Blue Cross Blue Shield Medicaid (2024)

In Blue Cross Blue Shield Medicaid plan, CMS – The Centers for Medicare & Medicaid Services and the Illinois State have contracted with BCBSIL or Blue Cross and Blue Shield of Illinois along with other Managed Care Organizations to implement Medicaid to all counties in Illinois. BCBSIL offers two plans: Blue Cross Community Health Plans and Blue Cross Community MMAI Medicare-Medicaid Plan.

Blue Cross Community Health Plans (BCCHP)

Blue Cross and Blue Shield of Illinois offers Blue Cross Community Health Plans which includes a network of independently contracted providers with  physicians, hospitals, skilled nursing facilities, Long-term Services,  ancillary providers, and Support (LTSS) and other health care providers through which Illinois Medicaid members may obtain covered services.  

Blue Cross Community MMAI -Medicare-Medicaid Plan

The CMS and the State of Illinois have contracted with Blue Cross and Blue Shield of Illinois (BCBSIL) along with other Managed Care Organizations (MCO) to implement MMAI.

Medicaid (BCCHP/MMAI)

Blue Cross and Blue Shield of Illinois collects Healthcare Effectiveness Data and Information Set which is known as HEDIS data from our providers to measure the quality of care which our members receive and also work to improve it.

Every year, Blue Cross and Blue Shield of Illinois reports audited HEDIS results for Blue Cross Community Health Plans-BCCHPand Blue Cross Community MMAI – Medicare-Medicaid Plan. These results are sent to the Illinois Department of Healthcare and Family Services, CMS and NCQA – National Committee for Quality Assurance. 

Anthem Medicaid provides you with What health benefits?

  • A primary care provider you can select
  • Behavioural health Services
  • Pharmacy Services
  • Checkups and screenings

No-cost transportation to your medical appointments

If you need a transportation to and from your doctor office, you may have access to transportation for covered non-emergency appointments as well in Blue cross Blue shield Medicaid plans.

In New York City and Putnam County

Call Medical Answering Services at Phone- 1-800-850-5340

You will need:

  • Medicaid ID number
  • Your appointment date and time
  • The address where you’re going
  • The name of the doctor you’re seeing

In Nassau County

Call LogistiCare at 1-866-481-9488 (TTY 1-866-288-3133)

You will need:

  • Your Empire ID number
  • Your appointment date and time
  • The address where you are going
  • The name of the doctor you are seeing

To find out eligibility of ride, please visit transportation.ky.gov.

For more details about this benefit, you can review your member handbook.

You’ll also get these extras like:

  • Transportation assistance for work or school
  • Childcare assistance for work or school
  • GED support – Earn your high school degree on us with GED test vouchers
  • Record expungement – We’ll help pay to have your criminal record modified, sealed or removed

Focused on health

  • Doctors, specialists, hospitals, and other providers to choose from near you
  • Visits with a PCP- Primary Care Provider you choose
  • 24/7 health advice, even on holidays, with our 24/7 NurseLine
  • Immunizations
  • Behavioral health care and our Behavioral Health
  • Pharmacy services
  • Crisis Hotline: 855-661-2025 (TTY 711)

Dental care in BCBS Medicaid

Call DentaQuest at 855-343-7405 to find a dentist or set up your dental services, such as:

  • Oral cleanings and examinations
  • Fillings, X-rays, and extractions
  • Oral surgery for members under 21

Vision care:

All members get:

  • Eye exams and screenings
  • Eyeglasses or a credit for contacts each year as an extra just for Anthem Medicaid members


Members under 21 get:

  • Glasses


Call eye Quest at 855-343-7405 to set up routine eye care.

Dental Care:

Good dental care is important to your overall health. There are no co pays for covered dental services, including:

  • Teeth cleaning twice a year
  • Oral exams
  • X-rays
  • Extractions
  • Fillings
  • Emergency care
  • Dentures (removable or partial)
  • Orthodontics

Empire offers dental care through LIBERTY Dental, an expert in providing high quality dental services. To find or change your dentist,

call LIBERTY Dental at 1-833-276-0847, or

visit their website. Go to LIBERTY Dental

Referrals in Medicaid Blue Cross Blue Shield :

Some of the medical services need a referral from your PCP -Primary Care Provider before getting services.

You will need to get a referral from your PCP before:

  • Going to a hospital for non-emergency care
  • Getting medicine from a doctor other than your PCP

You do not need a referral for:

  • Women’s health care
  • Pregnancy services
  • Family planning services
  • Emergency services
  • School-based healthcenter services
  • Adult dental care (ages 21 and over)
  • Adult vision care (age 21 and over)
  • Behavioral health and substance use disorder services
  • Certain doctors for children with special health care needs

Pre-Authorization or Pre-approvals:

Some of the medical services require pre-approval or pri-authorization for getting start the service or care or treatment. This means that patient or treatment provider doctor must ask Empire to approve those services or benefits before start.

You will need preapproval for:

  • Ambulance transportation (emergency air and non-emergency)
  • Chiropractic services
  • Certain medicines
  • Durable medical equipment
  • Diagnostic testing
  • End-stage renal disease services
  • Home health extended services for people age 20 and younger
  • Home health services for people age 21 and over
  • Hospice services
  • Inpatient acute care hospitalization
  • Mental health rehab services
  • Nurse-midwifery services
  • Organ transplant services
  • Outpatient hospital services including physical therapy, occupational therapy, speech therapy and surgical procedures
  • Pediatric Day Health Care (PDHC) for people ages 20 and older
  • Personal Care Services (PCS) for people ages 20 and older
  • Physician services including medical assessments, treatments and surgical services
  • Podiatry services
  • Post-stabilization care services
  • Radiology services
  • Rehabilitation services: physical therapy, occupational therapy and speech therapy
  • Vision care for people age 20 and younger

In ILS – Lieu of Services other physical and behavioral health services may receive instead of those covered by your Medicaid state plan. ILS services:

  • Are cost-effective substitutes for covered services and settings.
  • Are approved by the State.
  • Help us give you more options for your care.

To learn more about ILS offers,

Please visit the New York State Department of Health website.

Healthy Rewards in Blue cross Blue shield Medicaid:

Healthy Rewards is a no-cost, and optional program for eligible members enrolled in health plan. Empire blue cross blue shield Medicaid program encourage members to get the care , improve their health and also create a healthy lifestyle.

Members redeem these Healthy Rewards through the Benefit Reward Hub:

  • Get up to $40 for high blood pressure medication refills
  • Get $50 for a diabetic retinal eye exam
  • Get $5 for completing a What do you know about diabetes? quiz
  • Get up to $50 for viral load tests with their HIV care team
  • Get $50 for spirometry testing for COPD
  • Get $50 for a breast cancer screening (mammogram)
  • Get $50 for a colorectal cancer screening
  • Get $25 for a cervical cancer screening (Pap smear)
  • Get $25 for a chlamydia screening
  • Get $25 for a follow-up visit with their provider within 7 days of a behavioral health hospitalization
  • Get $25 for yearly well-child visits
  • Get $25 for yearly childhood dental visits
  • Get $25 for Combo 2 adolescent immunizations (shots)
  • Get $25 for Combo 3 childhood immunizations (shots)
  • Get up to $40 for ADHD medication refills
  • Get $25 for pregnant members who go to a prenatal visit in their first trimester, or within 42 days of joining our plan
  • Get $50 for a postpartum visit within 7-84 days of delivering their baby
  • Get $50 for six well-baby visits within the first 15 months of life
  • Get up to $40 for two well-baby visits between 15 and 30 months of life

Please visit  Benefit Reward Hub to redeem Healthy Rewards.

For more information call the Healthy Rewards Customer Service at 888-990-8681 (TTY 711) Monday to Friday from 9 a.m. to 8 p.m. Eastern time. 

Note-

  • If need help setting up your Empire online account, call Member Services at the number on Empire member ID card.

Reference PDF:

For more information and guidelines please go through the below Pdf’s.

EMPIRE BLUECROSS BLUESHIELD HEALTHPLUS MEDICAID MANAGED CARE PROGRAM

Empire BCBS New York State Medicaid Managed Care

What is the BCBS Alpha prefix?

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  • NSingh (MBA, RCM Expert)

    The author and contributor of this blog "NSingh" is working in Medical Billing and Coding since 2010. He is MBA in marketing and Having vaste experience in different scopes of Medical Billing and Coding as AR-Follow-up, Payment Posting, Charge posting, Coding, etc.

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