Blue Review Email Validation Survey We want to make sure that important information from Blue Cross and Blue Shield of Illinois (BCBSIL) is routed appropriately. We are improving communications to enable messaging that is customized and distributed according to your specific role and needs. The purpose of this survey is to confirm the email address we have on file for you. Please help us by completing all fields below.Please note: The information you provide in this survey will be used for email verification purposes only — it will not be used to make changes to your existing provider record with BCBSIL. 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
