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 [email protected].
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 [email protected].
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
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 [email protected].
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 [email protected].
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: [email protected]
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.
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