BLUE CHOICEPREFERREDPPO

Presented by: J’ne Kanady,

Provider Network Consultant

February 10, 2016

BCBSIL will offer a narrow network called Blue Choice Preferred PPO (BCE)*

The broad PPO products previously offered on the healthcare exchange will

be discontinued

Providers must be identified as BCE organizations in order to be considered

in-network for these Exchange members

In-network status for professional providers is based on:

• Hospital admitting privileges,

• Specific provider specialties, or

• A signed Blue Choice Agreement

Broad PPO options will continue to be available to premium and employer-

funded groups across Illinois

* This is a separate product from Blue Choice Select (BCS) which is only offered in the Chicago Metro and Quad Cities. BCS is solely a group product.

Effective Jan 1, 2016

BLUE PPO℠

BLUE CHOICE PPO℠

BLUE PRECISION HMO℠

•COVERAGE AREA

•Statewide

•COVERAGE AREA

•Chicago Metro

•Quad Cities

•COVERAGE AREA

•Chicago Metro

•Rockford

2015 Exchange Offerings

BLUE Choice Preferred PPO℠

BLUE Care Direct℠

BLUE PRECISION HMO℠

•COVERAGE AREA

•Statewide

•COVERAGE AREA

•Chicago Metro

•COVERAGE AREA

•Chicago Metro

•Rockford

2016 Exchange Offerings

* Including behavioral health treatment

Emergency services

Prescription drugs

Laboratory services

Hospitalization

Ambulatory patient services

Preventive and wellness services

and chronic disease management

Habilitative and rehabilitative services and

devices

Maternity and newborn care

Pediatric services, including oral and

vision care

Mental health and substance abuse disorder services*

Blue Choice Preferred PPO patients will still

have coverage for the essential benefits as

outlined by the Affordable Care Act

Rural Health Clinics

Rural Health Clinics statewide

will automatically be considered

in-network for BCE members*

Reimbursement will continue to

be based off the PPO fee

schedule

Rural Health Clinic designation

must be on file with Medicare

and BCBSIL

Providers are encouraged to

verify their specialty / network

status and update the

information when applicable

* Most local health departments are classified as rural health clinics

www.bcbsil.com/provider

BlueReview

Provider Network Consultant Assignments

Tutorials/User Guides

Update Your Information

Blue Access for ProvidersSM

Forms

8

BCBSIL Provider Website

Provider Network Consultants

As a team, the Provider

Network Consultants

(PNC) support over

105,000 individual

practitioners and

professional provider

groups throughout the

state.

Each PNC averages a

caseload of 5,800billing providers.

Keeping You Informed

• Discussing BCBSIL products and services

• Updating you on important initiatives (e.g. ACA, ICD-10)

Understanding Your Provider Contract

• Answering questions you have about your contract

• Helping you navigate through the provider manual, when needed

Helping You Locate Resources

• Directing you to the appropriate department

• Helping you locate forms and tutorials

Visiting Your Office

• When you need us

• To address special needs and concerns

Complex Claim Situations

• When they cannot otherwise be resolved by normal channels

• Large-volume (100+) claim adjustments

10

Provider Network Consultants

Questions