Pharmacy Program Updates ............ 2

eSolutions Workshop and Vendor Exhibit ... 3

Workshop Schedule........... 3

New Account Groups ............. 3

2008 HMO PCP & PPO Practitioner Survey Results..... 4

BlueCard® Tip: Medical Records.. 5

Fairness in Contracting ........ 6

Provider Network Relations Spotlight............. 6

Recredentialing Data Collection Schedule and Requirements ...... 7

What’sInside?

Visit our Web site at www.bcbsil.com/providerVisit our Web site at www.bcbsil.com/pro idididddvidvidererer

Wellness Tools Can HelpYour Patients MakeHealthy Choices

May 2009

Video Stories at Be Smart. Be Well.TM

Address the Childhood Obesity EpidemicThe Alliance for a Healthier Generation* has reported that nearly 25 million American children

between the ages of 2 and 19 are overweight or at risk of becoming overweight. That’s almost

one out of every three kids.

Childhood obesity is the topic currently featured on our Be Smart. Be Well. Web site at

www.besmartbewell.com. We encourage you to share this site with your patients to make

them aware of what childoood obesity is, why it’s important to understand and what families

can do about it, such as adopting the following “Healthy Habits to Have”:

• Consume less, expend more

• Make food fun

• Make family dinners a priority

• Be a role model

• Remember, no one is perfect

Also featured are engaging video stories as told by real kids who have learned to think

about food, exercise and health in a whole new way. “Alejandra’s Story” shows how

shopping together, looking at labels and portion control

became a family effort for one young girl named

Alejandra and her parents.

Personal accounts by real families are complemented

by other helpful resources, such as a link to the

Centers for Disease Control and Prevention.

Viewers can also tap into the latest headlines

focusing attention on childhood obesity via

the site’s rolling “News” feed.

The purpose of Be Smart. Be Well. continues to

be presenting simple-to-use knowledge that

can help promote increased awareness and

healthier decision making. Additional

topics in the Be Smart. Be Well.

archives at www.besmartbewell.com

include traumatic brain injury

(TBI), caregiving, drug safety and

mental health. What’s “due” next

on the list of featured topics?

Healthy pregnancy.

*The Alliance for a Healthier Generation

is a partnership between the American

Heart Association and the William J. Clinton

Foundation. Please visit their Web site

at www.healthiergeneration.org for

additional information.

Increasing wellness by making more

informed health choices is a common goal

between providers and their patients. The

Blue Access® for Members (BAM) Web

site offers tools and information to help

your patients make these informed

decisions. One of these tools is our

Health Risk Assessment (HRA). Since

December 2008, over 15,000 members

have used this tool to evaluate their

health status and assess potential

changes to improve that status.

Once the HRA assessment is complete,

your patients gain knowledge regarding

topics such as recommended vaccinations

and tests based upon the gauged status.

We urge them to discuss these results with

their health care practitioner and to

decide together what course of action to

take. Talk to your patients about this and

other tools to help evaluate their health

status at www.bcbsil.com/member.

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

Formulary ChangesBased on the availability of new prescription medications and the Prime National Pharmacy and

Therapeutics Committee’s review of changes in the pharmaceuticals market, some revisions will

be made to the BCBSIL formulary effective July 1, 2009.

Low Cost Retail Generic Programs The low cost generic programs that have become widely available at various retail pharmacies

nationwide have raised concerns among various stakeholders and have become a topic of

extensive discussion. These programs offer a one-month supply of selected generic drugs at $4.

The BCBSIL standard pharmacy contract through Prime Therapeutics provides our members

the “lowest of” logic between the discounted price of the drug, the member’s copay or the usual

and customary (U&C) price. This means that if a retail pharmacy submits a claim for a $4

generic (commonly submitted as the U&C price) and the network discount is $8, then the

patient pays only $4. On the other hand, if a retail pharmacy submits a claim for a $4 generic

and the network discount is $3, then the patient pays only $3.

The important point to make is that in most cases the member will still benefit from the low

cost products by using their drug card and may actually get a lower cost than if they had paid

cash. By being cognizant about presenting their drug card for every prescription being filled at

retail pharmacies, members will always be able to take advantage of the lowest out-of-pocket

cost for their medication.

Pharmacy Program Updates

Drugs Moving to Non-Formulary Status July 1, 2009

Non-formularyBrand*

(Tier 3 copayment/coinsurance)

IndicationGeneric Alternative(s)(Tier 1 copayment/

coinsurance)

Formulary BrandAlternative*

(Tier 2 copayment/coinsurance)

Betoptic S 0.25% Glaucomacarteolol soln, levobunololsoln, metipranolol soln,timolol maleate soln

Betaxolol soln, 0.5%

Renagel Hyper-phosphatemia calcium acetate Renvela, Phoslo

Vytorin Hyper-cholesterolemialovastatin, pravastatinsimvastatin

Crestor

Zetia Hyper-cholesterolemiafenofibrate, gemfibrozil;lovastatin, pravastatinsimvastatin

Crestor, Tricor

Medical Policies Identify Non-covered Allergy Tests and Services

Non-covered services include the following types of

testing for food and chemical sensitivity, along with

treatments based on this testing:

• Mediator Release Test (MRT)

• Lifestyle Eating and Performance (LEAP) Program

• Antigen Leukocyte Cellular Antibody Test (ALCAT)

The MRT is a non-covered blood test which

attempts to quantify how strongly circulating

immune cells react to substances such as histamine,

serotonin and prostaglandins. The results of the

MRT often lead to utilization of the non-covered

LEAP program, a specialized diet that may involve

supplements and/or herbal treatments. ALCAT is

another non-covered blood test which attempts

to measure how blood cells may react to foods in

certain situations.

Based on a lack of published, peer-reviewed

scientific data from well-constructed prospective

clinical trials, there is no evidence that these testing

strategies result in intervention or therapy changes

that improve health outcomes. BCBSIL Medical

Policies MED206.001, Allergy Management and

MED206.003, Idiopathic Environmental

Intolerance or Illness (IEI) Management specify

that, as methods of allergy testing and/or as services

provided for the diagnosis, treatment and ongoing

management of IEI management, MRT, LEAP andALCAT are considered experimental,investigational and unproven, and therefore

ineligible for benefit coverage.

To review the complete policies, visit our Web site

at www.bcbsil.com/provider and select “Medical

Policies.” After reading the Medical Policies

Disclaimer, click on “I Agree.”

Since MRT, LEAP and ALCAT are non-coveredservices, they should not be billed to BCBSIL.However, if a BCBSIL member requests that you

bill, please do not report CPT Code 83516, which

may result in an incorrect payment and ultimately

a refund request. You may instead use the Unlisted

CPT Code 84999.

Note: Unlisted CPT Codes must be accompanied

by a description and/or Special Report of the

actual service performed.

* Third party brand names are the property of their respective owners.

Workshop Schedule

3 May 2009

Upcoming workshops include:

Register today! Visit our Web site at www.bcbsil.com/provider/training.htm

to view the agenda and sign up.

We welcome your participation and value your input.

Workshop Date LocationEFT, ERA & EPS Webinar May 6, 2009 Online

eSolutions/Vendor Exhibit May 13, 2009 St John’s Hospital, Springfield, IL

eSolutions June 24, 2009 St. Mary’s Good Samaritan, Centralia, IL

eSolutions July 22, 2009 Advocate Trinity Hospital, Chicago, IL

Join us in May for... an eSolutions Workshop and Vendor Exhibit The BCBSIL Network Management Provider Education Team is pleased to offer an eSolutions

Workshop and Vendor Exhibit. The goal of the workshop is to promote administrative

efficiencies and have vendors available to help you “explore your paperless possibilities.”

To register online, visit our Web site at www.bcbsil.com/provider/training.htm.

If you have any questions, please call (312) 653-4019.

Group Name: Texas Laborers’Group Number: P35159Alpha Prefix: TLXProduct Type: PPO(Portable)Effective Date: May 1, 2009BC BS

Group Name: The Marmon GroupGroup Number: 044438Alpha Prefix: MNXProduct Type: PPO(Portable)Effective Date: March 1, 2009BC BS

Group Name: The Marmon GroupGroup Number: 044440, 044443Alpha Prefix: MNXProduct Type: PPO(Portable)Effective Date: April 1, 2009BC BS

Group Name: United Brotherhood of Carpenters and Joinersof America

Group Number: P39498Alpha Prefix: CRPProduct Type: PPO(Portable)Effective Date: April 1, 2009BC BS

NOTE: The information noted above is current as of thedate of publication; however, BCBSIL reserves the rightto amend this information at any time without notice.The fact that a group is included on this list is not aguarantee of payment or that any individuals employedby any of the listed groups, or their dependents, will beeligible for benefits. Benefit coverage is subject to theterms and conditions set forth in the member’scertificate of coverage.

New Account Groups

Wednesday, May 13, 2009St. John’s Hospital Bunn Auditorium

800 East Carpenter StreetSpringfield, IL 62769

Registration: 9 to 9:30 a.m.General Session/Vendor Exhibit:

9:30 a.m. to 12:30 p.m.

Refreshments will be served.

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

Results are in from the 2008 HMO Illinois and BlueAdvantage HMO Primary Care Physician (PCP) Survey. BCBSIL received completed questionnaires

from 998 HMO physicians, for a response rate of 19.2 percent. The table below shows highlights of the results from the 2006, 2007 and 2008 surveys.

Coordination of Care results regarding feedback received from various facilities and key specialists are included.

The survey used a 5-point rating scale, from Excellent to Poor. The results shown below are based on combined responses in the “Top Three Boxes”

(Excellent, Very Good, and Good) or “Yes” answers. Hospital Information questions are based on the Top Two Boxes (Excellent and Very Good).

Hospital InformationOnce again on this year's survey is a question regarding the primary

admitting hospital. Ninety-five percent of the responding PCPs would

recommend their primary admitting hospital to family and friends.

Continuity and Coordination between Managed CarePhysicians and Health Care FacilitiesIn 2008, 88 percent or more of the responding PCPs in the HMO

rated the reports they received from hospitals †, outpatient

surgery/surgicenters †, skilled nursing facilities and home health care

facilities as Excellent, Very Good or Good. At least 90 percent of PCPs

rated feedback from general surgeons, cardiologists, orthopedic

surgeons, ophthalmologists and dermatologists † as Excellent,

Very Good or Good, but only 80 percent of PCPs gave these positive

ratings to feedback from behavioral health specialists †. (Items

denoted by a † symbol experienced a significant increase.)

New IndicatorsNew in 2008 were questions regarding the use of hospitalists

in the respondent’s primary hospital. More than 71 percent of

PCPs responded that hospitalists are on staff at their primary

hospital. Thirty-two percent of PCPs responded that they use

hospitalists. Also new in 2008 were questions about familiarity

with and rating of BCBSIL’s Blue Star reports. Thirty-four

percent of respondents were familiar with the Blue StarSM Hospital

Report and 96 percent of these rated the report as Excellent,

Very Good or Good. Forty percent of respondents were familiar

with the Blue StarSM Medical Group/IPA Report, and 97 percent

of these rated the report as Excellent, Very Good or Good.

In summary, there were significant improvements in many

of the HMO Primary Care Physician survey indicators,

including several of the indicators regarding facility and

specialist feedback to PCPs. BCBSIL encourages providers

and practitioners to consistently communicate with the

member’s PCP so that he/she can better coordinate care.

2008 HMO Primary Care Physician Survey Results

HMO Survey QuestionsHMO PCPs

2008 2007 2006

Survey Response Rate 19% 19% 19%

IPA Overall Rating* 93% † 90% 87%

IPA Referral Procedures*

• Overall Process 89% † 85% 84%

• Adequacy of Specialist Network 88% † 85% 84%

• Quality of Specialist Network 93% † 91% 90%

IPA Utilization Management (UM)*

• Case Management 92% † 87% 86%

• Timeliness of UM decisions 91% † 85% 85%

• Overall UM Process 91% † 86% 86%

IPA Claims Payment*

• Timeliness 87% † 80% 80%

• Accuracy 86% † 82% 80%

BCBSIL Services

• Provider Telecommunications Center (PTC) Overall 79% 75% 76%

• Have accessed NDAS Online/eCare Internet tool ^ 39% NA NA

o Rating of experience with NDAS Online/eCare ^ 91% NA NA

o Rating of experience with initial setup for NDAS Online/eCare ^ 91% NA NA

After-Hours Access

• Report of usual response time < 30 minutes 90% † 93% 90%

Hospital Information (Top Two Box scores)

• Pharmacy, in terms of providing medication correctly 78% 75% 76%

• Adequacy of the number of nurses 64% † 59% 57%

• Accuracy of processing physician orders 73% 70% 66%

• Quality of discharge plans 73% 69% 66%

• Agree that ER reports for patients not admitted to hospital arereceived in timely manner before follow-up care

74% 72% 68%

* HMO physicians were asked to evaluate the IPA on these attributes. ^ Baseline data in 2008. † Statistically significant change.Note: Percentages rounded to the nearest whole number.

2008 PPO Practitioner Survey ResultsResults also are in from the 2008 PPO Practitioner Survey. Physician specialties represented were the primary care specialties of Internal Medicine, Pediatrics,

Obstetrics-Gynecology and General Practice and other specialties including, but not limited to Allergy, Cardiology, Dermatology, Gastroenterology, General Surgery,

Neurology, Ophthalmology, Otolaryngology, Orthopedics, Psychiatry and Urology. BCBSIL received 3,444 completed surveys, for a 12 percent response rate

(a significant increase). The table shows 2006, 2007 and 2008 results of the survey. Coordination of Care results regarding feedback received from various facilities

and key specialists are included.

The survey used a 5-point rating scale, from Excellent to Poor. The results shown below are based on combined responses in the Top Three Boxes

(Excellent, Very Good, and Good) or “Yes” answers. Hospital Information questions are based on the Top Two Boxes (Excellent and Very Good).

Hospital InformationOnce again on this year's survey is a question regarding the physician's likelihood to recommend his/her primary admitting hospital.

Ninety-five percent of the responding practitioners would recommend their primary admitting hospital to family and friends.(continued on next page)

5 May 2009

Continuity and Coordination between Managed Care Physicians and Health Care Facilities and PractitionersIn 2008, more than 83 percent of the responding PPO practitioners gave a rating of Excellent,

Very Good or Good to the reports they received from health care facilities, including hospitals †,

outpatient surgery/surgicenters, skilled nursing facilities and home health care facilities.

More than 90 percent rated feedback from general surgeons, cardiologists †, orthopedic

surgeons, ophthalmologists and dermatologists as Excellent, Very Good or Good, and

83 percent gave these positive ratings to feedback from behavioral health specialists.

(Items denoted by a † symbol experienced a significant increase.)

New IndicatorsNew in 2008 were questions about familiarity with and rating of BCBSIL’s Blue Star reports.

Nine percent of respondents were familiar with the Blue Star Hospital Report and 89 percent

of these rated the report as Excellent, Very Good or Good. Nine percent of respondents were

familiar with the Blue Star Medical Group/IPA Report, and 91 percent of these rated the report as

Excellent, Very Good or Good.

In summary, there were significant improvements in many of the PPO Practitioner survey

indicators. BCBSIL encourages providers and practitioners to consistently communicate

with other physicians so that care can be better coordinated.

2008 PPO Practitioner Survey Results (continued from page 4)

** Responses of PPO Practitioners in General Practice, Internal Medicine, Obstetrics-Gynecology and Pediatrics only.† Statistically significant change.^ Baseline data in 2008.Note: Percentages rounded to the nearest whole number.

PPO Survey Questions 2008 2007 2006

Survey Response Rate 12% † 9% 11%

Overall Satisfaction 94% † 92% 94%

PPO Utilization Management

• Pre-certifying Inpatient Admissions 86% † 83% 87%

• Authorizing Additional Days 86% † 83% 85%

PPO Network

• Adequacy of Specialist Network 94% 95% 95%

• Quality of Specialist Network 95% 95% 96%

BCBSIL Claims Payment

• Timeliness 89% 90% 91%

• Accuracy 87% 86% 88%

BCBSIL Services

• Provider Telecommunications Center (PTC) Overall 74% † 67% 74%

• Have accessed the NDAS Online/eCare Internet tool (% “Yes”) ^ 26% NA NA

o Rating of experience with NDAS Online/eCare ^ 77% NA NA

o Rating of experience with initial setup for NDAS Online/eCare ^ 78% NA NA

• Have accessed iEXCHANGE (pre-notification) online/Internet tool (% “Yes”) ^ 6% NA NA

o Rating of experience with iEXCHANGE ^ 71% NA NA

o Rating of experience with the response time after a BCBSIL member ispre-notified through iEXCHANGE ^

72% NA NA

After-Hours Access

• Report of usual response time < 30 minutes ** 92% † 88% 90%

Hospital Information (Top Two Box scores)

• Pharmacy, in terms of providing medication correctly 82% † 77% 79%

• Adequacy of the number of nurses 64% † 57% 56%

• Accuracy of processing physician orders 75% † 70% 70%

• Quality of discharge plans 74% † 69% 69%

• Agree that ER reports for patients not admitted to hospital are received intimely manner before follow-up care

67% 69% 67%

BlueCard® Tip: Medical Records It is important to send medical records only when

they are requested. Do not send medical records

with your claims, as unsolicited claim attachments

may cause payment delays. Submit your claims

electronically and BCBSIL will notify you if medical

records are needed.

Here are examples of circumstances that may

prompt BCBSIL or other Blues Plans to request

medical records from you for out-of-area members:

1. While the claim is being processed or reviewedBCBSIL may request additional information

or medical records that are needed to make a

benefit decision on a claim. You will receive a

letter requesting specific medical records, along

with instructions for submission.

• Submit the requested information to BCBSIL

as soon as possible to expedite processing.

• Only send the medical records for dates of

service requested. In most instances, complete

medical records are not necessary.

• Include the cover letter you received with the

request when submitting the medical records.

This is necessary to make sure the records are

routed properly once they are received by BCBSIL.

2. When pre-authorization is requiredIf you receive requests for medical records from

other Blue Plans prior to rendering services, you

will be instructed to submit the records directly to

the member’s Plan. This is normally the onlycircumstance where you would not submit the

medical records to BCBSIL.

Blue Cross and Blue Shield Plans nationwide are

continuing to improve the process of receiving and

sending medical records. Electronic transmission of

medical records between Blues Plans reduces the need

to request records multiple times and eliminates lost

or misrouted records for out-of-area claims.

Your Feedback Makes All the DifferenceWe value your feedback. Please share your

out-of-area member servicing experiences

with us via e-mail at paet@bcbsil.com.

For additional information, refer to the

BlueCard Program Manual on our Web site at:

www.bcbsil.com/PDF/bluecard_program_manual.pdf.

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

The Provider Review Form is used to request a review of previously adjudicatedclaims. While it is important to include all required information, such as claimand provider data, the reason for the review and any necessary documentation,it is equally important to ensure that all information included on the form isaccurate and legible.

Remember: You must include the member’s group and ID number, or yourform may be returned to your office to supply this information. Original claims should not be attached to the Provider Review Form. If attached, theywill be returned back to you with a letter explaining the correct procedure forclaim submission.

Tip: Rather than printing out multiple copies of a form, or saving the PDF to yourhard drive, it is best to go online each and every time to obtain the form you need,as the forms and other information on our Web site are updated frequently

The Provider Review Form and other forms are available on our Web site atwww.bcbsil.com/provider. Taking the time to access the most updated form and making sure your information is clear and complete will help facilitate a quicker review process.

In the Know…this month’s topic for professional andinstitutional providers:

Keeping Your Provider Review Form Clear and Complete

In an effort to comply with Fairness in Contracting

Legislation and keep our independently contracted

providers informed, BCBSIL has designated a

column in the Blue Review to notify you of any

changes to the physician fee schedules. Be sure to

review this area each month.

Effective March 6, 2009, code E1902 was updated.

Effective April 1, 2009, code J7517 was updated.

Effective June 1, 2009, BCBSIL will implement its annual update of the Schedule of MaximumAllowances (SMA) in relation to the CMS ResourceBased Relative Value Scale (RBRVS) revisions and CMS fees for DME, clinical laboratory and J codes.Reimbursement for services provided on or after June 1, 2009, will be based on the updated feeschedule. This update affects PPO and BlueChoice fee schedules. Providers may request fee schedulesfor this update starting May 21, 2009.

Annual and quarterly fee schedule updates can be

requested by downloading the Fee Schedule Request

Form at www.bcbsil.com/provider/ forms.htm.

Specific code changes that are listed above can also be

obtained by downloading the Fee Schedule Request

Form and specifically requesting the updates on the

codes listed in the Blue Review.

Fairness in Contracting

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 goal of providing

the best service to our provider community. This issue features Amanda Williams, Senior

Provider Network Consultant, Cathy Dismuke, Provider Network Consultant and Teresa

Trumbley, Provider Network Coordinator.

Amanda Williams is a Senior Provider Network Consultant who has

been a member of the Provider Network Relations team for 10 years.

Amanda provides service to physicians, medical groups and hospitalproviders in Central Illinois.

Amanda’s background is unique, as she works with both facilities and

professional providers. Her ability to adapt to either environment is

an asset to the rest of the Provider Network Relations team. Amanda’s

flexible attitude also helps her balance her schedule in order to maintain

office time while accommodating provider needs for on-site visits.

For Amanda, the best thing about working for BCBSIL is having the opportunity to interact with

staff from the various provider offices. She makes it her mission to “understand the providers’

frustrations and problems while working with them to find long-term resolutions and create

positive influences on their practice.”

There are many advantages to being a member of the Provider Network Relations team,

but Amanda narrows it down to two: “The positive feedback from the providers and the

relationships that I have developed throughout the years.” Amanda is available via telephone

at (217) 698-5179, or you may e-mail her at williamsa4@bcbsil.com.

Provider Network Relations Spotlight

7 May 2009

Correction to ‘Electronic ClaimAlert: Edit Message ChangesRelated to NPI’ Article in AprilBlue ReviewAn incorrect page reference was included within

the “Electronic Claim Alert: Edit Message Changes

Related to NPI” article on page 7 of the April Blue

Review. While information on how to make provider

record updates was included within this article, a note

at the end of the article directed the reader to page 6

“for more information.” However, no additional

information was included on page 6. We apologize for

any inconvenience this oversight may have caused.

Recredentialing Data CollectionSchedule and RequirementsThe State of Illinois Single Recredentialing

Cycle requires Health Care Entities to collect

recredentialing documentation once but not more

than every three years. Data collection is determined

by the last digit of the health care professional’s

Social Security Number (SSN) and provides for a

one month notification and a two month collection

period. Consistent with the State of Illinois Single

Cycle during the first week of April 2009, BCBSIL

will forward a request to all physicians and IPAs to

submit recredentialing documentation for physicians

whose SSN ends with a “1.” To ensure the provider’s

continued participation in the BCBSIL network(s),

submission of the requested information is required

by July 2009.

For future reference, the following table identifies when

a practitioner will be contacted and recredentialed to

meet the three year cycle, according to the last digit of

their SSN. “Open” refers to a time period in which

Health Care Entities may not collect data.

Provider Network Relations Spotlight (continued from page 6)

Cathy Dismuke has been with BCBSIL for 32 years. She has served the

company in a variety of roles, including a Technician in the Medicare

Secondary Payer Department, and an HMO Customer Service

Representative. Her previous roles have helped Cathy develop a

strong network of internal support at BCBSIL so that she can

quickly find answers and related resources to assist internal and

external customers.

Cathy joined the Provider Network Relations team in 2001 as a

Provider Network Assistant, providing in-office support and

follow-up for her senior team members and serving as a liaison to

facilitate claims adjustments. Her role has since evolved and, as a Provider Network Consultant,

Cathy now provides direct service to physicians and medical groups in Kane, Kendall, LaSalleand DeKalb counties, along with 25 surgical centers.

Cathy says the best thing about working for BCBSIL is the team atmosphere. She and several

of her co-workers have worked together for so long that they are more like friends or family.

In the same way that she’s always there to support her team members, Cathy is also there for

her providers. “Sometimes providers call me when they’re at their wits’ end,” Cathy says.

“I know I’m their last resort in some cases, and it’s my job to be calm and understanding.”

If Cathy doesn’t have an answer right away, she knows where to get it. She has received positive

feedback from her providers in the form of complimentary letters and e-mails, but the best

reward is the satisfaction of a job well done. “It feels good when I can resolve issues for my

providers.” Cathy is available via telephone at (312) 653-2388, or you may e-mail her at

dismukec@bcbsil.com.

Teresa Trumbley is a Provider Network Coordinator who has been

a member of the Provider Network Relations team since June 2008.

Currently, Teresa provides service to physicians and medical groupsfrom Springfield and Southern Illinois.

Teresa brings with her more than eight years of experience with

the Provider Telecommunication Center (PTC), where she quoted

benefits, claim status, claims research, claims adjustments and

worked with other Blues Plans via the BlueCard program. Teresa’s

background and skills are a good fit with the Provider Network

Consultant team. “Our team of PNCs has a wealth of knowledge

in all areas which is very beneficial as we are able to help one another. We are always looking

to the future and striving to be the best we can be for our providers and members.”

Teresa explains that her approach to servicing providers is “through MAGIC (Make a Great

Impression on the Customer). My main goal is to help them in any way that I can. I enjoy being

able to answer their questions while I’m at their office. With my background in the PTC area,

I’m familiar with guidelines and procedures and can explain the process to the provider.”

Teresa enjoys meeting with providers and getting to know them. While she is unable to

meet each and every provider, she is glad for the opportunity to make a difference, one

provider at a time. “When I am able to resolve an issue for a provider, then I know I’ve

done my job.” Teresa is available via telephone at (618) 998-2528, or you may e-mail

her at trumbleyt@bcbsil.com.

2009 2010 2011 2012 2013

January 0 4 8 0 4

February

March

April 1 5 9 1 5

May

June

July 2 6 (open) 2 6

August (open)

September (open)

October 3 7 (open) 3 7

November (open)

December (open)

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 site atwww.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 60601-5099E-mail: 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

00014.0509 A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

10%

Certno.SCS-COC-001528