Blue Cross Medicare Advantage (HMO)^SM

The MA HMO Policy and Procedures are intended to provide Medical Groups/Independent Practice Associations (MGs/IPAs) an overview of established BCBSIL guidelines and the necessary steps needed to complete in the treatment of members.

Policy/Procedure Number	Policy/Procedure Name	Review Date
IL MA 1.01 A IL MA 1.01 B	MA 3rd Trimester Pregnancy IPA Transfers Policy MA 3rd Trimester Pregnancy IPA Transfers Procedure	8/8/2023 8/8/2023
IL MA 1.02 A IL MA 1.02 B	MA Ancillary and Hospital Institution Care Transition and Exceptions Policy MA Ancillary and Hospital Institution Care Transition and Exceptions Procedure	8/8/2023 8/8/2023
IL MA 1.04 A IL MA 1.04 B	MA Collaboration Between Primary Care Physicians (PCPs) and Behavioral Health Practitioners Policy MA Collaboration Between Primary Care Physicians (PCPs) and Behavioral Health Practitioners Procedure	6/30/2022 6/30/2022
IL MA 1.05 A IL MA 1.05 B	MA Complex Case Management Policy MA Complex Case Management Procedure	6/30/2022 6/30/2022
IL MA 1.07 A IL MA 1.07 B	MA Corrective Action for Failed Utilization Management Audit of Participating IPAs Policy MA Corrective Action for Failed Utilization Management Audit of Participating IPAs Procedure	6/30/2022 6/30/2022
IL MA 1.08 A IL MA 1.08 B	MA Emergency Room Services Policy MA Emergency Room Services Procedure	7/11/2023 7/11/2023
IL MA 1.09 A IL MA 1.09 B	MA Administered Complaints Policy MA Administered Complaints Procedure	7/11/2023 7/11/2023
IL MA 1.10 A IL MA 1.10 B	MA Financial Risk Claims Policy MA Financial Risk Claims Procedure	8/8/2023 8/8/2023
IL MA 1.13 A IL MA 1.13 B	MA IPAs Request for Member Transfer Policy MA IPAs Request for Member Transfer Procedure	8/8/2023 8/8/2023
IL MA 1.17 A IL MA 1.17 B	MA Primary Care Physician (PCP) Access Standards Policy MA Primary Care Physician (PCP) Access Standards Procedure	8/8/2023 8/8/2023
IL MA 1.19 A IL MA 1.19 B	MA Provider Complaint Inquiries Policy MA Provider Complaint Inquiries Procedure	7/11/2023 7/11/2023
IL MA 1.20 A IL MA 1.20 B	MA Retroactive IPA Member Changes Policy MA Retroactive IPA Member Changes Procedure	8/8/2023 8/8/2023
IL MA 1.22 A IL MA 1.22 B	MA Transition of Medical Care Policy MA Transition of Medical Care Procedure	8/8/2023 8/8/2023
IL MA 1.23 A IL MA 1.23 B	MA Utilization Management Adherence Audit of Participating IPAs Policy MA Utilization Management Adherence Audit of Participating IPAs Procedure	6/30/2022 6/30/2022

Blue Cross Medicare Advantage (HMO)SM

Blue Cross Medicare Advantage (HMO)^SM