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Workshops Coming Soon!




HMO Forum Registration
 

Please Select Workshop and complete the registration form below:

HMO Summer Forum

 August 12, 2009, BCBSIL - 300 East Randolph, Chicago, IL 60601, CAL Auditorium (Parking available across street at Monroe/Millennium Garage)


HMO Winter Forum

 December 9, 2009, BCBSIL 300 East Randolph, Chicago, IL 60601, CAL Auditorium (Parking available across street at Monroe/Millennium Garage)

*Are you a...

 BCBSIL Provider

Please indicate below:
 Physician
Administrative Office Staff

 Billing Agency

Please indicate submitter ID below:

*Provider/Billing Agency Name:  
*Billing NPI Number(s):
Billing Agencies must list all NPI numbers

 Type 1(Individual)

 Type 2(Organizational)

*Address:  
*City/*State/*Zip Code: / /  
*Telephone Number: / /  
*Fax Number:   /  /  
*E-mail Address:  
*Number of Attendees:   
*Name(s) of Attendees  
*How do you submit claims?
(choose only one)
 Electronic
Paper
 
What Products do you currently have contracts with:
(choose all that apply) 
 PPO BlueChoice
HMO

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