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2024
Blue Review
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1.
What is your first name?
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2.
What is your last name?
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3.
What is your title?
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Administrator
Billing Contact
Blue Distinction
Business Office Manager
Case Management
Chief Accounting Officer
Chief Executive Officer
Chief Executive Officer Interim
Chief Dev Officer
Chief Financial Officer
Chief Medical Officer
Chief Operating Officer
Contracting
Credentialing
Director of Revenue Cycle
EMR Access
EMR Functionality
Financial Manager
Key Facility Contact
Legal Counsel
Office Manager
Patient Account Rep
Physician
President
Vice President
Other (please specify)
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4.
What is your organization name?
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5.
What is your email address?
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6.
What is your 10-digit phone number?
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7.
What is your 9-digit Tax ID number?
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8.
Please specify your National Provider Identifier (NPI) information:
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Type 1 (Individual)
Type 2 (Organizational)
N/A (Atypical provider)
Please enter the 10-digit NPI for the type selected above (for atypical providers, enter N/A):
* Questions marked with an asterisk are required.
Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
