Blue cross blue shield community medicaid providers

Blue cross blue shield community medicaid providers

December 2017

The Illinois Department of Healthcare and Family Services (HFS) has entered into a contract with Blue Cross and Blue Shield of Illinois (BCBSIL) to offer Blue Cross Community Health Plans (BCCHPSM) beginning Jan. 1, 2018. BCCHP will be offered to eligible participants in every county of Illinois.

Blue Cross Community Health Plans replaces three previous Medicaid programs:

  • Blue Cross Community Family Health PlanSM (FHP)
  • Blue Cross Community Integrated Care Plan (ICP)SM
  • Blue Cross Community Managed Long Term Supports and ServicesSM (MLTSS)

Enrollment in a managed care organization (MCO) is mandatory for those individuals who are eligible for Medicaid Managed Care. Eligible individuals may enroll in the plan of their choice, or the State of Illinois will automatically enroll them. Illinois Client Enrollment Services (ICES) provides individuals with access to unbiased education and information on available health plan options and assists members in the enrollment processes.

BCBSIL has a network of independently contracted providers including physicians, hospitals, skilled nursing facilities, ancillary providers, Long Term Supports and Services (LTSS) and other health care providers through which members may obtain covered services.

Required Training for Providers
The State of Illinois contract with BCBSIL requires providers servicing BCCHP members to participate in mandatory training. This training is also required for providers serving members in the Blue Cross Community MMAI (Medicare-Medicaid Plan)SM. MMAI is offered to eligible participants in six Illinois counties: Cook, DuPage, Kane, Kankakee, Lake and Will. BCBSIL is required by the State of Illinois to offer training to providers on the following topics:

  • Model of Care/Medical Home (Person Centered Practice)
  • Combating Medicare Parts C and D Fraud, Waste, and Abuse
  • Abuse, Neglect, Exploitation/Critical Incidents
  • Cultural Competency
  • Americans with Disabilities Act (ADA)/Independent Living
  • Medicare Parts C and D General Compliance Training

For links to our online training modules please refer to the Medicare/Medicaid page in the Network Participation section of our website at bcbsil.com/provider.

For More Information
The Blue Cross Community Health Plans Provider Manual includes additional details about the network. The manual can be viewed in the Standards and Requirements/BCBSIL Provider Manual section of our Provider website. Information contained in the BCBSIL Provider Manual section is password protected. You will need to follow the instructions given on our Provider website to gain access to this secure information.

If you have any questions related to BCCHP or MMAI, please contact our Provider Network team via email at .

The University of Illinois Hospital & Health Sciences System (UI Health) has an exciting announcement for our UI Health Plus members! Beginning January 1, 2015, UI Health will be teaming up with Blue Cross Community Family Health Plan. You will still receive the same great care through UI Health and your UI Health providers AND have the added benefit of having Blue Cross Community Family Health Plan insurance.

If you have questions about your new health plan (insurance) with Blue Cross Community Family Health Plan, please call member services at 1-877-860.2837.

How is HealthChoice Illinois different than regular Medicaid? 

HealthChoice Illinois is health coverage specially built to serve Medicaid members. Without managed care, most Medicaid members were given medical cards, and then it was up to them to find doctors and other medical providers. You may have heard of these cards as “Public Aid” cards too.

Now with HealthChoice Illinois, you can get the same services and options as under regular Medicaid – and even more.

With HealthChoice Illinois managed care, a health plan organization is there to help you find the right care at the right time and place.

What exactly are health plans?

They are the organizations you get to choose from. They offer you a network of doctors, hospitals, specialists, providers and other services. Their job is to make sure you are getting the health care that is available to you. The health plans are chosen to be part of HealthChoice Illinois only after they meet standards to show they can provide the right kind of care.

Helpful hint: If you already have a primary care provider or other medical professionals you trust, ask them which HealthChoice Illinois health plans they are signed up with and you can join that plan yourself.   

How do I become a member of HealthChoice Illinois?

Check out “How to join” to find out if HealthChoice Illinois coverage might be available to you.

How do I find out which health plans I can choose from in my area?

There are several health plans you can pick from once you become part of HealthChoice Illinois:

    1. Blue Cross Community Family Health Plan 

    2. CountyCare Health Plan (in Cook County only)

    3. IlliniCare Health

    4. Merdian Health Plan

    5. Molina Healthcare

    6. NextLevel Health (in Cook County only)

For more information, visit https://enrollhfs.illinois.gov/enroll

Can I change my health plan if I want to?

If you’re new to HealthChoice Illinois, you can change your health plan one time in your first 90 days. After that, you can change health plan once each year during your “open enrollment” period. This takes place one year after joining HealthChoice Illinois. You will be informed when this time is coming. (Please note that if you’re in the Medicare Medicaid Alignment Initiative (MMAI), you can change your health plan at any time.)

Can I keep my doctor as my Primary Care Provider (PCP)?

Yes, if you pick a health plan that your PCP is in. Your PCP is the doctor or clinic you go to when you are sick or need a checkup. To make sure you keep yours, contact your PCP to see which health plans they are part of.

What happens if I don’t choose a health plan during my choice period?

If you don’t choose a health plan by the deadline listed in your enrollment letter, a health plan and a PCP will be picked for you. That’s why it is so important to get informed and pick the plan that’s right for you.

Can I change my Primary Care Provider (PCP)?

Yes. You can change your PCP once a month. To change your PCP, call your health plan.

If my PCP leaves my health plan’s network, what do I do?

Contact your health plan as soon as possible. They will help you find a different provider who can meet your needs.

What if I have a treatment plan when I first enroll in a health plan?

If you are in a current, ongoing course of treatment, you can continue with your provider for 90 days when first enrolling in a health plan - whether that provider is in the plan’s network or not. You can then work with your health plan for future treatment.

Will I have co-pays?

If you have co-pays now, you may still have them. Some plans have no co-pays. Go to EnrollHFS.illinois.gov and click on “Compare Plans” to see which plans have co-pays.

I recently moved. Does this affect my health plan enrollment?

If your current health plan is also available in your new county, it will not make a difference to your coverage. But if current your plan is not available in your new county, make sure your Department of Human Services caseworker has your new address. You will be able to pick a new health plan after your address is updated. Until then, you’ll need to use your HFS Medical Card to receive benefits.

I recently had a baby. How can I enroll my newborn in a health plan?

Ask the hospital to help you add your baby to your medical case right away. If you do not have a medical case, you can apply for an HFS Medical card for your baby by calling 1-800-843-6154 or online at https://ABE.illinois.gov. You will receive an enrollment packet for your baby in the mail. The enrollment packet will give you your baby’s health plan options and a date for when you must decide.

What additional services does HealthChoice Illinois managed care offer?

Visit “The HealthChoice Illinois advantage” webpage to learn about added benefits that might be available to you above and beyond the services offered with regular, traditional Medicaid.

How can I contact my health plan?

For a list of member services and answers to other questions, check out the contact information on the medical card that your health plan gave you. If you do not have that, you can call their member services department.

Is Blue Cross Blue Shield of Illinois Medicaid?

Blue Cross and Blue Shield of Illinois (BCBSIL), a Division of Health Care Service Corporation, is contracted with IHFS as an MCO and operates a Medicaid plan, the Blue Cross Community Health Plan (BCCHP) in the state of Illinois.

What are the different Illinois Medicaid plans?

HealthChoice Illinois Health Plan Contact Information:.
www.ilyouthcare.com |1-844-289-2264..
Blue Cross Community Health Plan. www.bcbsil.com/bcchp/ | 1-877-860-2837..
CountyCare Health Plan (Cook County only) ... .
IlliniCare Health. ... .
Meridian Health Plan (Former Youth in Care Only) ... .
Molina Healthcare..

Who takes Illinois Medicaid?

Medicaid pays for medical assistance for eligible children, parents and caretakers of children, pregnant women, persons who are disabled, blind or 65 years of age or older, those who were formerly in foster care services, and adults aged 19-64 who are not receiving Medicare coverage and who are not the parent or ...

Is Arkansas Blue Cross Blue Shield Medicaid?

Arkansas Works is a Medicaid program that offers eligible Arkansans private health insurance coverage. The insurance is offered through qualified health plans from Arkansas BlueCross BlueShield, Arkansas Health & Wellness (Ambetter), and Qualchoice.