCare DirectSM and Blue FocusCareSM networks

Professional PNCs for contracted physicians and other health care practitioners and provider groups

Select the appropriate PNC team name below to obtain contact information for your assigned PNC or PNC team:

  • Commercial Ancillary Provider Network Consultants

    BCBSIL contracts with more than 2,000 independent ancillary providers in Illinois and Northwest Indiana.

    Our Ancillary Provider Network Consultants (PNCs) focus specifically on the services provided by commercial skilled and intermediate nursing facilities, supportive living facilities, home health agencies, hospice, home infusion therapy, durable medical equipment (DME) suppliers, orthotics and prosthetics and dialysis centers.

    Our Ancillary Provider Network Consultants are available to provide training and discuss BCBSIL policies and procedures, billing and contractual or operational issues.

    You may direct your requests and inquiries to our Ancillary Networks, or leave a message at 312-653-4820.

  • Government Program Network Consultants (Illinois Medicaid and Medicare Advantage)

    Our experienced staff of Government Provider Network Consultants (PNCs) is dedicated to building and maintaining strong working relationships with our providers. Your assigned PNC is available to provide services including but not limited to discussion and training on BCBSIL policies and procedures, regulations, billing inquiries, and contractual or operational issues.

    Illinois Medicaid (BCCHP, MMAI)

    Independent professional providers and providers in Cook and the Collar counties can email our Government Programs Provider Relations team or call 855-653-8126 for further information.

    Also refer to the Government Medicaid Provider Network Consultant List, which shows your designated PNC according to your provider type and county, as outlined below:

    PNCs in the downstate area service all provider types. Please refer to the Medicaid Downstate tab in the Government Medicaid Provider Network Consultant List.

    If you’re an Independent Practice Association (IPA), Medical Group, Physician Hospital Organization (PHO), Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) in Northwestern Illinois, your designated PNC can be found on the Medicaid Northwest, Cook, Collar tab in the Government Medicaid Provider Network Consultant List.

    If you’re located in Northwestern Illinois, Cook or the Collar counties and are a Senior Living Facility (SLF), Skilled Nursing Facility (SNF), Dialysis, Durable Medical Equipment (DME), Orthotics and Prosthetics (O and P), Intermediated Care Facility (ICF), Specialized Mental Health Rehabilitation Facility (SMHRF), Home Health, Hospice, Home Infusion, Community Mental Health Center (CMHC), Substance Use Prevention and Recovery (SUPR), Long Term Supports and Services (LTSS) or Behavioral Health provider, please see the Medicaid Northwest, Cook, Collar tab in the Government Medicaid Provider Network Consultant List. 

    Medicare Advantage (MA HMO and MA PPO)

    If you participate in the Medicare Advantage Program, please see the Medicare Advantage (MA) tab in the Government Medicare Advantage Provider Network Consultant List to determine your designated Provider Network Consultant and key contacts.

  • HMO MG/IPA Provider Network Consultants

    HMO Provider Network Consultants (PNCs) serve as the liaisons between BCBSIL and the HMO Medical Groups/Independent Practice Associations (MG/IPAs) in the HMO Illinois, Blue Advantage HMO, BlueCare Direct, Blue Precision HMO, and Blue FocusCare networks.

    Each PNC must keep their assigned MG/IPA up-to-date on HMO product and process changes, BCBSIL news that may affect the providers affiliated with their group, and help ensure contract compliance. HMO PNCs also serve as an internal voice for the MG/IPAs regarding the administration and delivery of managed health care, such as quality improvement and utilization management programs, the implementation of legislative requirements, and preventive care and wellness initiatives. 

    HMO MG/IPA Provider Network Consultant List 

  • Institutional (Hospital, Ambulatory Surgery Center and Behavioral Health) Provider Network Consultants

    Our experienced team of Institutional Provider Network Consultants (PNCs) is dedicated to maintaining the strong working relationships we have with our more than 250 contracted hospitals in Illinois and Northwest Indiana. This includes hospital-owned and billed professional groups, substance abuse and other freestanding facilities. 

    The Provider Network Relations staff also includes a team of PNCs dedicated to providing assistance to our more than 100 contracted ambulatory surgery centers in Illinois and Northwest Indiana. These ambulatory surgery centers include freestanding, outpatient facilities that provide highly specialized, often same-day surgical services to meet the needs of BCBSIL members. 

    Your assigned Institutional PNC specializes in initiatives, programs, regulations and claim processing concerns most relevant to facility providers. In addition to keeping you informed of BCBSIL news and updates, your PNC is available to visit your office as needed and can assist you by investigating billing issues, compiling data and developing solutions. 

    To find the name of your assigned hospital or behavioral health PNC, along with their contact information, refer to the Institutional Provider Network Consultant List.

  • Professional Provider Network Consultants

    Our dedicated Professional Provider Network Consultants (PNCs) provide service to more than 25,000 contracted physicians and medical groups throughout Illinois and Northwest Indiana.

    The PNC team assigned to your territory specializes in investigating issues, producing data and developing solutions. If needed, a PNC can visit your office to help address any special needs or concerns.