Blue cross blue shield community health plan providers

CareFirst BlueCross BlueShield Community Health Plan District of Columbia (CareFirst CHPDC) offers a comprehensive portfolio of health insurance benefits and services to over 66,000 enrollees in the District of Columbia. Since 2013, CareFirst CHPDC has provided comprehensive managed care services to Medicaid recipients in the District of Columbia through a consumer-centric, high-touch health plan focused on personal enrollee engagement. CareFirst CHPDC is committed to providing care to the region's most vulnerable and diverse populations including children, the elderly and people living with disabilities.

CareFirst Community Health Plan Maryland (CareFirst CHPMD)​ works with our network of over 7,000 physicians and health care providers to deliver the best quality care to our members. We believe that the doctor-patient relationship is critical to good patient care. We believe that all health care is delivered locally and supporting our provider network is critical to our success.

CareFirst CHPMD is a Medicaid Managed Care Organization serving members in the Maryland HealthChoice program.

The Maryland Department of Health (MDH) provides Medical Assistance, also called Medicaid coverage to individuals determined to be categorically eligible or medically needy. Medicaid coverage is automatically given to individuals receiving certain other public assistance, such as Supplemental Security Income (SSI), Temporary Cash Assistance (TCA), or Foster Care.

Our service area includes the following counties and city: Anne Arundel, Baltimore, Baltimore City, Calvert, Caroline, Carroll, Cecil, Charles, Dorchester, Frederick, Harford, Howard, Kent, Montgomery, Prince George’s, Queen Anne’s, Somerset, St. Mary’s, Talbot, Wicomico and Worcester.

Blue Cross Community Centennial has a network of doctors, specialists and hospitals. These providers are contracted with BCBSNM to provide medical services to members.

You must use in-network providers. If you choose to see a doctor who is not part of our network, you will have to pay for the services. Except in an emergency, this plan does not cover care received from out-of-network providers. Check with the provider to make sure that he or she is in the network before you get care.

You must choose a PCP when you join the plan. Our network has PCPs in almost every county in the state. There's also a wide selection of specialists.

If you need help finding Medicaid providers, call 1-866-689-1523.

December 2017

The Illinois Department of Healthcare and Family Services (HFS) has entered into a contract with Blue Cross and Blue Shield of Illinois (BCBSIL) to offer Blue Cross Community Health Plans (BCCHPSM) beginning Jan. 1, 2018. BCCHP will be offered to eligible participants in every county of Illinois.

Blue Cross Community Health Plans replaces three previous Medicaid programs:

• Blue Cross Community Family Health PlanSM (FHP)
• Blue Cross Community Integrated Care Plan (ICP)SM
• Blue Cross Community Managed Long Term Supports and ServicesSM (MLTSS)

Enrollment in a managed care organization (MCO) is mandatory for those individuals who are eligible for Medicaid Managed Care. Eligible individuals may enroll in the plan of their choice, or the State of Illinois will automatically enroll them. Illinois Client Enrollment Services (ICES) provides individuals with access to unbiased education and information on available health plan options and assists members in the enrollment processes.

BCBSIL has a network of independently contracted providers including physicians, hospitals, skilled nursing facilities, ancillary providers, Long Term Supports and Services (LTSS) and other health care providers through which members may obtain covered services.

Required Training for Providers
The State of Illinois contract with BCBSIL requires providers servicing BCCHP members to participate in mandatory training. This training is also required for providers serving members in the Blue Cross Community MMAI (Medicare-Medicaid Plan)SM. MMAI is offered to eligible participants in six Illinois counties: Cook, DuPage, Kane, Kankakee, Lake and Will. BCBSIL is required by the State of Illinois to offer training to providers on the following topics:

• Model of Care/Medical Home (Person Centered Practice)
• Combating Medicare Parts C and D Fraud, Waste, and Abuse
• Abuse, Neglect, Exploitation/Critical Incidents
• Cultural Competency
• Americans with Disabilities Act (ADA)/Independent Living
• Medicare Parts C and D General Compliance Training

For links to our online training modules please refer to the Medicare/Medicaid page in the Network Participation section of our website at bcbsil.com/provider.

For More Information
The Blue Cross Community Health Plans Provider Manual includes additional details about the network. The manual can be viewed in the Standards and Requirements/BCBSIL Provider Manual section of our Provider website. Information contained in the BCBSIL Provider Manual section is password protected. You will need to follow the instructions given on our Provider website to gain access to this secure information.

If you have any questions related to BCCHP or MMAI, please contact our Provider Network team via email at .

How do I find out what providers are on my network?

Is Blue Cross Blue Shield of Illinois Medicaid?

What are the different Illinois Medicaid plans?

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