Provider Network Consultant Assignments



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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 for providers
  • Assist you with adhering to financial requirements and contractual compliance

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

 

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

 

Government PNCs for Blue Cross Community Health Plans (BCCHP)SM, Blue Cross Community MMAI (Medicare-Medicaid) PlansSM and Blue Cross Medicare AdvantageSM 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 Associations (IPAs) PNCs for MG/IPAs in the HMO Illinois and BlueAdvantageSM HMO networks

 

Professional PNCs for contracting 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:




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

 

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

 

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 general email box at ancillarynetworks@bcbsil.com, or leave a message at 312-653-4820.


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.

 

Medicaid

For independent professional providers as well as providers in Cook and the Collar counties, please contact govproviders@bcbsil.com or call 855-653-8126 for further information.

 

Provider Network Consultants (PNCs) in Central and Southern IL service all provider types with the exception of Hospitals, Free-Standing Lab, Radiology and PT/OT/ST sites. Please refer to the Medicaid Central, Southern IL tab which reflects by county, your designated PNC.

 

If you are an IPA, Medical Group, PHO, FQHC and RHC in Northwestern IL, your designated PNC can be found on the Medicaid Northwest, Cook, Collar tab. If you’re located in Northwestern IL, Cook and the Collar counties and are a SLF, SNF, Dialysis, DME, O and P, ICF, SMHRF, Home Health, Hospice, Home Infusion, CMHC, SUPR, LTSS or Behavioral Health provider, please see the Medicaid Northwest, Cook, Collar tab as well.

 

Medicare Advantage

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

 

To find your designated point of contact, please refer to the Government Provider Network Consultant List.

 

If more than two PNC’s are indicated for a particular county, feel free to reach out to either PNC and they will direct you to the correct contact.

 


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 and BlueAdvantage HMO 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; PNCs also help ensure contract compliance. HMO PNCs also serve as an internal voice for the MGs/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


Our experienced staff 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. This listing includes several tabs for your convenience. Note: For ambulatory surgery centers, contact Ruth Dela Cruz directly at Ruth_Dela_Cruz@bcbsil.com or 630-445-6355.


Our dedicated team of Professional PNCs provides service to more than 25,000 contracting physicians and medical groups throughout Illinois and northwest Indiana.

 

With a thorough knowledge of the PPO product, your shared email address has assigned PNCs that specialize in investigating issues, producing data and developing solutions. If needed, a PNC can visit your office to help address any special needs or concerns.

Refer to the Professional Provider Resource Card  for additional information.