Northshore Physician Associates (NPA) BCBSIL Site 447

NorthShore Physician Associates (NPA) is a network of more than 3,000 physicians throughout the north and northwest suburbs of Chicago. The network includes primary care physicians in the areas of family practice, internal medicine, and pediatrics; specialists trained in more than 50 different areas of medicine; and six hospitals: Evanston Hospital, Glenbrook Hospital, Highland Park Hospital, Northwest Community Hospital, Skokie Hospital, and Swedish Hospital. NPA offers its Members and providers the benefits of a multispecialty network including PCPs, specialists, and hospitals that provide state-of-the-art, comprehensive, and efficient healthcare to meet patients’ medical needs. NPA is delegated by Blue Cross Blue Shield of Illinois for 55,000+ BCBS Commercial HMO members (Site 447).

NPA and it’s sister organization, Illinois Health Partners (IHP – BCBSIL Site 243/312; 30,000+ lives) have a reciprocal agreement for specialty services across the two regions (including IHP’s hospitals: Edwards and Elmhurst Hospitals). NPA and IHP have both designated Arcadia Health Solutions (Arcadia) as the management services organization responsible for administering and managing the operations required to successfully support its health plan contracts. Pod (NPA: NorthShore Legacy, Northwest Community, and Swedish Hospitals & IHP: Edward and Elmhurst Hospitals) Management leadership also serve on all committees (Board, Finance, Quality, and UM) to provide medical network insight, make recommendations for administrative operations, and communicate initiatives to NPA leadership, committees, and network providers.

Join the PHO

There are many benefits to joining our PHO, such as:

Having a voice in the decision-making process at Northwest Community Healthcare (NCH)
Expertise dedicated to building your practice
Innovative means to connect providers with each other and with their patients to improve quality of care
Group contracting with payers at a higher fee schedule, which you may not have under individual contracts

However, we do have membership criteria set in place to ensure that we maintain the highest levels of care for our patients. These criteria state that:

All physicians must be members of our medical staff to be eligible to apply
Physicians must be American Medical Association (AMA) board certified
Physicians must have current state licensure and state and federal controlled substance licenses/certificates
Minimum malpractice coverage and full disclosure of malpractice liability history are required
Physicians must be able to arrange reasonable coverage through another PHO participating provider for patients contracted through the PHO
Required to utilize Northwest Clinical Laboratories for PHO patients

You can express interest in joining NWHP partners by completing the application request form and submitting it to NCH Medical Staff Services at medicalstaffservices@nch.org or fax to 847-618-5669.

FAQs

Have questions? We can help. Hopefully, you can find the answers you’re looking for here.

Who is eligible to join the PHO?

All physicians who are active members of our medical staff are eligible to apply.

How long does it take to be credentialed?

The PHO usually credentials a complete application and enrolls to managed care entities within 120 days. Process time is shorter if you are currently on our medical staff.

What is the contracting process?

Once your application is approved, you will be given a PHO Risk and CI contract to sign. All physicians seeking membership must take all risk products and participate in CI. There are additional managed care plans that you can opt in or out of; a form will be provided with those options.

Are there any other requirements?

Each physician is responsible for applying and completing a CAQH application. A CAQH number is necessary to enroll in managed care plans. Each physician is responsible for ensuring his or her office meets ADA requirements and must provide a completed form to the PHO.