7 Wellness Tools That Can Help Providers Improve Their Patients' Medical Billing

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1 May 2009 What s Inside? 2008 HMO PCP & PPO Practitioner Survey Results... 4 BlueCard Tip: Medical Records.. 5 Pharmacy Program Updates... 2 esolutions Workshop and Vendor Exhibit... 3 Workshop Schedule... 3 New Account Groups... 3 Fairness in Contracting... 6 Provider Network Relations Spotlight... 6 Recredentialing Data Collection Schedule and Requirements... 7 Wellness Tools Can Help Your Patients Make Healthy Choices Increasing wellness by making more informed health choices is a common goal between providers and their patients. The Blue Access for Members (BAM) Web site offers tools and information to help your patients make these informed decisions. One of these tools is our Health Risk Assessment (HRA). Since December 2008, over 15,000 members have used this tool to evaluate their health status and assess potential changes to improve that status. Once the HRA assessment is complete, your patients gain knowledge regarding topics such as recommended vaccinations and tests based upon the gauged status. We urge them to discuss these results with their health care practitioner and to decide together what course of action to take. Talk to your patients about this and other tools to help evaluate their health status at Visit our Web site at vider id der TM Video Stories at Be Smart. Be Well. Address the Childhood Obesity Epidemic The Alliance for a Healthier Generation* has reported that nearly 25 million American children between the ages of 2 and 19 are overweight or at risk of becoming overweight. That s almost one out of every three kids. Childhood obesity is the topic currently featured on our Be Smart. Be Well. Web site at We encourage you to share this site with your patients to make them aware of what childoood obesity is, why it s important to understand and what families can do about it, such as adopting the following Healthy Habits to Have : Consume less, expend more Make food fun Make family dinners a priority Be a role model Remember, no one is perfect Also featured are engaging video stories as told by real kids who have learned to think about food, exercise and health in a whole new way. Alejandra s Story shows how shopping together, looking at labels and portion control became a family effort for one young girl named Alejandra and her parents. Personal accounts by real families are complemented by other helpful resources, such as a link to the Centers for Disease Control and Prevention. Viewers can also tap into the latest headlines focusing attention on childhood obesity via the site s rolling News feed. The purpose of Be Smart. Be Well. continues to be presenting simple-to-use knowledge that can help promote increased awareness and healthier decision making. Additional topics in the Be Smart. Be Well. archives at include traumatic brain injury (TBI), caregiving, drug safety and mental health. What s due next on the list of featured topics? Healthy pregnancy. *The Alliance for a Healthier Generation is a partnership between the American Heart Association and the William J. Clinton Foundation. Please visit their Web site at for additional information.

2 Medical Policies Identify Non-covered Allergy Tests and Services Non-covered services include the following types of testing for food and chemical sensitivity, along with treatments based on this testing: Mediator Release Test (MRT) Lifestyle Eating and Performance (LEAP) Program Antigen Leukocyte Cellular Antibody Test (ALCAT) The MRT is a non-covered blood test which attempts to quantify how strongly circulating immune cells react to substances such as histamine, serotonin and prostaglandins. The results of the MRT often lead to utilization of the non-covered LEAP program, a specialized diet that may involve supplements and/or herbal treatments. ALCAT is another non-covered blood test which attempts to measure how blood cells may react to foods in certain situations. Based on a lack of published, peer-reviewed scientific data from well-constructed prospective clinical trials, there is no evidence that these testing strategies result in intervention or therapy changes that improve health outcomes. BCBSIL Medical Policies MED , Allergy Management and MED , Idiopathic Environmental Intolerance or Illness (IEI) Management specify that, as methods of allergy testing and/or as services provided for the diagnosis, treatment and ongoing management of IEI management, MRT, LEAP and ALCAT are considered experimental, investigational and unproven, and therefore ineligible for benefit coverage. To review the complete policies, visit our Web site at and select Medical Policies. After reading the Medical Policies Disclaimer, click on I Agree. Pharmacy Program Updates Formulary Changes Based on the availability of new prescription medications and the Prime National Pharmacy and Therapeutics Committee s review of changes in the pharmaceuticals market, some revisions will be made to the BCBSIL formulary effective July 1, Non-formulary Brand* (Tier 3 copayment/ coinsurance) Betoptic S 0.25% Drugs Moving to Non-Formulary Status July 1, 2009 Glaucoma Indication Generic Alternative(s) (Tier 1 copayment/ coinsurance) carteolol soln, levobunolol soln, metipranolol soln, timolol maleate soln Formulary Brand Alternative* (Tier 2 copayment/ coinsurance) Betaxolol soln, 0.5% Renagel Hyper-phosphatemia calcium acetate Renvela, Phoslo Vytorin Zetia Hyper-cholesterolemia Hyper-cholesterolemia * Third party brand names are the property of their respective owners. lovastatin, pravastatin simvastatin fenofibrate, gemfibrozil; lovastatin, pravastatin simvastatin Crestor Crestor, Tricor Low Cost Retail Generic Programs The low cost generic programs that have become widely available at various retail pharmacies nationwide have raised concerns among various stakeholders and have become a topic of extensive discussion. These programs offer a one-month supply of selected generic drugs at $4. The BCBSIL standard pharmacy contract through Prime Therapeutics provides our members the lowest of logic between the discounted price of the drug, the member s copay or the usual and customary (U&C) price. This means that if a retail pharmacy submits a claim for a $4 generic (commonly submitted as the U&C price) and the network discount is $8, then the patient pays only $4. On the other hand, if a retail pharmacy submits a claim for a $4 generic and the network discount is $3, then the patient pays only $3. The important point to make is that in most cases the member will still benefit from the low cost products by using their drug card and may actually get a lower cost than if they had paid cash. By being cognizant about presenting their drug card for every prescription being filled at retail pharmacies, members will always be able to take advantage of the lowest out-of-pocket cost for their medication. Since MRT, LEAP and ALCAT are non-covered services, they should not be billed to BCBSIL. However, if a BCBSIL member requests that you bill, please do not report CPT Code 83516, which may result in an incorrect payment and ultimately a refund request. You may instead use the Unlisted CPT Code Note: Unlisted CPT Codes must be accompanied by a description and/or Special Report of the actual service performed. Visit our Web site at 2

3 Join us in May for... an esolutions Workshop and Vendor Exhibit The BCBSIL Network Management Provider Education Team is pleased to offer an esolutions Workshop and Vendor Exhibit. The goal of the workshop is to promote administrative efficiencies and have vendors available to help you explore your paperless possibilities. Wednesday, May 13, 2009 St. John s Hospital Bunn Auditorium 800 East Carpenter Street Springfield, IL Registration: 9 to 9:30 a.m. General Session/Vendor Exhibit: 9:30 a.m. to 12:30 p.m. Refreshments will be served. To register online, visit our Web site at If you have any questions, please call (312) Workshop Schedule Upcoming workshops include: Workshop Date Location EFT, ERA & EPS Webinar May 6, 2009 Online esolutions/vendor Exhibit May 13, 2009 St John s Hospital, Springfield, IL esolutions June 24, 2009 St. Mary s Good Samaritan, Centralia, IL esolutions July 22, 2009 Advocate Trinity Hospital, Chicago, IL Register today! Visit our Web site at to view the agenda and sign up. We welcome your participation and value your input. New Account Groups Group Name: Texas Laborers Group Number: P35159 Alpha Prefix: TLX Product Type: PPO(Portable) Effective Date: May 1, 2009 BC BS Group Name: The Marmon Group Group Number: Alpha Prefix: MNX Product Type: PPO(Portable) Effective Date: March 1, 2009 BC BS Group Name: The Marmon Group Group Number: , Alpha Prefix: MNX Product Type: PPO(Portable) Effective Date: April 1, 2009 BC BS Group Name: United Brotherhood of Carpenters and Joiners of America Group Number: P39498 Alpha Prefix: CRP Product Type: PPO(Portable) Effective Date: April 1, 2009 BC BS NOTE: The information noted above is current as of the date of publication; however, BCBSIL reserves the right to amend this information at any time without notice. The fact that a group is included on this list is not a guarantee of payment or that any individuals employed by any of the listed groups, or their dependents, will be eligible for benefits. Benefit coverage is subject to the terms and conditions set forth in the member s certificate of coverage. 3 May 2009

4 2008 HMO Primary Care Physician Survey Results Results are in from the 2008 HMO Illinois and BlueAdvantage HMO Primary Care Physician (PCP) Survey. BCBSIL received completed questionnaires from 998 HMO physicians, for a response rate of 19.2 percent. The table below shows highlights of the results from the 2006, 2007 and 2008 surveys. Coordination of Care results regarding feedback received from various facilities and key specialists are included. The survey used a 5-point rating scale, from Excellent to Poor. The results shown below are based on combined responses in the Top Three Boxes (Excellent, Very Good, and Good) or Yes answers. Hospital Information questions are based on the Top Two Boxes (Excellent and Very Good). HMO Survey Questions HMO PCPs Survey Response Rate 19% 19% 19% IPA Overall Rating* 93% 90% 87% IPA Referral Procedures* Overall Process 89% 85% 84% Adequacy of Specialist Network 88% 85% 84% Quality of Specialist Network 93% 91% 90% IPA Utilization Management (UM)* Case Management 92% 87% 86% Timeliness of UM decisions 91% 85% 85% Overall UM Process 91% 86% 86% IPA Claims Payment* Timeliness 87% 80% 80% Accuracy 86% 82% 80% BCBSIL Services Provider Telecommunications Center (PTC) Overall 79% 75% 76% Have accessed NDAS Online/eCare Internet tool ^ 39% NA NA o Rating of experience with NDAS Online/eCare ^ 91% NA NA o Rating of experience with initial setup for NDAS Online/eCare ^ 91% NA NA After-Hours Access Report of usual response time < 30 minutes 90% 93% 90% Hospital Information (Top Two Box scores) Pharmacy, in terms of providing medication correctly 78% 75% 76% Adequacy of the number of nurses 64% 59% 57% Accuracy of processing physician orders 73% 70% 66% Quality of discharge plans 73% 69% 66% Agree that ER reports for patients not admitted to hospital are received in timely manner before follow-up care 74% 72% 68% Hospital Information Once again on this year's survey is a question regarding the primary admitting hospital. Ninety-five percent of the responding PCPs would recommend their primary admitting hospital to family and friends. Continuity and Coordination between Managed Care Physicians and Health Care Facilities In 2008, 88 percent or more of the responding PCPs in the HMO rated the reports they received from hospitals, outpatient surgery/surgicenters, skilled nursing facilities and home health care facilities as Excellent, Very Good or Good. At least 90 percent of PCPs rated feedback from general surgeons, cardiologists, orthopedic surgeons, ophthalmologists and dermatologists as Excellent, Very Good or Good, but only 80 percent of PCPs gave these positive ratings to feedback from behavioral health specialists. (Items denoted by a symbol experienced a significant increase.) New Indicators New in 2008 were questions regarding the use of hospitalists in the respondent s primary hospital. More than 71 percent of PCPs responded that hospitalists are on staff at their primary hospital. Thirty-two percent of PCPs responded that they use hospitalists. Also new in 2008 were questions about familiarity with and rating of BCBSIL s Blue Star reports. Thirty-four percent of respondents were familiar with the Blue Star SM Hospital Report and 96 percent of these rated the report as Excellent, Very Good or Good. Forty percent of respondents were familiar with the Blue Star SM Medical Group/IPA Report, and 97 percent of these rated the report as Excellent, Very Good or Good. In summary, there were significant improvements in many of the HMO Primary Care Physician survey indicators, including several of the indicators regarding facility and specialist feedback to PCPs. BCBSIL encourages providers and practitioners to consistently communicate with the member s PCP so that he/she can better coordinate care. * HMO physicians were asked to evaluate the IPA on these attributes. ^ Baseline data in Statistically significant change. Note: Percentages rounded to the nearest whole number PPO Practitioner Survey Results Results also are in from the 2008 PPO Practitioner Survey. Physician specialties represented were the primary care specialties of Internal Medicine, Pediatrics, Obstetrics-Gynecology and General Practice and other specialties including, but not limited to Allergy, Cardiology, Dermatology, Gastroenterology, General Surgery, Neurology, Ophthalmology, Otolaryngology, Orthopedics, Psychiatry and Urology. BCBSIL received 3,444 completed surveys, for a 12 percent response rate (a significant increase). The table shows 2006, 2007 and 2008 results of the survey. Coordination of Care results regarding feedback received from various facilities and key specialists are included. The survey used a 5-point rating scale, from Excellent to Poor. The results shown below are based on combined responses in the Top Three Boxes (Excellent, Very Good, and Good) or Yes answers. Hospital Information questions are based on the Top Two Boxes (Excellent and Very Good). Hospital Information Once again on this year's survey is a question regarding the physician's likelihood to recommend his/her primary admitting hospital. Ninety-five percent of the responding practitioners would recommend their primary admitting hospital to family and friends. Visit our Web site at 4 (continued on next page)

5 2008 PPO Practitioner Survey Results (continued from page 4) Continuity and Coordination between Managed Care Physicians and Health Care Facilities and Practitioners In 2008, more than 83 percent of the responding PPO practitioners gave a rating of Excellent, Very Good or Good to the reports they received from health care facilities, including hospitals, outpatient surgery/surgicenters, skilled nursing facilities and home health care facilities. More than 90 percent rated feedback from general surgeons, cardiologists, orthopedic surgeons, ophthalmologists and dermatologists as Excellent, Very Good or Good, and 83 percent gave these positive ratings to feedback from behavioral health specialists. (Items denoted by a symbol experienced a significant increase.) PPO Survey Questions Survey Response Rate 12% 9% 11% Overall Satisfaction 94% 92% 94% PPO Utilization Management Pre-certifying Inpatient Admissions 86% 83% 87% Authorizing Additional Days 86% 83% 85% PPO Network Adequacy of Specialist Network 94% 95% 95% Quality of Specialist Network 95% 95% 96% BCBSIL Claims Payment Timeliness 89% 90% 91% Accuracy 87% 86% 88% BCBSIL Services Provider Telecommunications Center (PTC) Overall 74% 67% 74% Have accessed the NDAS Online/eCare Internet tool (% Yes ) ^ 26% NA NA o Rating of experience with NDAS Online/eCare ^ 77% NA NA o Rating of experience with initial setup for NDAS Online/eCare ^ 78% NA NA Have accessed iexchange (pre-notification) online/internet tool (% Yes ) ^ 6% NA NA o Rating of experience with iexchange ^ 71% NA NA o Rating of experience with the response time after a BCBSIL member is pre-notified through iexchange ^ After-Hours Access ** Responses of PPO Practitioners in General Practice, Internal Medicine, Obstetrics-Gynecology and Pediatrics only. Statistically significant change. ^ Baseline data in Note: Percentages rounded to the nearest whole number. 72% NA NA Report of usual response time < 30 minutes ** 92% 88% 90% Hospital Information (Top Two Box scores) Pharmacy, in terms of providing medication correctly 82% 77% 79% Adequacy of the number of nurses 64% 57% 56% Accuracy of processing physician orders 75% 70% 70% Quality of discharge plans 74% 69% 69% Agree that ER reports for patients not admitted to hospital are received in timely manner before follow-up care 67% 69% 67% New Indicators New in 2008 were questions about familiarity with and rating of BCBSIL s Blue Star reports. Nine percent of respondents were familiar with the Blue Star Hospital Report and 89 percent of these rated the report as Excellent, Very Good or Good. Nine percent of respondents were familiar with the Blue Star Medical Group/IPA Report, and 91 percent of these rated the report as Excellent, Very Good or Good. BlueCard Tip: Medical Records It is important to send medical records only when they are requested. Do not send medical records with your claims, as unsolicited claim attachments may cause payment delays. Submit your claims electronically and BCBSIL will notify you if medical records are needed. Here are examples of circumstances that may prompt BCBSIL or other Blues Plans to request medical records from you for out-of-area members: 1. While the claim is being processed or reviewed BCBSIL may request additional information or medical records that are needed to make a benefit decision on a claim. You will receive a letter requesting specific medical records, along with instructions for submission. Submit the requested information to BCBSIL as soon as possible to expedite processing. Only send the medical records for dates of service requested. In most instances, complete medical records are not necessary. Include the cover letter you received with the request when submitting the medical records. This is necessary to make sure the records are routed properly once they are received by BCBSIL. 2. When pre-authorization is required If you receive requests for medical records from other Blue Plans prior to rendering services, you will be instructed to submit the records directly to the member s Plan. This is normally the only circumstance where you would not submit the medical records to BCBSIL. Blue Cross and Blue Shield Plans nationwide are continuing to improve the process of receiving and sending medical records. Electronic transmission of medical records between Blues Plans reduces the need to request records multiple times and eliminates lost or misrouted records for out-of-area claims. Your Feedback Makes All the Difference We value your feedback. Please share your out-of-area member servicing experiences with us via at paet@bcbsil.com. For additional information, refer to the BlueCard Program Manual on our Web site at: In summary, there were significant improvements in many of the PPO Practitioner survey indicators. BCBSIL encourages providers and practitioners to consistently communicate with other physicians so that care can be better coordinated. 5 May 2009

6 Fairness in Contracting In an effort to comply with Fairness in Contracting Legislation and keep our independently contracted providers informed, BCBSIL has designated a column in the Blue Review to notify you of any changes to the physician fee schedules. Be sure to review this area each month. Effective March 6, 2009, code E1902 was updated. Effective April 1, 2009, code J7517 was updated. Effective June 1, 2009, BCBSIL will implement its annual update of the Schedule of Maximum Allowances (SMA) in relation to the CMS Resource Based Relative Value Scale (RBRVS) revisions and CMS fees for DME, clinical laboratory and J codes. Reimbursement for services provided on or after June 1, 2009, will be based on the updated fee schedule. This update affects PPO and BlueChoice fee schedules. Providers may request fee schedules for this update starting May 21, Annual and quarterly fee schedule updates can be requested by downloading the Fee Schedule Request Form at forms.htm. Specific code changes that are listed above can also be obtained by downloading the Fee Schedule Request Form and specifically requesting the updates on the codes listed in the Blue Review. In the Know this month s topic for professional and institutional providers: Keeping Your Provider Review Form Clear and Complete The Provider Review Form is used to request a review of previously adjudicated claims. While it is important to include all required information, such as claim and provider data, the reason for the review and any necessary documentation, it is equally important to ensure that all information included on the form is accurate and legible. Remember: You must include the member s group and ID number, or your form may be returned to your office to supply this information. Original claims should not be attached to the Provider Review Form. If attached, they will be returned back to you with a letter explaining the correct procedure for claim submission. Tip: Rather than printing out multiple copies of a form, or saving the PDF to your hard drive, it is best to go online each and every time to obtain the form you need, as the forms and other information on our Web site are updated frequently The Provider Review Form and other forms are available on our Web site at Taking the time to access the most updated form and making sure your information is clear and complete will help facilitate a quicker review process. Provider Network Relations Spotlight In this section of the newsletter, we introduce you to some of the key players on our Provider Network Relations team, briefly describing their areas of expertise and their goal of providing the best service to our provider community. This issue features Amanda Williams, Senior Provider Network Consultant, Cathy Dismuke, Provider Network Consultant and Teresa Trumbley, Provider Network Coordinator. Amanda Williams is a Senior Provider Network Consultant who has been a member of the Provider Network Relations team for 10 years. Amanda provides service to physicians, medical groups and hospital providers in Central Illinois. Amanda s background is unique, as she works with both facilities and professional providers. Her ability to adapt to either environment is an asset to the rest of the Provider Network Relations team. Amanda s flexible attitude also helps her balance her schedule in order to maintain office time while accommodating provider needs for on-site visits. For Amanda, the best thing about working for BCBSIL is having the opportunity to interact with staff from the various provider offices. She makes it her mission to understand the providers frustrations and problems while working with them to find long-term resolutions and create positive influences on their practice. There are many advantages to being a member of the Provider Network Relations team, but Amanda narrows it down to two: The positive feedback from the providers and the relationships that I have developed throughout the years. Amanda is available via telephone at (217) , or you may her at williamsa4@bcbsil.com. Visit our Web site at 6

7 Provider Network Relations Spotlight (continued from page 6) Cathy Dismuke has been with BCBSIL for 32 years. She has served the company in a variety of roles, including a Technician in the Medicare Secondary Payer Department, and an HMO Customer Service Representative. Her previous roles have helped Cathy develop a strong network of internal support at BCBSIL so that she can quickly find answers and related resources to assist internal and external customers. Cathy joined the Provider Network Relations team in 2001 as a Provider Network Assistant, providing in-office support and follow-up for her senior team members and serving as a liaison to facilitate claims adjustments. Her role has since evolved and, as a Provider Network Consultant, Cathy now provides direct service to physicians and medical groups in Kane, Kendall, LaSalle and DeKalb counties, along with 25 surgical centers. Cathy says the best thing about working for BCBSIL is the team atmosphere. She and several of her co-workers have worked together for so long that they are more like friends or family. In the same way that she s always there to support her team members, Cathy is also there for her providers. Sometimes providers call me when they re at their wits end, Cathy says. I know I m their last resort in some cases, and it s my job to be calm and understanding. If Cathy doesn t have an answer right away, she knows where to get it. She has received positive feedback from her providers in the form of complimentary letters and s, but the best reward is the satisfaction of a job well done. It feels good when I can resolve issues for my providers. Cathy is available via telephone at (312) , or you may her at dismukec@bcbsil.com. Teresa Trumbley is a Provider Network Coordinator who has been a member of the Provider Network Relations team since June Currently, Teresa provides service to physicians and medical groups from Springfield and Southern Illinois. Teresa brings with her more than eight years of experience with the Provider Telecommunication Center (PTC), where she quoted benefits, claim status, claims research, claims adjustments and worked with other Blues Plans via the BlueCard program. Teresa s background and skills are a good fit with the Provider Network Consultant team. Our team of PNCs has a wealth of knowledge in all areas which is very beneficial as we are able to help one another. We are always looking to the future and striving to be the best we can be for our providers and members. Teresa explains that her approach to servicing providers is through MAGIC (Make a Great Impression on the Customer). My main goal is to help them in any way that I can. I enjoy being able to answer their questions while I m at their office. With my background in the PTC area, I m familiar with guidelines and procedures and can explain the process to the provider. Teresa enjoys meeting with providers and getting to know them. While she is unable to meet each and every provider, she is glad for the opportunity to make a difference, one provider at a time. When I am able to resolve an issue for a provider, then I know I ve done my job. Teresa is available via telephone at (618) , or you may her at trumbleyt@bcbsil.com. Correction to Electronic Claim Alert: Edit Message Changes Related to NPI Article in April Blue Review An incorrect page reference was included within the Electronic Claim Alert: Edit Message Changes Related to NPI article on page 7 of the April Blue Review. While information on how to make provider record updates was included within this article, a note at the end of the article directed the reader to page 6 for more information. However, no additional information was included on page 6. We apologize for any inconvenience this oversight may have caused. Recredentialing Data Collection Schedule and Requirements The State of Illinois Single Recredentialing Cycle requires Health Care Entities to collect recredentialing documentation once but not more than every three years. Data collection is determined by the last digit of the health care professional s Social Security Number (SSN) and provides for a one month notification and a two month collection period. Consistent with the State of Illinois Single Cycle during the first week of April 2009, BCBSIL will forward a request to all physicians and IPAs to submit recredentialing documentation for physicians whose SSN ends with a 1. To ensure the provider s continued participation in the BCBSIL network(s), submission of the requested information is required by July For future reference, the following table identifies when a practitioner will be contacted and recredentialed to meet the three year cycle, according to the last digit of their SSN. Open refers to a time period in which Health Care Entities may not collect data January February March April May June July 2 6 (open) 2 6 August September (open) (open) October 3 7 (open) 3 7 November December (open) (open) 7 May 2009

8 Visit us online at Have an idea for an article? We want to hear from you! Let us know if Blue Review continues to meet your standards. Does this publication address your needs? What topics would you like to read about? BCBSIL s success is dependent on your business as a contracting provider. Blue Review has been created to communicate tools, updates and tips to support your health care practice. Think of Blue Review as a canvas for your Blue Cross and Blue Shield business information. We invite you to submit your feedback and suggestions for improvements via , to bluereview@bcbsil.com. Blue Review is a monthly newsletter published for Institutional and Professional Providers contracting with Blue Cross and Blue Shield of Illinois. We encourage you to share the content of this newsletter with your staff. Blue Review is located on our Web site at The editors and staff of Blue Review welcome letters to the editor. Address letters to: Blue Review Blue Cross and Blue Shield of Illinois 300 E. Randolph Street 25th Floor Chicago, Illinois bluereview@bcbsil.com Web site: Publisher: Stephen Hamman, VP, Network Management Editor: Gail Larsen, DVP, Provider Relations Managing Editor: Jeanne Trumbo, Sr. Manager Editorial Staff: Margaret O Toole, Marsha Tallerico and Allene Walker BCBSIL makes no endorsement, representations or warranties regarding any products or services offered by independent third party vendors mentioned in this newsletter. The vendors are solely responsible for the products or services offered by them. If you have any questions regarding any of the products or services mentioned in this periodical, you should contact the vendor directly. PRSRT STD U.S. POSTAGE PAID PERMIT NO. 581 CHICAGO, IL 10% Cert no. SCS-COC A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association