July 2007

INSIDENPI EDI Information 2 Medicare Advantage 4

Managed Care Updates 2 Tips for Border County Providers 4

Fairness In Contracting 3 IVR Helpful Hints 5

Assistant Surgeon Providers 3 New Account Groups 6

Pharmacy: Lupron Depot 3 NPI Frequently Asked Questions 6-7

Visit our Web site at www.bcbsil.com/providerA Division of Health Care Service Corporation, a Mutual Legal Reserve Company,

an Independent Licensee of the Blue Cross and Blue Shield Association

We are pleased to introduce a new tutorial forcompletion of the CMS 1500 (08/05) Claim Form.This tutorial, which is located on our Web site atwww.bcbsil.com/provider, will provide you withinstructions on:

• How to correctly complete the CMS-1500(08/05) claim form

• What fields are defined by BCBSIL as Required,Conditional, and Optional

• What fields are new or revised on the CMS-1500 08/05 claim form

Just follow the step-by-step instructions, paying special attention to the new and revised formfields on this CMS-1500 08/05 version. Particular

emphasis is placed on the proper entry of yourBCBSIL provider number(s) and National ProviderIdentifier (NPI). During our dual-identifier acceptance phase, we request that you enter yourBCBSIL provider number(s), as well as the appropriate Type 1 and/or Type 2 NPI number(s).

For your convenience, we have developed a casescenario for you to use as an example when completing each field on the form.

If your office submits claims electronically, you will still find this tutorial helpful in increasingyour familiarity with the information required toproperly file a claim to BCBSIL.

New Online CMS-1500 (08/05) Tutorial Available 2007 BCBSIL Preventive Care Guidelines

The BCBSIL Preventive Care Guidelines have

recently been updated. The complete text of

all of the BCBSIL guidelines is available in the

Provider Manual, which is located in the

Provider Library on the BCBSIL Web site

www.bcbsil.com/provider. A paper copy may be

obtained by calling (312) 653-3465.

The Preventive Care Guidelines are based

upon recommendations from entities such as

the U.S. Preventive Services Task Force

(USPSTF), the Advisory Committee on

Immunization Practices (ACIP), the

American Cancer Society (ACS), and the

American Academy of Pediatrics (AAP).

The guidelines reference the source of

each recommendation.

In 2007, the childhood and adult immunization

schedules were updated to include the 2006

and 2007 recommendations of the ACIP.

Guidelines for HIV screening were also

updated, based upon recommendations of the

Centers for Disease Control and Prevention

and the USPSTF.

Among the changes in the ACIP childhood

immunization schedule are the addition of

rotavirus vaccine, human papillomavirus

vaccine and a second dose of varicella

vaccine. In addition, annual influenza

vaccine is now recommended for all children

age 6-59 months.Continued on page 3

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

NNPPII UUppddaatteess ffoorr EElleeccttrroonniicc SSuubbmmiitttteerrssBilling Services, Clearinghouses, Submitters/Providers and Vendors

Visit Us OnlineStay connected with BCBSIL on the Web

HMO and BlueChoice Updated Policies and Procedures on Web

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 BlueChoice Appointment/Reappointment Report on Web

On a monthly basis, we post a report of the Appointed and Reappointed providers onour Web site. To access this report, go to www.bcbsil.com/provider. Select“Appointed/Reappointed PCPs/PSPs” under the Credentialing/Contracting section. The data provided is cumulative and is updated by the third Wednesday of each month.

BlueChoice Updated Depart List

A listing of all specialists no longer participating in the network for the BlueChoiceproduct can be found at www.bcbsil.com/provider/securedpage.htm. Note: You can findparticipating specialists for the BlueChoice product on our Provider Finder® at www.bcbsil.com.

Managed Care Web Updates

Use Dual-Identifiers on your Medicaid Claims Healthcare and Family Services Billers

Visit Us Online at www.bcbsil.com/provider toaccess updated information on:

Electronic Commerce • EDI Transactions• EDI Format Specs• EFT/ERA• Clearinghouse Enrollment• Nebo/NDAS Online• NPI Filing Requirements • RealMed• HIPAA

Credentialing/Contracting• Receive Credentialing Updates • Update your demographic information • Request a Contract Application

Provider Library• BlueCard Program• Blue Review archives• Forms• BlueChoice and HMO Resources• Medical Policies• Refund/Payment Recovery Program• Provider manuals/reference guides• PTC Phone Navigation Guides

UM/QI/Medical Management• QI Order Forms• Quality Improvement Programs • HEDIS Reports • BlueChoice Tiering • Clinical Quality Indicators

Provider Tools• Radiology Quality Initiative (RQI) Program• Obesity Management Tool Kit • Hospital Comparison Tool • BlueStar Hospital Report

Pharmacy Management • Drug Formulary Changes • Rx Benefit Management

Workshop Schedule • Online registration for free workshops

What's New • Find out about new initiatives

All of this information is just a “click” away. Weencourage you to visit our Web site to becomefamiliar with the information available and accessthe web-based applications you need to better service our members and your patients. If you havesuggestions on how we can further improve theProvider Web site, or just want to share your feedback, please email us at bluereview@bcbsil.com.

Blue Cross and Blue Shield of Illinois (BCBSIL) was substantially compliant withthe HIPAA National Provider Identifier (NPI)as of May 23, 2007. However, after assessingthe response and preparedness of our participating provider networks, we decided toextend our dual-identifier acceptance phase toallow our electronic submitters to further testand prepare for an NPI-only environment.

We want you, our electronic claim submitters, to submit both the NPI and your BCBSILprovider number until further notice. A

"warning message" will be generated on theresponse reports when the NPI information isnot included in the claim(s) transmission orwhen the NPI is invalid. As you may be aware, a"warning message" may become a "rejection"within 30 days.

At this crucial point in time, it is imperativethat you begin testing NPI only. Please contactus immediately at (800) 746-4614, or feel freeto contact your EDI Representative directly.Together we will begin the testing process tomake this implementation of NPI only a success for you, for us and for your clients!Visit the Electronic Commerce section of theBCBSIL Web site at www.bcbsil.com/providerand select “Alerts” for an example of NPI-onlytesting requirements.

Electronic submitters will be required tomigrate to a new communication platform.Very shortly, you will receive detailed instructions and additional information fromAvaility. Should you have any questionsregarding Availity’s notice you may refer totheir Web site at www.availity.com.

As always, thank you for your continued support. Should you have questions regarding this article, please contact your EDI Representative or call our EDI Hotline at (800) 746-4614.

If you are submitting your Medicaid claims electronically, via the Provider TerminalSystem (PTS) and/or THIN/Availity, please continue sending both the NPI and yourBCBSIL provider number or BCBSIL provider number only until further notice.

REMINDER - Pharmacy Provider for Lupron Depot

In an effort to comply with Fairness In ContractingLegislation and keep our contracting providersinformed, BCBSIL has designated a column in theBlue Review to notify you of any changes to thephysician fee schedules. Be sure to review this areaeach month.

Effective July 1, 2007, BCBSIL implemented itsannual update of the Schedule of MaximumAllowances (SMA) in relation to the CMSResource Based Relative Value Scale (RBRVS)revisions. Reimbursement for services providedon or after July 1, 2007, will be based on theupdated fee schedule. This update affects PPOand BlueChoice fee schedules.

Please note that the fee schedule form is availableby downloading the Fee Schedule Request Format www.bcbsil.com/provider/forms.htm.

3 July 2007

Fairness In Contracting

continued from page 12007 BCBSIL Preventive Care Guidelines

Among the changes to the ACIP adult immunization schedule are the addition ofhuman papillomavirus vaccine for women lessthan 26 years of age and a recommendation for adults under age 64 to receive one-dose ofTdap one time. A second dose of varicella vaccine is recommended for adults who are notimmune, and a second dose of mumps vaccine is recommended for some adults. There havealso been clarifications regarding some of theother vaccines.

New or revised Medical Policies will be postedin the “Pending Policies” section of the MedicalPolicy site on the BCBSIL Web site. The newor revised policies will be available on the firstday of each month. The specific effective orimplementation date will be noted for each policy that is posted.

To review these policies, visit our Web site atwww.bcbsil.com/provider and select “MedicalPolicies.” After reading the Medical PoliciesDisclaimer, click on “I Agree.” The policies thatare awaiting implementation can be found inthe “Pending Policies” section of the MedicalPolicy site.

Medical PolicyDisclosure Statement

Effective June 1, 2007, the following nonphysician surgical assistants became part of ourcontracting Participating Provider Option(PPO) network:

• Certified Surgical Assistant (CSA)• Certified Surgical Technician (CST)• Registered Nurse First Assist (RNFA)• Registered Surgical Assistant (RSA), and• Surgical Assistant - Certified (SA-C).

Assistant surgeon services performed by aCSA, CST, RNFA, RSA, or SA-C must bereported with the Current ProceduralTerminology (CPT) Modifier “AS.”

Criteria

To ensure appropriateness of care, coverage for assistant surgery is limited to the following criteria:

• Service must be defined by the Blue Cross and Blue Shield of Illinois contract in force as “eligible” for assist-as-surgery

• Service must be performed in a state-licensed hospital or ambulatory surgery center, and• The CSA, CST, RNFA, RSA, or SA-C must not be an employee of the facility.

Assistant Surgeon Providers Added to PPO Network

Visual Rehabilitation/VisionTraining/VisionTherapy is not a covered service under theBCBSIL standard contracts. It is BCBSIL's position that the most appropriate code for visual rehabilitation vision therapy or vision training is CPT code 92065 (Orthopticand/or pleoptic training, with continuing medical direction and evaluation). Therefore,when billing BCBSIL for these services, CPT code 92065 should be reported.

Coverage

BCBSIL BlueChoice, PPO, and indemnityplans cover Lupron Depot IM injectionsbased on a conditional Medical Policy.Please refer to this Medical Policy forLupron Depot on our Web site atwww.bcbsil.com.

Pre-Authorization

BCBSIL encourages providers to confirmcoverage based on the Medical Policy bysubmitting a Pre-Determination ofBenefits. However, pre-authorization is notrequired for Lupron Depot IM injectionsadministered in a physician’s office.

Reimbursement

The reimbursement for Lupron Depot iscurrently set at 59.6% of the AverageWholesale Price (AWP).

Ordering Lupron Depot

Lupron Depot can be ordered throughTAP Pharmacy at no cost to you. TAPPharmacy will arrange shipment to youroffice and bill BCBSIL directly for thecost of the Lupron Depot. You can order by calling TAP Pharmacy at (800) 859-0220.

Billing Guidelines

For providers who do not use TAPPharmacy, you may bill BCBSIL directlyusing HCPC Codes J1950, “Injection,leuprolide acetate (for depot suspension),per 3.75 mg” and J9217, “Leuprolideacetate (for depot suspension), 7.5 mg.”

If you have any questions regardingLupron Depot IM injections, please contact our Provider TelecommunicationsCenter at (800) 972-8088.

Visual Rehabilitation/VisionTraining/VisionTherapy

CHRIS B. HALLSubscriber No.XYZ123456789123

70125

Group No.

740BS Plan

240BC Plan

07/04Date Issued

M E D I C A R E ADVANTAGE PPO

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

Quick Claims Filing Tips for Border County Providers

Do you practice in a county bordering another state and have contracts with Blue Plans inyour home state and the neighboring state (Blue Cross and Blue Shied of Illinois)? If so, youshould file all claims with the local Blue Plan, based on where you provided the service,except when a member has coverage with the neighboring state’s Blue Plan. Please read thefollowing examples for details:

Example 1Provider has contracts with Blue Plans inboth statesA provider is located in an Indiana county thatborders Illinois and has contracts with Blue Plansin both states.• When this provider renders a service to a Blue

Cross and Blue Shield of Illinois member, theclaim is filed with Blue Cross and Blue Shieldof Illinois.

• All other claims are filed with Anthem BlueCross and Blue Shield.

Example 2Provider has a contract only with the BluePlan in the provider’s home state.A provider is located in an Indiana county thatborders Illinois and has a contract only withAnthem Blue Cross and Blue Shield.• All claims are filed with Anthem Blue Cross

and Blue Shield.

Example 3Provider does not have a contract with the local Blue Plan in the home state, but has a contract with the Blue Plan in aneighboring state.A provider is located in a Indiana county thatborders Illinois. The provider doesn’t have acontract with Anthem Blue Cross and BlueShield, but has a contract with Blue Cross andBlue Shield of Illinois.• When this provider renders a service to a

Blue Cross and Blue Shield of Illinois member, the claim is filed with Blue Crossand Blue Shield of Illinois.

• All other claims are filed with Anthem Blue Cross and Blue Shield.

If you have any questions, contact BCBSIL at (800) 972-8088, or visit our Web site at www.bcbsil.com.

IllinoisMember

All otherBlue Members

IndianaIllinois

ClaimClaim

Any Blue Member

IndianaIllinois

Claim

IllinoisMember

All otherBlue Members

IndianaIllinois

ClaimClaim

“Medicare Advantage” is the program alternativeto standard Medicare Part A and Part B fee-for-service coverage (generally referred to as “traditional Medicare”). Medicare AdvantagePrivate Fee-For-Service (PFFS) is one of the product offerings under the Medicare Advantageprogram that pays physicians and providers on afee-for-service basis. Medicare Advantage PFFSallows members to use any doctor, specialist orhospital that accepts the Blue Plans’ PFFS termsand conditions of Plan payment, as long as theprovider is lawfully authorized to provide servicesunder original Medicare.

Eligibility Verification

To obtain the most accurate information about aBlue Medicare Advantage member’s eligibility and benefits, please submit a HIPAA 270 eligibility transaction to BCBSIL or call (800) 676-BLUE (2583).

Note: The Centers for Medicare and MedicaidServices (CMS) maintains a common working file(CWF) that your office may access to verifyMedicare eligibility. The CWF does not currentlydistinguish between Medicare Advantage HMOcoverage and enrollment in a non-networkMedicare Advantage PFFS benefit plan. CMS isaware of the issue and anticipates correction of theCWF by July 2007.

ID card

BCBS MedicareAdvantagemembers areeasy to recognize,since theycarry IDcards withthe PFFS, PPO, HMOor POS logo, letting you know in whichplan the member is enrolled.

Providing Services to Blue Out-of-Area

Medicare Advantage Members

BCBSIL does not offer any Medicare Advantageproducts at this time. However, you may see Blueout-of-area members belonging to MedicareAdvantage products offered in other states. TheseBlues Plans generally use the CMS MedicareAdvantage “Deemed Provider” concept, rather thandirect contracts, to arrange for services to members.

If you are aware in advance of providing services that a person is enrolled in a MedicareAdvantage product and you either possess or have

Out-of-Area MedicareAdvantage Members

Continued on page 5

To receive information for eligibility:

To receive information for benefits:

To receive information for claims:

Interactive Voice Response (IVR)Helpful Hints and Tips

5 July 2007

BCBSIL Refresher Workshop

July 16, 2007 LaRabida Hospital, Chicago, IL

BCBSIL Refresher Workshop

July 30, 2007St. Elizabeth’s Hospital, Belleville, IL

Summer HMO Forum

August 8, 2007In-House - BCBSIL, Chicago, IL

BCBSIL Refresher Workshop

August 29, 2007Southern Illinois Healthcare, Carbondale, IL

New PPO Provider Workshop

(Providers that have been in the PPO network less than two years)

September 18, 2007Provena St. Joseph’s Hospital, Elgin, IL

Make sure to go online atwww.bcbsil.com/provider/training.htm to view theschedule and register for our workshops offeredat a site near you.

Save the Date...

2007 Workshop Schedule

Interactive Voice Response (IVR) is ournew voice-activated automated system simplifying the way you receive eligibility,benefits or claim status information. Thissystem provides a user-friendly, timely andefficient caller experience by responding tovoice commands rather than touch-toneinput. Note: Many prompts still accommo-date touch-tone entry.

Follow these tips to ensure

a trouble-free call:

• Speak clearly• Minimize background noise in your area• Avoid using speaker or cellular phone • Interrupt — it’s OK!• Be prepared to document responses and

confirmation number• Feel free to complete multiple self-service

requests for various products and groupsduring one call

• Speak numbers in single-digit format– For example, if your provider

number is 61, this should be spokenas “six one” versus “sixty-one”

• Omit preceding zeros• Speak using correct numerical grammar

– For example, if your provider number is 206, you should say “twozero six” versus “two oh six”

To receive the following information… You should answer these questions…

• Current effective date

• Group number

• Alpha prefix

• If pre-existing applies for this date What’s the subscriber’s ID?• Patient’s first and last name

• Type of coverage (i.e., PPO, HMO, etc.) What’s the patient’s date of birth?• PCP name or PCP not on file, if applicable

• PCP effective date, if applicable to coverage

• Inquiry Confirmation number

To receive the following information… You should answer these questions…

• Benefit information specific to your

provider number

• If provision is/is not covered

• If pre-notification is/is not required

• If policy is contract/calendar year What is the type of service? • Percentage (%) of services payable, up to

a specified dollar amount Where is the service being rendered?• If visit max applies

• OPX limit per contract/calendar year

• Lifetime maximum

• Inquiry confirmation number

To receive the following information… You should answer these questions…

If claim is finalized:• Total charges billed• Amount paid What’s the subscriber’s ID? • Payee and check number• Process date - paid date• Patient share amount applied to What’s the date of birth?

deductible and coinsurance• If adjusted, date and payment amount• If not paid, denial reason description What’s the date of service?If claim is in process:• Claim receipt date and claim number

System Availability

You may access the IVR during the following hours:

Monday through Friday, 6 a.m. to 11:30 p.m.Saturday, 6 a.m. to 3 p.m.

access to the Plan’s terms and conditions of pay-ment (via the internet, telephone or otherwise),you are a “Deemed Provider” for the services ren-dered, except in limited instances (for example,where the member is treated in an emergencydepartment of a hospital and you are required bylaw to see the patient).

Note: If you choose not to accept the MedicareAdvantage Plan’s terms and conditions of payment, you should not provide services to the member, except in urgent or emergency care situations.

Utilization/Disease/Care Management

Programs or Prior Authorizations

Information on utilization, disease, care management programs or prior authorizations maybe obtained by calling the number on the member’sID card or by calling (800) 676-BLUE (2583).

Claims Filing Information for Blue

Out-of-Area Members

Submit all Blue Plan claims to BCBSIL electronically, or via paper on the new CMS-1500 (08/05) claim form to:

Blue Cross and Blue Shield of Illinois

P.O. Box 805107

Chicago, IL. 60680-4112

For questions regarding claim status for Blue Planout-of-area members, contact our ProviderTelecommunications Center at (800) 972-8088.

Out-of-Area Medicare Advantage MembersContinued from page 4

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

Group Name: IDEX Corporation

Group Number: DX1550

Alpha Prefix: IDX

Product Type: PPO(Portable)

Effective Date: July 1, 2007

BC BS

Group Name: Mayer Brown Rowe

and Maw

Group Number: 016924-25

Alpha Prefix: KMK

Product Type: PPO

Group Number: 016926, 016929

Alpha Prefix: KMK

Product Type: BlueEdge-CDHP

Group Number: 016927-28

Alpha Prefix: XOT

Product Type: CMM

Effective Date: July 1, 2007

BC BS

Group Name: Neal Gerber

Group Number: 016981

Alpha Prefix: XOF

Product Type: PPO(Portable)

Group Number: 016982-83

Alpha Prefix: XOF

Product Type: BlueEdge-CDHP

Effective Date: July 1, 2007

BC BS

Group Name: Ungaretti and Harris

Group Number: 017000

Alpha Prefix: XOF

Product Type: PPO(Portable)

Group Number: 017000-02

Alpha Prefix: XOF

Product Type: BlueEdge-CDHP

Effective Date: July 1, 2007

BC BS

Now that the NPI transition is underwayhere are some of the questions we are hear-ing from our provider community...

General Information:

Q. Are paper claim submitters required byBCBSIL to use NPI(s)?

A. Yes. BCBSIL is requiring all eligibleproviders to use NPI number(s) on electronic and paper claim transactions.

Q. I’m a referring physician, do I need toshare my NPI with other physicians?

A. Yes. As outlined in the current regulation, providers must share theirNPI with any entity that may need it forbilling purposes — including those whoneed it for designation of ordering orreferring physician.

Q. When does a provider need both aType 1 and a Type 2 NPI?

A. All eligible individual providers (such asphysicians, nurses, chiropractors, andphysical therapists) are required toobtain a Type 1 (Individual) NPI.Providers who are in a solo practice andwho bill currently with their SocialSecurity Number or sole proprietorshipTax ID number may continue to bill assolo practitioners using only their Type1 NPI.

Per the regulation, individuals who haveincorporated their practice must alsoobtain an organizational Type 2 NPI fortheir corporation. When billing, theindividual Type 1 NPI will be used toidentify the provider who performed theservice, while the organizational Type 2NPI will identify the group or entity tobe paid.

Individual health care providers who arepart of an incorporated group practicewill have an individual Type 1 NPI; the practice or clinic must obtain anorganizational Type 2 NPI for the groupfor claims submission purposes.

Large corporations may have manygroups working under a shared Tax IDnumber as DBAs. Since each DBA hasits own BCBSIL billing number, eachDBA should also obtain and use its ownType 2 NPI to maintain the one-to-one relationship.

Q. I heard the deadline for compliance was extended. How does this extensionimpact me?

A. The deadline for compliance has not been extended. BCBSIL was substantiallycompliant as of the May 23, 2007 effective date. However, after assessingthe response and preparedness of our participating provider networks, we have extended our dual-identifier acceptance phase to allow providers to further test and prepare for an NPI-only environment.

During the extended dual-identifieracceptance phase, you must continue tosubmit electronic and paper claims withyour NPI and your BCBSIL providernumber, or only your BCBSIL providernumber, until you have received notification from BCBSIL confirmingyour participation in our NPI-only transition program.

Please refer to the BCBSIL Provider Web site at www.bcbsil.com for additional information.

CMS-1500 (08/05) Claim Form:

Q. Where do I get assistance on how to complete the new claim form?

A. For paper submitters, there is a newguide for completing the CMS-1500(08/05) in the Provider Library of ourWeb site at www.bcbsil.com. This guideprovides you with a sample claim form,including fields designated by BCBSIL asrequired, conditional, or optional. Theguide also provides detailed instructionson how to properly complete the form.

Electronic submitters may refer to the NPI201 - Claims Filing Instructions located inthe NPI Educational Resources section ofour Provider Web site.

Q. Do I have to submit my paper claimsusing the red, original CMS-1500claim form, or can I use a black-and-white copy instead?

A. You must use the original red claimform. This form is printed in a specialred ink to ensure proper scanning andclear and accurate placement of data.

New Account Groups National Provider Identifier (NPI)

7 July 2007

We’re here to serve you!Frequently Asked Questions

Q. Which fields require use of dual-identifiers (my BCBSIL providernumber and my NPI) on the paper claim form?

A. Dual-identifiers are required in fields 17, 32 and 33. Field 17a: BCBSIL provider number of the referring, ordering, or

supervising provider and appropriate qualifier in the fieldto the immediate right of 17a.

Field 17b: 10-digit NPI number of referring, ordering, or supervising provider.

Field 32a: 10-digit NPI number of service facility location

Field 32b: Appropriate qualifier, immediately followed by the service facility location’s BCBSIL provider number.

Field 33a: 10-digit NPI number of billing provider (Note: You mayenter "SAME" if the information to be entered here isthe same as information entered in field 32a.)

Field 33b: Appropriate qualifier, immediately followed by the billingprovider’s BCBSIL provider number. (Note: You mayenter "SAME" if the information to be entered here isthe same as information entered in field 32b.)

Q. How do I complete the fields where an “ID Qualifier” is required?A. An ID Qualifier further classifies your information for accurate

processing. ID Qualifiers are required in fields 17a, 24i, 32b and 33b.

Field 17a: Enter the BCBSIL provider number of the referring, ordering,or supervising provider, and include the appropriate qualifier(see table below) in the field to the immediate right of 17a.

Field 24i: Enter the performing provider’s State License numberQualifier (0B) in the shaded area.

Field 32b: Enter the appropriate qualifier (see table below), immediately followed by the service facility location’sBCBSIL provider number. Do not use any type of separator between the qualifier and the provider number.

Field 33b: Enter the appropriate qualifier (see table below), immediately followed by the billing provider’s BCBSILProvider number. Do not use any type of separatorbetween the qualifier and the provider number.

NPI transition updates – Troubleshooting to avoid claims rejection

Electronic claim submitters:

Q. What do I need to do to be able to participate in the NPI-only transition program?

A. Providers must complete successful testing using dual identifiers(submission of claims using both the NPI and the BCBSIL providernumber) prior to working with us to transition to NPI-only claimssubmission. Have your electronic trading partners (billing services,clearinghouses, and software vendors) call our Electronic DataInterchange (EDI) Hotline at (800) 746-4614 to schedule a testingand implementation date for NPI-only claims submission.

Q. What do I do if I believe I am ready to submit my electronicclaims with NPI only?

A. The provider will need to work with their electronic trading partner.When both parties have completed testing in the dual-identifier phase,the electronic trading partner should contact the EDI Hotline at (800) 746-4614. Our EDI staff will work with the electronic tradingpartner to transition the provider to an NPI-only environment.

Q. What should I do if my claims were denied?A. If the EDI Hotline has already given the go-ahead to submit claims with

NPI only, the provider should have their electronic trading partner contact the EDI Hotline at (800) 746-4614 to help determine the reasonfor the denial. If we have not worked with the electronic trading partnerto submit claims with NPI only, the claims can be resubmitted with dualidentifiers, or the BCBSIL provider number only.

Paper claim submitters:

Q. What do I do if I believe I am ready to submit paper claims with NPI only?

A. During the extended dual-identifier acceptance phase, you shouldcontinue to submit paper claims with the following information:• Both BCBSIL provider number and NPI, or• BCBSIL provider number only

Upon completion of successful testing, we will notify you when weare ready to accept your claims with only your NPI.

Q. Will my claims be rejected if I don’t use an NPI number?A. During the dual-identifier transition phase, claims will not be

rejected if they are missing an NPI number. However, if the claimonly has an NPI and no BCBSIL provider number, it may be rejected.We will provide notification in the near future as to the specific datewe will no longer accept claims that are submitted without an NPI.

Q. What will happen if a provider sends their claim using only theirNPI without previously notifying BCBSIL?

A. Submitting an NPI-only claim without previously sharing that NPI number with BCBSIL may result in a claim delay or denial. However, ifthe provider sends us both their NPI and BCBSIL provider number onthe claim, we can match the numbers and test our systems.

Q. What should I do if my claims were denied?A. Claims that are denied should be resubmitted with dual identifiers

(both your BCBSIL provider number and your NPI), or your BCBSIL provider number only.

Qualifier Qualifier Description

0B State License Number1A Blue Cross Provider Number1B Blue Shield Provider Number1C Medicare Provider Number1D Medicaid Provider Number1G Provider UPIN Number1H CHAMPUS Identification NumberEI Employer’s Identification Number1J Facility ID NumberB3 Preferred Provider Organization NumberBQ Health Maintenance Organization Code NumberFH Clinic NumberG2 Provider Commercial NumberG5 Provider Site NumberLU Location NumberN5 Provider Plan Network Identification NumberSY Social Security Number (The social security

number may not be used for Medicare.)U3 Unique Supplier Identification Number (USIN)X5 State Industrial Accident Provider NumberZZ Provider Taxonomy

PRSRT STDU.S. POSTAGE

PAIDPERMIT NO. 581

CHICAGO, IL

00014

Your views are important to us, and we would like to know if our newlyredesigned Blue Review meets your needs.

• How useful is the information?

• Is this publication easier to read?

• Are there topics you want us to include in future issues?

If you have suggestions on how we can further improve the Blue Review, or just want to share your feedback, please email us at bluereview@bcbsil.com.

Remember, the Blue Review is your newsletter, designed to serve you as acontracting provider. You are an integral part of BCBSIL’s success as a leaderin the health care industry, and we highly value your opinion.

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 withyour staff. The Blue Review is located onour Web site at www.bcbsil.com/provider.

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

Blue ReviewBlue Cross and Blue Shield of Illinois300 E. Randolph Street – 25th FloorChicago, IL 60601-5099Email: bluereview@bcbsil.com(312) 653-4019, or fax (312) 938-8021Web site: www.bcbsil.com/provider.

Publisher: Phil Lumpkin, VP, Provider AffairsEditor: Carol Pjosek, DirectorManaging Editor: Jeanne Trumbo, Sr. ManagerEditorial Staff: Margaret O’Toole, Marsha Tallerico and Allene Walker.

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

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