Secure Content

• EPO, PPO, Blue Choice PPO^SM Networks 

• FEP and Custom Networks 

• HMO Networks 

• Government Programs Networks  

The BCBSIL Commercial Provider Manual is organized into the following sections for providers participating in PPO, Blue Choice PPO^SM, HMO and the Blue High Performance Network^SM (Blue HPN^SM) EPO. Click on a section title to view the content.

• Behavioral Health Program 
• Billing and Reimbursement  
  
• Coordinated Home Care 
• Credentialing Standards 
• Durable Medical Equipment 
• Electronic Commerce 
• Extended Care 
• Fraud and Abuse 
• HMO Claims Processing 
• HMO Coordination of Benefits 
• HMO Membership Information 
• HMO Medical Service Agreement Highlight and Process Summary 
• HMO Network Adequacy
• HMO Payment/Compensation to the IPA 
• HMO Scope of Benefits
• HMO Utilization Management Plan 
• Health Care Medical Management (This section includes Utilization Management and Prior Authorization.)
• Home Infusion Therapy 
• Hospice 
• NCQA Accreditation Requirements 
  
• Pharmacy Management 
• Quality Improvement
• Glossary of Terms

HMO Policy and Procedures

Health Care Delivery Policy and Procedures

Blue Cross Community Health Plans Provider Manual

BCCHP Provider Finder

Critical Incident Form

Medicaid Prior Authorization Request Form

MMAI Provider Manual

Annual Health Assessment Form

Blue Cross Community Options^SM Behavioral Health Benefit Grid

Critical Incident Form

MMAI Member Handbook

MMAI Provider Finder

Medicaid Prior Authorization Request Form

Medical Power of Attorney

Compliance, Fraud, Waste and Abuse Program and Reporting:

HCSC and its subsidiaries are founded on the basic principles of good business behavior. Among these principles are a commitment to the highest standard of business ethics and integrity. This includes strict observance of and compliance with the laws and regulations governing the business operations of HCSC, and in particular, the services that it performs or has delegated to others to perform pursuant to its Medicare and Medicaid contract(s).

Any individuals who impact HCSC's Medicare or Medicaid contract(s) are expected to abide by the Medicare and Government Contracts Compliance Program, the Code of Business Ethics and Conduct and the Medicare Compliance Policies. These documents are located in http://www.hisccompliance.com.

Provided on the website you will find the following documents:

Vendor Code of Conduct

Medicare and Government Contracts Compliance Program

HCSC Compliance Program

HCSC Code of Conduct

Compliance Program Guidelines

Debarment Screening Process

Fraud, Waste, and Abuse Training

• Appointment of Representative
• CMS Qualified Medicare Beneficiary Program
• MA Annual Wellness Visit Form 
• MA Annual Wellness Visit Guide
• MA HMO IL Notice of Non-Discrimination Notice
• MA HMO IL Notice of Non-Discrimination Notice (Spanish Version)
• MA HMO Integrated Denial Notice Letter
• MA HMO Integrated Denial Notice Letter (Spanish Version)
• MA HMO Notice of Dismissal of Organization Determination Request
• MA HMO Notice of Dismissal of Organization Determination Request (Spanish Version)
• MA HMO Notice of Medicare Non-Coverage
• MA HMO Notice of Medicare Non-Coverage (Spanish Version)
• MA HMO Medicare Re-opening Letter
• MA HMO Medicare Re-opening Letter (Spanish Version)
• MA HMO Right to Expedited Grievance
• MA HMO Right to Expedited Grievance (Spanish Version)
• MA HMO UM Approval In-network Provider Letter
• MA HMO UM Approval In-network Provider Letter (Spanish Version)
• MA HMO UM Approval Out-of-network Provider Letter
• MA HMO UM Approval Out-of-network Provider Letter (Spanish Version)

The manual is organized into the following sections for your convenience. Click on a section title to view the content.  

• MA HMO Delegated Manual
• MA HMO Policy and Procedure
• MA HMO Utilization Management

Blue Cross Medicare Advantage HMO Non-Delegated Model Manual

Blue Cross Medicare Advantage PPO Provider Manual

CMS Qualified Medicare Beneficiary Program

MA Annual Wellness Visit Form

MA Annual Wellness Visit Guide

MA PPO Appendix D

• HMO Provider Credentialing Pre-application 
• HMO Online Access Request Form 
• IPA Contact List (March 2024)