March 17, 2025
New legislation in Illinois allows pharmacists to submit medical claims for hormonal contraceptive and HIV assessment and consulting services. To submit claims for our members with Blue Cross Community Health PlansSM, pharmacists must enroll with Illinois Medicaid and apply to become a participating provider with Blue Cross and Blue Shield of Illinois.
What’s changing: Effective July 1, 2025, pharmacists can bill for hormonal contraceptive and HIV assessment and consulting services under the medical benefit for Illinois Medicaid members. Payable services are limited to contraceptive assessment and consultation services, and HIV pre- and -post exposure prophylaxis assessment and consultation services.
View the Illinois Department of Healthcare and Family Services fee schedule for more information.
Illinois Medicaid enrollment: To bill under the medical benefit, the Centers for Medicare & Medicaid Services requires all Illinois Medicaid providers, including pharmacists, to enroll in the Illinois Medicaid Program Advanced Cloud Technology system.
For more information on how to enroll, visit the IMPACT website. If you have questions, IMPACT Provider Enrollment call center staff are available Monday through Friday from 8:30 a.m. to 5 p.m. at 877-782-5565, or you may email IMPACT staff.
Join our network: To bill for services under the medical benefit for our members with BCCHPSM, pharmacists must apply to become a participating provider for these networks. To join, fill out the Provider Onboarding Form. Also see the application instructions on our website. Once a pharmacist has completed their individual IMPACT enrollment and become a participating provider with BCBSIL, they will be able to submit medical claims for assessment and consulting services.
Attend orientation: Once contracted, you’ll receive an invitation from BCBSIL to attend a real-time virtual provider orientation session. We offer orientation sessions every month. View dates and register on our training page, which also includes an on-demand links to the recorded presentation.
The provider orientation includes information on:
- Checking eligibility and benefits
- Submitting claims for reimbursement
- Verifying claim status
Electronic options: Our provider orientations focus on using electronic options for all transactions. If you haven’t already, we encourage you to register with Availity® Essentials.
The importance of checking eligibility and benefits: Prior to providing care to our members, always check eligibility and benefits first through Availity or your preferred vendor portal. This step confirms members’ coverage status and other important information, such as applicable copays, coinsurance and deductibles.
Verification of eligibility and benefit information is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility, any claims received during the interim period and the terms of the member’s certificate of coverage applicable on the date services were rendered.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.