• Welcome
  • Employers
  • Producers
  • Providers
  • Company Information
  • Contact Us
  • Language Assistance
Blue Cross and Blue Shield of Illinois logo
Blue Cross and Blue Shield of Illinois logo
Menu
Blue Cross and Blue Shield of Illinois logo
Blue Cross and Blue Shield of Illinois logo
Blue Cross and Blue Shield of Illinois logo
  • icon home
  • Home
  • Network Participation

    Network Participation

    • Network Participation
    • Contracting
    • Credentialing
    • Join Our Network
    • Medicaid
    • Medicare Advantage Plans
    • Provider Network Consultant Assignments
    • Verify and Update Your Information
    • Welcome to Our Network
  • Claims and Eligibility

    Claims and Eligibility

    • Claims and Eligibility
    • BlueCard®
    • Claim Payment and Remittance
    • Claim Review and Appeal
    • Claim Status and Adjudication
    • Claim Submission
    • Eligibility and Benefits
    • Electronic Commerce
    • Fee Schedule
    • Refund Management
    • Utilization Management
  • Education and Reference Center

    Education and Reference

    • Education and Reference
    • Blue Review
    • Forms
    • Fraud and Abuse
    • News and Updates
    • Provider Tools
    • Webinars/Workshops
  • Clinical Resources

    Clinical Resources

    • Clinical Resources
    • Behavioral Health Program
    • Clinical Practice Guidelines
    • Health Equity and Social Determinants of Health (SDoH)
    • HEDIS
    • Opioid Resources
    • Preventive Care Guidelines
    • Quality Improvement
  • Pharmacy Programs

    Pharmacy

    • Pharmacy
    • Dispensing (Quantity vs. Time) Limits
    • Medicaid
    • Over the Counter Equivalent Exclusion Program
    • Prescription Drug List
    • Prior Authorization and Step Therapy Programs
    • Specialty Pharmacy Program
  • Standards and Requirements

    Standards and Requirements

    • Standards and Requirements
    • Consolidated Appropriations Act & Transparency in Coverage
    • Clinical Payment and Coding Policies
    • Medical Policy
    • Medical Policy and Prior Authorization: Out-of-area Members
    • Provider Manuals
    • Risk Adjustment
  • Employers
  • Producers
  • Providers
  • Company Information

MA HMO Delegated ODAG Templates

MA HMO In-network Approval Letter
MA HMO In-network Approval Letter (Spanish)
MA HMO Medicare Re-Opening
MA HMO Medicare Re-Opening (Spanish)
MA HMO Notice of Denial of Medical Coverage
MA HMO Notice of Denial of Medical Coverage (Spanish)
MA HMO Notice of Dismissal of Coverage Request
MA HMO Notice of Dismissal of Coverage Request (Spanish)
MA HMO Notice of Medicare Non-Coverage
MA HMO Notice of Medicare Non-Coverage (Spanish)
MA HMO Notice of Non-discrimination
MA HMO Notice of Non-discrimination (Spanish)
MA HMO Out-of-network Letter
MA HMO Out-of-network Letter (Spanish)
MA HMO Right to Expedited Grievance
MA HMO Right to Expedited Grievance (Spanish)

 
     
Blue Cross and Blue Shield of IL FacebookBlue Cross and Blue Shield of IL  YouTubeBlue Cross and Blue Shield of IL ConnectBlue Cross and Blue Shield of IL LinkedIn
 
  • Legal and Privacy
  • Non-Discrimination Notice
  • Careers
  • Contact Us
  • Newsroom
 

Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association


© Copyright 2022 Health Care Service Corporation. All Rights Reserved.

 

PDF File is in portable document format (PDF). To view this file, you may need to install a PDF reader program. Most PDF readers are a free download. One option is Adobe® Reader® which has a built-in reader. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com

 

External link You are leaving this website/app (“site”). This new site may be offered by a vendor or an independent third party. The site may also contain non-Medicare related information. In addition, some sites may require you to agree to their terms of use and privacy policy.