How to make an Inquiry and File an Appeal
Blue Cross and Blue Shield of Illinois (BCBSIL) works diligently to ensure our network physicians and Contracted Providers understand the affordability and practice information listed in our Transparency Pilot Project. The Transparency Pilot, which will run through the end of May 2008, is displaying the Cost and Quality information on a limited number of Contracted Providers. It will be viewed by a limited number of BCBSIL members.

If you have a general question regarding the quality and cost indicators listed on the Web site, want further clarification about a particular aspect of the results, or are requesting a copy of your PPO Practitioner Profile please contact us at (312) 653-5005.

At any time during the pilot period (the pilot is scheduled to run through May 31, 2008) you may elect to "opt-out" of the program by completing and faxing back an "opt-out" form. The timeline for "an-opt" out request to post on the Web site is usually 3 business days.  All physicians in your practice will receive the same designation. An "opt-out" will apply to all physicians using the same Blue Shield number. You must opt-out of the entire project. You cannot choose to "opt-out" of one indicator and participate in another. The physicians in practices choosing to "opt-out" of the Transparency Pilot will be displayed on the Web site with a message indicating "voluntarily declined."

How to Request an Appeal: 
If you wish to appeal your cost and/or quality indicator designation, please read the following steps. It is important to note that during the appeal process your Quality and Cost information will not show on the Web site. Instead a message will read "voluntarily declined" next to your name or group.

You may request an appeal of your Cost and Quality Indicators at any time. All appeals must be in writing. Appeals should be e mailed to: network_development@bcbsil.com.

Requests should include:

• name of physician group or individual physician
• the date of the request
• your name and address
• your Provider Number
• the indicator(s) for which you are requesting a review
• a statement of the reason(s) for requesting a review
• documentation in support of the appeal

We are committed to making every effort to make certain that Contracted Provider appeals are responded to in a reasonable, prompt, and transparent manner. We will provide a written response with the results of the appeal within 30 days from our receipt of your request. In some instances, the timeframe may be extended in order to review any additional information submitted or due to the timing of the Transparency Appeals Committee meeting dates.