Blue goes GreenSM

Initiatives........... 2

BlueCard® Quick Tips......... 3

Pick Paperless Receive Blue Review via E-mail ............... 4

Network Updates ............ 4

Take Advantage of Our New Online Resources!......... 4

Provider Network Relations Spotlight ........... 5

Wellness Corner.............. 6

On the Line with the PTC............. 7

New Account Groups ............. 7

What’sInside?

Visit our Web site at www.bcbsil.com/provider

Millions of Americans are caring for

aging parents or ailing loved ones.

Unfortunately, caregiving can be an

emotionally and physically exhausting

ordeal. Understanding the challenges and

being prepared for the responsibility of

taking care of loved ones is important.

Be Smart. Be Well.TM FeaturesNew Topic on Caregiving

February 2009

Switch from Paper Checks to Electronic Funds Transfer (EFT)Imagine: no more opening envelopes, suffering paper cuts, filling out deposit slips,

standing in teller lines at the bank or waiting at the drive-through simply to deposit funds.

These inconveniences are a reality for many of our independently contracted professional

and institutional provider offices throughout Illinois. But it doesn’t have to be that way.

With Electronic Funds Transfer (EFT), you can have your payments transferred directly

into your bank account. This alternative to receiving paper checks can help save you

time, in addition to reducing the frustration – and the security risk – of lost or

misrouted payments.

To start enjoying the convenience and security of EFT, just go to the Electronic Commerce

section of our Web site at www.bcbsil.com/provider. Click on the Electronic FundsTransfer (EFT) / Electronic Remittance Advice (ERA) link to access the enrollment

forms. For EFT, you will need to fill out an HCSC Electronic Funds Transfer Agreement.

Once you have completed the EFT enrollment materials, just mail your form and signed

Agreement, along with an original voided check or letter from your financial institution, to

the address indicated on the form. We’ll take it from there!

Note: You have the option of selecting daily EFT payments, or you can remain on your

current payment cycle; however you may wish to opt for weekly payments, to lump

multiple claims into a larger, single payment.

Choose to Receive Electronic Reporting on Your Processed ClaimsFor providers receiving claims information via a paper Provider Claims Summary (PCS),

there are two options for receiving the same information in as little as 24 hours after the

claim has completed processing. These options are called Electronic Remittance Advice

(ERA) and Electronic Payment Summary (EPS). Once you have signed up for these

transactions, you will have approximately 30 days of simultaneous paper and electronic

delivery to make sure the new files are a good fit for your practice operations. After this 30-

day period, the paper PCS will be discontinued.

The ERA is a HIPAA-compliant file that is generated in the ANSI X12 835 format. You or your

billing service will need translation programming to read the ERA. Contact your software

vendor to verify compatibility and availability of automatic posting software or programs.

Explore Your Paperless Possibilities at BCBSIL

continued on page 3continued on page 4

Visit our Web site at www.bcbsil.com/provider 2

Our Blue goes GreenSM Initiatives are Good for You,Better for the Planet

BCBSIL is committed to eco-friendly business practices. One way we maintain this

commitment is by providing you with a variety of electronic resources to help reduce paper

and streamline administrative processes in your office.

We invite you to take advantage of these paperless opportunities:

• Sign up for Electronic Funds Transfer (EFT), Electronic Remittance Advice (ERA) and

Electronic Payment Summary (EPS) to enjoy paperless payments and reporting

• Enroll in NDAS Online for easy access to claims, benefits and eligibility information

• Participate in iEXCHANGE to simplify pre-certification processes

• Share your e-mail address with BCBSIL – Use our online “Pick Paperless” e-mail collection

form to receive your Blue Review electronically

• Visit our Web site for a variety of other helpful online resources

Would you like to learn more?Attend one of our free Blue goes Green eSolutions workshops to find out how you can benefit

from participating in the electronic options available to you at BCBSIL

You’re Invited to Our Blue goes GreenSM

eSolutions WorkshopThe Network Management Provider Education Team at BCBSIL continues to offer cutting

edge workshops that are free to you, our independently contracted providers, to show our

appreciation for your participation in our network.

This year, we are focused on engaging your participation in “going green” initiatives at BCBSIL.

Our Blue goes Green eSolutions workshop covers electronic options that can help reduce the

amount of paper in your office. Electronic transactions can also help save you time and money

by simplifying your administrative processes.

We encourage you to make plans to join us at one of the following workshops:

Blue goes GreenSM eSolutions WorkshopMarch 11, 2009Holy Family Medical CenterDes Plaines, Illinois

March 25, 2009FHN Memorial Hospital Freeport, Illinois

Please visit our Web site at www.bcbsil.com/provider for complete registration information.

Save the Date…Managed Care Roundtable

The next Managed Care Roundtable will be held at

the BCBSIL headquarters on April 15, 2009. Watch

the Blue Review and the Provider Web site for

more details.

3 February 2009

In the Know…this month’s topic for professional providers: Understanding the Differences BetweenCoinsurance and Copayment

Coinsurance is the percentage of a covered charge that is the member's

responsibility to pay after the deductible has been met. Deductibles and

coinsurance may vary for each member based upon the terms of their health

benefit plans and can be obtained through NDAS Online. PPO and BlueChoice

professional providers may not bill covered persons for deductible and

coinsurance amounts prior to billing BCBSIL.

Copayment is a fixed dollar amount the member is required to pay for coveredservices at the time care is rendered. The copayment amount may also vary for

each member based upon the terms of their health benefit plans and can be

obtained by using NDAS online. The copayment is in addition to any coinsurance

amount for which the member is responsible.

Explore Your PaperlessPossibilities at BCBSILcontinued from page 1BCBSIL is Your ‘One Stop Shop’

Did you know that the BlueCard program allows you to submit claims for members from

other Blue Cross and Blue Shield Plans, domestic and international, directly to the Illinois Plan?

Also, if you have any claims-related questions, you are welcome to contact our Provider

Telecommunications Center (PTC) at (800) 972-8088 for assistance. This is what we mean when

we say you can think of BCBSIL as your "One Stop Shop" for all BlueCard claims submissions.*

Please refer to the BlueCard Program Provider Manual on our Web site at

www.bcbsil.com/PDF/bluecard_program_manual.pdf for additional details.

*NOTE: For out-of-state member benefits and eligibility, contact the BlueCard Hotline at

(800) 676-BLUE (2583).

BlueCard® Quick Tips

We are pleased to announce that, for the eighth straight year, BCBSIL has received a

Compliance Best Practice Award from the Health Ethics Trust, a division of the Council of

Ethical Organizations. This year’s award recognizes our corporation’s Vendor Governance

Program, which is administered by our Corporate Compliance, Corporate Security and Safety,

and Strategic Sourcing departments.

Perhaps you remember the headlines not so long ago that made a leading sporting apparel

company, a major games manufacturer and a global energy group guilty by association for

their vendors' ethical lapses. These events also make clear the public’s expectation that

businesses hold their vendors to the same legal and ethical standards to which they hold

themselves and their employees.

While not a supplier of tangible goods like running shoes, board games or petroleum products,

the health insurance industry does have an obligation to protect the safety and privacy of its

customers. For these reasons, our corporation developed a Vendor Governance Program that

requires its vendors to agree to the same legal and ethical standards to which BCBSIL adheres.

BCBSIL Receives Recognition for Ethical Excellence

The EPS is an electronic print image of the PCS. It

can be easily read by your staff and also allows ease

of storage on your computer so you can readily

reprint whenever the need arises, without having to

call BCBSIL for paper reprints.

It’s easy to get started with ERA and EPS. Just visit

the Electronic Commerce section of our Web site at

www.bcbsil.com/provider. Click on the ElectronicFunds Transfer (EFT) / Electronic RemittanceAdvice (ERA) link to access the enrollment forms.

For ERA, simply fill out an Electronic Remittance

Advice Enrollment Form. Make sure to read and

follow all instructions on the form, then mail or fax

your completed ERA form to Availity®, as indicated

on the form.

When you enroll for the ERA, you will automatically

receive the EPS. If the EPS is requested to be

delivered differently than the ERA, you must fill out

two ERA enrollment forms. You cannot receive the

EPS without enrolling for the ERA.

NOTE: You will need to register with Availity if you

wish to enroll for the ERA and EPS, as Availity

processes these transactions. After enrollment, you

will connect via Availity’s Web portal to obtain your

ERA and EPS information. For more information on

how to register with Availity, visit the Electronic

Commerce section of our Web site, or call Availity

directly at (800) AVAILITY (282-4548).

Go Green with E-Commerce today!If you have questions or need additional

information, please visit the Electronic Commerce

section of our Web site, or call our E-Commerce

Center at (800) 746-4614.

Availity is a registered trademark of Availity, L.L.C.

Visit our Web site at www.bcbsil.com/provider 4

Listing of Services for Which Benefit Predeterminations can be RequestedIn response to your feedback, we are pleased to announce the addition of a new online

resource to help address some of your questions regarding records requests.

To access this new resource, visit the Provider Library section of our Web site at

www.bcbsil.com. Click on the Professional Coding Information link, and then select

Predetermination Medical Indications and Policies (December 2008).

In addition to a listing of services for which benefit predeterminations can be requested, this

new resource provides you with information regarding what records and supporting

documentation you may need to send, along with a link to the specific Medical Policy

Reference for each procedure for further information.

Note: This is not an all inclusive list. Always refer to the specific Medical Policy for details; or

contact the Provider Telecommunications Center (PTC) for additional assistance.

Online E-mail Submission and Paper Newsletter Opt-out FormYou may have noticed this new icon on the Provider Home page at www.bcbsil.com/provider:

Clicking on this icon will take you to an easy to use online form where you can share your e-

mail information electronically with us. Taking this step will enable you to receive future

issues of the Blue Review via e-mail.

“Losing the paper” will benefit your practice by giving you quicker access to BCBSIL

information each month. Receiving an electronic Blue Review will also make distribution

easier – just forward the newsletter to your staff, rather than making copies.

Think outside of the mailbox! Sign up today to receive a “green” Blue Review.

Note: Blue Cross and Blue Shield of Illinois is aware of your privacy concerns. We will make

every effort to ensure that your e-mail address is maintained in a secure environment and

held in the strictest confidence.

Coming Soon… Consumer Directed Health Plan/BlueEdge Online TutorialConsumer Directed Health Plans (CDHPs) are becoming increasingly popular with members

who want to take a more active role in managing their health care expenses. Are you familiar

with how CDHPs work? Are you prepared to discuss medical budgeting questions your

patients may start to ask?

Our new Consumer Directed Health Plan/BlueEdge online tutorial will walk you through the

ins and outs of CDHPs to help you understand the differences between the newer plans and

traditional models of health insurance. You will also learn how to recognize the different

CDHP spending accounts and gain insight into utilization of health care debit cards.

Watch our Web site and upcoming issues of the Blue Review for more details regarding the

forthcoming release of this exciting new online resource.

Take Advantage of These New Online Resources!

Network Updates

Rush North Shore Practice AssociationAdopts New NameEffective Jan. 1, 2009, IPA # 447 Rush North Shore

Practice Association changed its name to North

Suburban Associated Physicians.

Our Provider Finder® and HMO provider

directories will be updated to reflect the above-noted

changes.

St. Francis in Blue Island Changes Name toMetro South Medical CenterEffective July 2008, St. Francis in Blue Island changed

its name to Metro South Medical Center. This

information is updated on our Provider Finder.

Be Smart. Be Well. FeaturesNew Topic on Caregivingcontinued from page 1

Caregiving is the latest topic to be covered on Be

Smart. Be Well. – a Web site designed by Blue Cross

and Blue Shield to help build consumer awareness of

largely preventable health and safety issues.

Visit www.besmartbewell.com to learn about

preparing for what may lie ahead or to find out

where to turn for help with caregiving support.

Compelling, first-person video documentaries

feature medical experts as well as real-life stories

about individuals whose daily lives are affected by

giving care to a family member or loved one.

The Web site also includes archives of previous Be

Smart. Be Well. topics on mental health, traumatic

brain injury and drug safety. We encourage you and

your patients to look at www.besmartbewell.com today.

Pick Paperless...Receive your Blue Review

via e-mail

5 February 2009

New Member ID CardImplementation Delayed

In this section of the newsletter, we introduce you to some of the key players on our Provider

Network Relations team, briefly describing their areas of expertise and their objectives in

providing the best service to our provider community. This issue features two of our Senior

Provider Network Consultants, Michelle Brownfield-Nance and Chuck LeVault.

Michelle Brownfield-Nance is a Senior Provider Network

Consultant who has been a member of the Provider Network

Relations team for seven years. Prior to joining the Provider

Network Relations team, Michelle worked for 10 years with the

BCBSIL Subscriber Service Division in the Training and

Development area. Michelle’s combined experience working with a

wide range of internal and external customers gives her the unique

ability of “being able to look at both sides” before conducting

thorough research and presenting clear results.

Caring people are essential, and Michelle says that one of the best

things about BCBSIL is “working with a variety of people who are compassionate in what

they do.” Michelle believes her “team” includes her coworkers as well as her customers,

because all perspectives are equally important in determining the solutions that will work

best for everyone involved.

Currently, Michelle provides assistance to professional providers in the following areas:County 22 (DuPage), County 16 (Chicago) Southwest Suburbs (Orland Park, Tinley Park,

etc.) and the Northern Suburbs (Skokie, Evanston, etc.). When working with her providers,

Michelle’s main objective is “to serve as a liaison in helping to get matters resolved.” What’s

the key to maintaining the highest level of provider customer service? Michelle says that,

while many factors come into play, “A listening ear is always important.” Michelle Brownfield-

Nance is available via telephone at (312) 653-4727, or you may e-mail her at

michelle_brownfield-nance@bcbsil.com.

Chuck LeVault has been a member of the Provider Network

Relations team for eight years, where he has served as a Senior

Provider Network Consultant for seven years. Currently, Chuckprovides service to the Chicago Metropolitan and NorthwestIndiana hospitals, including the Advocate Healthcare hospital

system, University of Chicago and Sisters of Saint Francis health

care systems.

Chuck says that, “My previous 20 years of experience in the Blue

Cross and Blue Shield claims and customer service arena have made

my transition to a Provider Network Consultant very seamless.”

There are always challenges, such as the ever-changing environment of the health care

industry; however, Chuck is resolved not to let customer service “take a back seat.” He says he

tries to look at things from the provider’s point-of-view in order to determine an effective plan

of action. “I also encourage my providers to give me suggestions on how we can make things

right collectively. I really love my role and trust that my providers know I am there for them.”

Chuck derives great satisfaction from knowing that what he does on a daily basis helps make

the providers’ interaction with BCBSIL a positive one, which in turn affects the experience of

our members. “I enjoy the face-to-face contact with my providers. It’s very rewarding to see

that smile from one of my providers. It confirms I’ve accomplished my goal.” Chuck LeVault

is available via telephone at (312) 653-2390, or you may e-mail him at levaultc@bcbsil.com.

Provider Network Relations Spotlight

View Managed CareUpdates OnlineHMO and BlueChoice Updated Policies and Procedures On a monthly basis, we post updated policies and

procedures on our Web site under “Updates.” Go to

www.bcbsil.com/provider to view the updated policies.

HMO and BlueChoiceAppointment/Reappointment Report On a monthly basis, we post a report of the Appointed

and Reappointed providers on our Web site. To access

this report, go to www.bcbsil.com/provider. Select

“Appointed/Reappointed PCPs/PSPs” under the

Credentialing/Contracting section. The cumulative

data is normally updated by the third Wednesday of

each month.

BlueChoice Updated Depart ListA listing of all specialists no longer participating in

the network for the BlueChoice product can be found

at www.bcbsil.com/provider/securedpage.htm. Note: You

can find participating specialists for the BlueChoice

product on our Provider Finder® at www.bcbsil.com.

There has been a delay in our plans to phase in the

distribution of new member ID cards with the

magnetic stripe format. Implementation of this

project has required extensive testing of this new

technology with our systems to ensure that your

transactions go smoothly.

We appreciate your patience as we finalize testing

and reschedule dates for deployment.

Watch for updated information in future issues of

the Blue Review and the “What’s New” section on

the provider page of our Web site at

www.bcbsil.com/provider. For any additional

questions or if you need more information, you may

also contact your Provider Network Consultant.

To find the name of your Professional Network

Consultant, please refer to the Professional Provider

Network Consultant List in the Provider Library on

our Web site.

Visit our Web site at www.bcbsil.com/provider 6

Medical Identity Theft MayHave Costly Consequences

For years, people have experienced theft of mail, checks

and other information; these misappropriated

documents have led in some cases to personal identity

theft. Unfortunately, a newer type of identity theft –

medical identity theft – has also begun making

headlines, and provider offices may need to be on the

alert regarding potential risks.

When medical identification information is stolen or

misused, decisions that health care providers make can

be affected. To help protect your practice, you may wish

to consider verifying a minimum of two forms of

patient identification (particularly a photo ID) at the

time of check in to ensure that the patient presenting

the ID card is actually the owner of the card.

As this topic gains more recognition, we want our

providers to understand that our members are being

encouraged to contact their providers to review any

service or fee they do not recognize on their

Explanation of Benefits. If your patients begin asking,

“What do you mean I don’t have any more benefits?” –

something might be wrong, and the member should be

advised to contact the number on the back of their ID

card to confirm coverage and activity.

Awareness is key. Please continue to watch our Web site

and future issues of the Blue Review for further updates

on this and other topics that may affect your practice.

‘Staying Healthy’ Helps Members Help Themselves To help members of all ages take care and stay well, BCBSIL presents Staying Healthy – our

annual preventive care guidelines. This piece communicates to our members the value of

preventive health and wellness, with tips on how to maintain healthful living at every age.

Members will find the updated guidelines under their My Health tab when they log on to

Blue Access for Members at www.bcbsil.com/member.

Wellness Coaching Program Benefits HMO Members with Blue Care Connection®

Now all HMO members who have Blue Care Connection are eligible for telephonic wellness

coaching to assist them with our existing Weight Management and Tobacco Cessation

programs.

Your employees with coverage through BCBSIL can be identified as candidates for the Weight

Management and Tobacco Cessation telephonic wellness coaching programs in a number of

ways, including

• Worksite wellness events

• Health Risk Assessments

• Self-referral

Once members are identified, they will receive outreach regarding the programs available to

them according to their “readiness to change.” A wellness coach will reach out to members to

provide personal assistance on setting goals, followed by periodic progress check ups for

members who have the greatest need and desire to make health changes.

The online Smoking Cessation and Weight Management programs can assist employees who

want to quit smoking and/or lose weight, helping them to reach their goals through a variety

of resources.

To participate, members can go to Blue Access for Members at www.bcbsil.com/member

where they may click on the Personal Health Manager link and then select either “Stop

Smoking” or “Weight Loss.” These programs are not a substitute for the medical advice of a

doctor and members who have any questions or concerns are encouraged to discuss them

with their doctor.

Wellness Corner…Keep Your Patients Informed

Group Name: AARGroup Number: 032939-032948Alpha Prefix: RRJProduct Type: PPO(Portable)Effective Date: Jan. 1, 2009BC BS

New Account Groups

7 February 2009

Group Name: Midwest Banc Holdings, Inc.Group Number: 042141Alpha Prefix: XOFProduct Type: CDHP(Portable)

Group Number: 042122Alpha Prefix: XOFProduct Type: PPO(Portable)

Group Number: H31303Alpha Prefix: XOHProduct Type: HMO

Group Number: B31303Alpha Prefix: XOHProduct Type: BlueAdvantage HMOEffective Date: Jan. 1, 2009BC BS

Group Name: NAL Worldwide, LLCGroup Number: 217001-2Alpha Prefix: NLXProduct Type: PPO(Portable)

Group Number: 217003Alpha Prefix: NLXProduct Type: HSAEffective Date: Jan. 1, 2009BC BS

Group Name: The Marmon GroupGroup Number: 044292-3Alpha Prefix: MNXProduct Type: PPO(Portable)Effective Date: Feb. 1, 2009BC BS

Group Name: Veolia TransportationGroup Number: 034992Alpha Prefix: TPVProduct Type: PPO(Portable)Effective Date: Feb. 1, 2009BC BS

Group Name: WMSGroup Number: P64370Alpha Prefix: GAMProduct Type: PPO(Portable)

Group Number: H64365*Alpha Prefix: XOHProduct Type: HMOEffective Date: Jan. 1, 2009BC BS

*Correction: In the Jan. Blue Review, the incorrect group numberwas printed. The correct group number for WMS is H64365.

NOTE: The information noted above is current as of the date ofpublication; however, BCBSIL reserves the right to amend thisinformation at any time without notice. The fact that a group isincluded on this list is not a guarantee of payment or that anyindividuals employed by any of the listed groups will be eligible forbenefits. Benefit coverage is subject to the terms and conditions setforth in the member’s certificate of coverage.

On the Line with the PTCIVR Tips for Chiropractic and Behavioral Health Providers

Attention Chiropractic and Mental Health Providers: When calling to

request more detailed Chiropractic and Mental Health benefit coverage

information, please use the following verbiage when the IVR asks you what

type of service you need:

Mental Health Providers:Please say “Behavioral Health.” Your quote will include: Family Psychiatric,

Group Psychiatric, Individual Psychiatric, Psychiatric Testing, Copay, Deductible, Out-of-

pocket, Maximums and Filing Deadline.

Chiropractic Providers:Please say “Chiropractic Services.” Your quote will include: Office Visit, Muscle Manipulation,

Orthotics, Physical Therapy, Vitamins, Supports & Pillows, Copay, Deductible, Out-of-pocket,

Maximums and Filing Deadline.

For more information, please refer to the Caller Guides and Benefit Collection sheet on our

Provider Web site at www.bcbsil.com/provider/illinois_ivr_guides.htm and

www.bcbsil.com/PDF/ivr_benefit_sheet.pdf. These resources are housed within the Interactive Voice

Response System (IVR) section of our online Provider Library.

You may call our Provider Telecommunications Center (PTC) at(800) 972-8088 for claim status, benefits and eligibilityinformation for BCBSIL members.* Our easy-to-use InteractiveVoice Response (IVR) system is available Monday through Friday,6 a.m. to 11:30 p.m., and Saturday, 6 a.m. to 3 p.m.

*NOTE: For out-of-state member benefits and eligibility, contact the BlueCard Hotline at

(800) 676-BLUE (2583).

Visit us online at www.bcbsil.com/provider

Have an idea for an article?We want to hear from you! Let us know if Blue Review continues to meet your standards.Does this publication address your needs? What topics would you like to read about?BCBSIL’s success is dependent on your business as a contracting provider. Blue Review hasbeen created to communicate tools, updates and tips to support your health care practice.Think of Blue Review as a canvas for your Blue Cross and Blue Shield business information.

We invite you to submit your feedback and suggestions for improvements via e-mail, to bluereview@bcbsil.com.

Blue Review is a monthly newsletter published for Institutional and ProfessionalProviders contracting with Blue Cross andBlue Shield of Illinois. We encourage you toshare the content of this newsletter with yourstaff. Blue Review is located on our Web siteat www.bcbsil.com/provider.

The editors and staff of Blue Review welcomeletters to the editor. Address letters to:

Blue ReviewBlue Cross and Blue Shield of Illinois300 E. Randolph Street – 25th FloorChicago, Illinois 60601-5099Email: bluereview@bcbsil.com

Web site: www.bcbsil.com/provider.

Publisher:Stephen Hamman, VP, Network Management

Editor:Gail Larsen, DVP, Provider Relations

Managing Editor:Jeanne Trumbo, Sr. Manager

Editorial Staff:Margaret O’Toole, Marsha Tallerico and Allene WalkerBCBSIL makes no endorsement, representations or warrantiesregarding any products or services offered by independentthird party vendors mentioned in this newsletter. The vendorsare solely responsible for the products or services offered bythem. If you have any questions regarding any of the productsor services mentioned in this periodical, you should contactthe vendor directly.

PRSRT STDU.S. POSTAGEPAIDPERMIT NO. 581CHICAGO, IL

00014 A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association