Blue Cross and Blue Shield of Illinois is committed to providing you with the resources you need to collaborate with us in providing excellent service to your BCBSIL patients. This section of the website is designed to provide you with manuals, documents, procedures, policies and regulations so that you have the information at your fingertips to administer BCBSIL health insurance products, policies and procedures.
BCBSIL Provider Manual
The BCBSIL Provider Manuals are comprehensive guides for professional and facility providers. These manuals set forth the policies, procedures and requirements necessary for participation in the BCBSIL contracting provider networks. Learn more
BlueCard Program
BlueCard is a national program that enables members of one Blue Cross and Blue Shield Plan to obtain health care services while traveling or living in another BCBS Plan’s service area. Learn more
Consolidated Appropriations Act & Transparency in Coverage
The Consolidated Appropriations Act (CAA) of 2021 and the Transparency in Coverage Final Rule went into effect on Jan. 1, 2022. Learn more
Clinical Payment and Coding Policies
Clinical payment and coding policies are based on criteria developed by specialized professional societies, national guidelines (e.g. Milliman Care Guidelines (MCG) and the CMS Provider Reimbursement Manual. Learn more
Medical Policy
Providers should be knowledgeable about BCBSIL Medical Policies. These Medical Policies serve as guidelines for health care benefit coverage decisions, which may vary according to the different products and benefit plans offered by BCBSIL. Learn more
Medical Policy/Pre-certification: Out-of-area Members
To view out-of-area Blue Plan's medical policy or general pre-certification/pre-authorization information. Learn more
Medicare Advantage PFFS
If you provide care to a Medicare Advantage Private Fee-for-Service (PFFS) member from an out-of-area Blue Cross and Blue Shield Plan, you may use this tool to view the Terms and Conditions of the member's plan. Learn more
Risk Adjustment
Risk Adjustment seeks to level the playing field by discouraging adverse selection of members. Learn more