Blue Cross and Blue Shield of Illinois
Illinois • HMO, Medicaid, High-Deductible Health Plan (HDHP)
Under this HMO prefix, the member's coverage is limited to the plan's provider network. Care is coordinated through a primary care physician. Specialist visits require a referral from the PCP. When billing, confirm that the referring provider and the referral authorization number are included on the claim.
This prefix is associated with Medicaid managed care. When a BCBS plan administers Medicaid, the claims process may differ from commercial coverage: different payer ID, different claims address, different prior authorization rules, and different timely filing limits. Always verify Medicaid-specific details before submitting.
HDHP coverage under this prefix means the member carries a higher annual deductible in exchange for lower monthly premiums. Claims are processed normally but the member's cost-sharing will be higher than standard plans until the deductible is met. Preventive services are typically the exception and are covered at no cost to the member.
State's only statewide customer-owned health insurer and independent licensee of the Blue Cross Blue Shield Association. Serves Illinois with commercial, Medicare, Medicaid and other plans.