March 14, 2008

Dear Submitter:

As you are aware, BCBSIL, BCBSNM, BCBSTX, and BCBSOK, divisions of Health Care Service Corporation (HCSC), a Mutual Legal Reserve Company, are moving forward with our transition to an NPI-only environment.

Originally, we had published March 31, 2008, as the start date of our NPI Only phase. However, since some of our providers are experiencing technical difficulties preventing them from submitting NPI-only claims, we are no longer requiring submission of NPI-only claims as of March 31, 2008. We have announced to our providers that we have changed our NPI-only date to May 23, 2008, to coincide with the date the Centers for Medicare and Medicaid Services (CMS) will lift its enforcement-leniency policy, and fines will begin to be imposed for non-compliance. As of this critical date, claims received with only a BCBS provider number and claims received with dual identifiers (BCBS provider number and NPI) will be rejected.

We are encouraging our providers to begin sending NPI-only claims as soon as possible, in order to identify issues that could impact their business operations after May 23, 2008.* We need your help in increasing the number of NPI-only claims submitted on behalf of your clients, prior to the May 23, 2008, deadline. If you have already completed testing, please contact your assigned EDI representative to learn more about moving forward with NPI-only claims submission for your clients. If you do not know who your assigned representative is, you may contact our Electronic Commerce Center at 1-800-746-4614 for assistance.

Please be aware of the following information regarding your NPI-processing capability: In accordance with the ANSI rules, we require the entry of a valid NPI in the billing and rendering loops, or the claim will continue to be rejected. It is important to note that the pay-to loop is present only if different from the billing. Additionally, you must ensure NPI readiness for all fields listed in the attached survey. In fields labeled “S” for situational, it is imperative that you refer to the ANSI 837 Implementation Guides for an explanation of when a Situational field is Required. For further information on EDI Format Specifications, please refer to the HIPAA Implementation Guides or the HCSC 837 Companion Guides within the Electronic Commerce section of the appropriate Web site at www.bcbsil.com/provider, www.bcbsnm.com/provider, www.bcbsok.com/providers.html, or www.bcbstx.com/provider.

Will you be ready to submit NPI-only claims on May 23, 2008? We would appreciate your taking the time to fill out the enclosed NPI-only readiness survey, which also includes an area for your feedback so that we can assist you with any concerns you may have. Please complete and fax this survey to us at 312-938-6463. Your response is needed by Monday, March 31, 2008.

Thank you for your continued cooperation throughout the NPI transition period.

Sincerely,

HCSC Electronic Commerce Center

*Illinois only: BCBSIL medical groups/clinics must continue to send their State License Number for the Rendering provider in addition to the Rendering provider's NPI through mid-April, 2008, when a Warning edit will be implemented to discourage continued dual-identifier use. (After May 23, 2008, claims including the State License Number will not be allowed.)