2024 Blue Review Email Sign Up Question Title * 1. What is your first name? Question Title * 2. What is your last name? Question Title * 3. What is your title? 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) Question Title * 4. What is your organization name? Question Title * 5. What is your email address? Question Title * 6. What is your 10-digit phone number? Question Title * 7. What is your 9-digit Tax ID number? Question Title * 8. Please specify your National Provider Identifier (NPI) information: 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 Done
