This form is for Hospitals, Ambulatory Surgery (ASC) and Free-standing Radiology (FSR) Centers that received a letter from BCBSIL requesting updated information for our Care Comparison tool.

You will be using this online form to report the total volume for each procedure and service performed at your facility. The volume should include totals for all payers (i.e., Medicare, commercial, self-pay, etc.) for dates of service from January 1, 2009, through December 31, 2009.

• Simply click on the appropriate link below to access the online form.
• All fields are required. If you do not perform a particular procedure or service, simply indicate "N/A" for Not Applicable.
• You cannot save or pause, once you begin entering data. If you cannot complete the form during one sitting, or if you need to collect information from other sources within your organization, you may wish to print the online version, manually compile your data, and then transfer the information to the form online.
• Verify that all information is correct, then click on "Submit."
• Submit your data online no later than Aug. 13, 2010.

All data received will then be incorporated within the Care Comparison tool and made available to members and providers on our website during the 4th quarter 2010.

If you have additional questions about the Care Comparison tool, please contact Fabian Camarena at (312) 653-8293 or fabian_camarena@bcbsil.com.

We appreciate your participation!

Note: Your response to this request for information is completely voluntary. If you elect not to respond, a "Not Reported" designation will be displayed on our website.

Acute Care Facilities

Ambulatory Surgical Services

Free-standing Radiology Services

"Care Comparison" is a registered service mark used under license by Blue Cross and Blue Shield of Illinois.