BCBS prefix QMD: BCBS of Illinois, BlueCare Direct
The short answerQMD is a Blue Cross and Blue Shield of Illinois prefix: commercial HMO, on the BlueCare Direct (with Advocate) network (individuals, on the Marketplace public exchange). File the claim to your local Blue plan; outside Illinois, BlueCard routes it to BCBS of Illinois by the prefix.
By Javier Alvarez · Updated · 2 min read
What the QMD prefix means
| Home plan | Blue Cross and Blue Shield of Illinois, a division of Health Care Service Corporation (HCSC). Commercial HMO. 1 |
| Network | BlueCare Direct (with Advocate) (network code BHD). Plans: BlueCare Direct metallic QHPs: Gold, Silver and Bronze. 1 |
| Who it covers | Individuals, on the Marketplace public exchange. 1 |
| Area | Gold and Bronze: Cook, DuPage and Kane counties. Silver: Cook, DuPage, Kane, Lake and McHenry counties. 1 |
| How the network works | Built on the Advocate network. Members may self-refer within the Advocate network without a PCP referral in some instances. There are no out-of-network benefits without authorization, except in a medical emergency. 1 |
| Referrals | Members may self-refer within the Advocate network in some instances (not surgery or physical therapy); no out-of-network benefits without authorization. 1 |
| Where to file | To your local Blue plan, the one you're contracted with. Outside Illinois, BlueCard uses the prefix to route the claim to BCBS of Illinois. In Illinois, that is BCBS of Illinois itself. Send the member ID exactly as printed, prefix included. 2 3 |
| Verify benefits | Through your local Blue plan's eligibility tools, or BlueCard Eligibility at 1-800-676-BLUE (2583), before the first visit. 2 |
| Preventive MNT | BCBS of Illinois's preventive services policy (RP006) lists 97802 to 97804 under the USPSTF rows for healthy diet counseling with cardiovascular risk factors and for adults with a BMI of 30 or more. To process with no member cost share, the claim needs a preventive diagnosis code and a preventive procedure code. MNT for other reasons may be covered under another part of the plan, with cost sharing. Grandfathered plans don't have to cover preventive services at no cost share. 4 See MNT coverage at Blue Cross Blue Shield plans. |
Other prefixes on the BlueCare Direct (with Advocate) network
- QMC: Individuals, off the Marketplace, through BCBS of Illinois.
Before a visit with prefix QMD
- Copy the current card, front and back, and enter the member ID exactly as printed, QMD included.
- Verify benefits for 97802 and 97803: through your local Blue plan's eligibility tools, or BlueCard Eligibility at 1-800-676-BLUE (2583). Ask whether nutrition counseling is covered, how many visits, whether a referral is needed, and what the member pays.
- File to your local Blue plan, not to BCBS of Illinois directly, unless BCBS of Illinois is your local plan.
Another prefix? Type it in the lookup above or see every prefix we have. For how BlueCard routes an out-of-state Blue card, see BlueCard for dietitians.