Quality Improvement



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The BCBSIL Quality Improvement (QI) Program is based on the view that the process for delivery of medical care and services can be continuously improved. The information provided is a summary of the quality improvement programs in place for BCBSIL members and practitioners. Call 312-653-3465 with questions about the QI Program.




BCBSIL requires an on-site office visit at least every three years for primary care physicians (PCPs), including OB/Gynes and pediatricians, for continued participation in the HMO product. High-volume behavioral health specialists are reviewed for the HMO product for the purposes of credentialing. An on-site visit is not required for practitioners participating with PPO products. BCBSIL may perform an on-site visit more frequently than every three years for quality improvement purposes and as a result of a complaint. The current BCBSIL site visit standards used for auditing are available for you to print.

Site Visit Reports:

Behavioral Health Site and Medical Record Audit

PCP Site and Medical Record Audit

 

HMO Site Visit Summary:

Annual HMO Medical Site Visits 

Annual HMO Behavioral Health Site Visits 

 

HMO Quality Site Visit Standards:

HMO Quality Site Standards - Full Version 

HMO Utilization Management Plan