Before You Begin.

Blue Access for Providers^SM is available for use by authorized Providers and users authorized by such Providers or Provider Groups.

You, as a Provider ("Provider") or as a user authorized by your Provider or Provider Group, ("you" or "Authorized User") want to get started using Blue Access for Providers and we, Blue Cross and Blue Shield of Illinois (BCBSIL), want to ensure that you as an Authorized User of this website have an understanding of the following Terms of Use. As we make the information found on this website more detailed, accessible and easier to use, we must have appropriate Terms of Use in place that serve to protect the privacy and integrity of this information.

Please read these Terms of Use in their entirety since they constitute a binding agreement between you, BCBSIL and our licensors, and are not intended to replace or amend any other agreement(s) between the parties. Each paragraph provision contained in these Terms of Use is very important and requires your agreement and compliance.

Read each of the following sections via these quick links:

Introduction
Protected Health Information
Authorized User's Responsibilities
Our Responsibilities
Privacy Statement
Online Security and Website Links
Miscellaneous
Contact Us

Introduction

Blue Cross and Blue Shield of Illinois ("BCBSIL ", "us" or "we"), a division of Health Care Service Corporation, a Mutual Legal Reserve Company, offers Blue Access for Providers^SM, a secure online resource to provide Providers with tools, resources and information including:

• Search for Member eligibility and benefits
• Download Member Eligibility list and Capitation reports
• View and download member Changes Since Last Eligibility List
• Download Members Address List
• View and download the Capitation Reconciliation Report
• View Capitation Summary Report
• View member Activity Counts
• View and download Member Counts and Capitation by Benefit Plan
• View Age and Gender Counts
• View, download and submit 095 - Request for Group Approval Status List
• View, download and submit Past Due Claims(PDC) - 10 Day Notice List
• View and download 039- Medical Group Risk Claims
• Obtain access to:
• Provider Manual
• Benefit Matrix
• Benefit Matrix Numeric
• Benefit Matrix Alpha

Protected Health Information

When you receive Protected Health Information (PHI) as defined under the provisions of the Health Insurance Portability and Accountability Act of 1996, ("HIPAA") from BCBSIL through this website, you represent that as an Authorized User, you are permitted to view and access PHI for the members of your contracted Provider Group.

Authorized User's Responsibilities

All Authorized Users agree to:

• Act responsibly;
• Protect your unique identifier and/or password from any unauthorized use;
• Notify us immediately if you suspect or become aware of any unauthorized use or access to your account or any account-related security breach;
• Use information obtained through this site solely in connection with the Authorized Users agreement with BCBSIL and agree to indemnify and hold harmless BCBSIL for any harm that results from unauthorized use of this information outside the scope of the Authorized Users agreement with BCBSIL.

All Authorized Users agree not to:

• Disclose any information reviewed or received from the website to any other third person, organization, or entity, unless the disclosure is made pursuant to a valid court order, required by a state or federal government agency or as otherwise required by law.
• Share your unique identifier and/or password with anyone else;
• Provide any false or inaccurate information;
• Use any device or computer program in order to interfere or attempt to interfere with the proper operation of this website;
• Take any action that imposes an unreasonable load on the systems supporting this website;
• Attempt to disrupt, degrade, impair or violate the integrity or security of the infrastructure of this website (e.g., hacking, denial of service attacks), including any activity that precedes attempts to breach security such as scanning, probing, or other testing or vulnerability assessment activity, or engaging in or permitting any network or hosting activity that results in the blacklisting or other blockage of our IP space;
• Remove or obscure the copyright notice or other notices displayed on the content and/or frame BCBSIL's name or any BCBSIL content, trademark, logo or trademarks in any meta-tags or other hidden text, or other proprietary information on this website;
• Copy, reprint, modify, lease, distribute, assign, sell content, license, reverse engineer, create derivative works or take other actions that may be prohibited by the Federal regulation known commonly as the "Copyright Act" using information or content retrieved from this website or any of the third-party websites we may provide links to;
• Use this website in a manner that may adversely affect this website's resources or its availability to others, or that violates U.S., local, state or federal law.

We rely on the good faith of all Authorized Users of this website to honor these responsibilities. If you choose to provide inaccurate or false information, use poor judgment or allow unauthorized access, BCBSIL has the right to discontinue your access to this website.

Our Responsibilities

We agree to:

• Make reasonable efforts to present accurate and current information on this website; however it is possible that information found on this website may be out-of-date;
• Have security measures in place to protect against the loss, misuse or alteration of information under our control;
• Continually evaluate new technologies intended to safeguard your information;
• Provide the content and information on this website on an "AS IS" and "AS AVAILABLE" basis, without any representations or warranties;
• Grant you a personal, non-transferable, non-exclusive limited license to access this website and to download and print BCBSIL content from this website solely for Authorized User's non-commercial use;
• Protect your online information according to applicable U.S. local, state and federal laws and our established company policies, standards and practices.

Privacy Statement

Our Privacy Statement is part of the Terms of Use. The statement describes how we collect and use the data you provide via this website. From time to time, the Privacy Statement may need to be revised, so we encourage you to check periodically for any updates or changes.

Online Security and Website Links

Information on this website is protected by Secure Socket Layer (SSL) technology, the leading security protocol for data transfer on the Internet.

Even though there are extraordinary benefits to using this website, as with all electronic communications, there are some risks which may include:

• Failure of hardware, software and/or Internet connections. We are not responsible for failures, distortions, delays or other problems resulting from equipment configuration, connection, signal power, hardware, software or any equipment used to access the Internet.
• No guarantee that the confidentiality or security of electronic transmissions via the Internet can be assured due to potentially unsecure computers and links. This could result in data becoming lost or intercepted during transmission. Please use good judgment before deciding to send information via the Internet.

Miscellaneous

Governing Law

These Terms of Use and authorized access to Blue Access for Providers are governed exclusively by the laws of the State of Illinois, without reference to its rules regarding choice of law.

Limitation of Liability

You, as an Authorized User, agree that you will use this website at your own risk. BCBSIL and its licensors have no liability for any damages (whether direct or indirect, special, incidental, consequential or punitive) incurred by you as a result of your use of this website or the information you receive from or submit to this website.

BCBSIL and its licensors shall have no liability whatsoever for failure of electronic or mechanical equipment or communication, telephone or other connection problems, computer viruses, unauthorized access or interception of data from this website, theft or errors.

Ownership and Copyright Protection

All right, title and interest in the content (including software, text and images) and other intellectual property (including trademarks, service marks and copyrights) on this website are solely and exclusively the property of BCBSIL or its licensors, and are protected by intellectual property laws. Blue Cross, Blue Shield and the Cross and Shield symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. You acknowledge that content available through this website, including, without limitation, content of third parties is protected by copyright, trademark, patent or other intellectual proprietary rights and laws.

Dispute Resolution

All issues and questions between BCBSIL, our licensors, the Provider and/or Provider Group, and/or you, arising out of, relating to, or in connection with these Terms of Use, their interpretation, application, performance, nonperformance or breach, or any information received or otherwise relied on (collectively, "Dispute" or "Disputes") shall be resolved using alternative dispute resolution mechanisms as set forth in the Mediation/Arbitration Provisions delineated below.

Mediation/Arbitration Provisions

1. Initial Resolution by Meeting or Mediation of Dispute.

   1. BCBSIL or Authorized User (the "Notice Party"), as the case may be, shall deliver written notice to the other party (the "Receiving Party"), via certified mail, return receipt requested, of the existence of a Dispute (the "Initial Notice"), as follows:

      If to BCBSIL:
      Blue Cross and Blue Shield of Illinois
      300 East Randolph Street
      Chicago, IL 60601-5099
      Attn: Legal Department
      

      If to Authorized User: At the last known address of record.

   2. The Receiving Party has thirty (30) calendar days following the Notice Party's delivery of such notice to schedule a meeting.

   3. If the Receiving Party has failed to provide a prompt and effective remedy within thirty (30) calendar days following delivery of such notice, and the Receiving Party and Notice Party mutually agree that a meeting to attempt to resolve the Dispute would be advantageous, representatives of both parties shall schedule a meeting within thirty (30) calendar days after delivery of the Initial Notice in order to attempt to resolve the Dispute. Subsequent meetings may be held, upon mutual agreement of the parties.

   4. If such a meeting has not been mutually agreed upon within thirty (30) calendar days of delivery of the Initial Notice, or if the Dispute has not been resolved within thirty (30) calendar days of commencement of any such meetings, the Notice Party shall submit the Dispute (the "Mediation Submission") to mediation by an organization or company specializing in providing neutral, third-party mediators. The mediation process shall be coordinated by the Notice Party with the mediator and shall be subject to the following agreed-upon conditions:

      1. The parties agree to participate in the mediation in good faith;

      2. The parties agree to have present at the mediation one or more individuals with decision-making authority regarding the Dispute;

      3. Either party may, at its option, be represented by counsel;

      4. The mediation shall be conducted in English;

      5. The mediation shall be held at a mutually agreed upon venue location in or near Chicago, Illinois within sixty (60) days of the Mediation Submission, unless the parties mutually agree on a later date or an alternate venue location; and

      6. The parties shall each bear their own costs and shall each pay one-half of the venue location fee and the mediator's fees and costs, unless the mediator subsequently determines that one party did not participate in the mediation in good faith, in which case that party shall pay all of the venue location fee and mediator's fees and costs.

   
   
2. Binding Arbitration.

   1. Any Dispute or portion thereof that remains unresolved thirty (30) calendar days after the Mediation, either BCBSIL or Authorized User, on Authorized User's own behalf and not as a representative of a purported class, shall submit the Disputes to final and binding arbitration (the "Arbitration Submission") under the commercial rules and regulations of JAMS/Endispute, subject to the following:

      1. The arbitration shall be conducted by a single arbitrator selected by the parties from a list furnished by JAMS/Endispute (the "Arbitrator"), provided that in the event of a conflict with the terms of these Mediation/Arbitration Provisions, the terms of the Mediation/Arbitration Provisions shall control. If the parties are unable to agree on such Arbitrator from the list, such Arbitrator shall be appointed by JAMS/Endispute or in the alternative, each party shall select one arbitrator who, in turn, shall together select the Arbitrator who shall arbitrate the Dispute.

      2. The Arbitrator shall be required to render a written decision resolving all Disputes with the reasons therefore, and designating one party as the "Prevailing Party" within sixty (60) days from the date of the Arbitration Submission.

      3. The costs of arbitration, including the venue location fee, Arbitrator's fee and any reporting or other costs, but excluding lawyers', consultants' and witness fees, shall be borne by the non-Prevailing Party unless the Arbitrator subsequently determines as part of his or her award that such allocation is inequitable under the totality of the circumstances.

      4. The arbitration hearing shall be conducted in English and held at a mutually agreed to venue location in or near Chicago, Illinois, unless BCBSIL and Authorized User mutually agree to an alternate location.

      5. Except with respect to any Dispute or portion thereof involving actual or alleged violation of BCBSIL's or any of BCBSIL's supplier's intellectual property, the Arbitrator shall not have power to award (A) damages inconsistent with the Terms of Use; or (B) punitive damages or any other damages not measured by the Prevailing Party's actual damages, and the parties expressly waive their right to obtain such damages in arbitration or in any other forum.

      6. Any determination by the Arbitrator with respect to any Dispute shall be final and binding on each party. Judgment upon the award of the Arbitrator may be entered in any court having competent jurisdiction thereof.

   2. Authorized User acknowledges that these Mediation/Arbitration Provisions preclude Authorized User from filing an action at law or in equity and from having any Dispute covered by this agreement resolved by a judge or a jury. Authorized User further acknowledges that these Mediation/Arbitration Provisions preclude Authorized User from participating in a class action or class arbitration filed by any other Authorized User or any other plaintiff claiming to represent Authorized User or Authorized User's interest. Authorized User agrees to opt-out of any class action or class arbitration filed against BCBSIL that raises claims covered by the Mediation/Arbitration Provisions, including, but not limited to, class actions or class arbitrations that are currently pending.

   3. Notwithstanding the foregoing, each of the parties hereto retains the right to seek judicial assistance to obtain interim measures of protection pending arbitration for alleged or imminent breaches of intellectual property rights, confidentiality restrictions or security obligations. In the event that either party seeks judicial assistance to obtain interim relief, or in the event that any dispute arises relating to arbitration, the sole jurisdiction and venue for such actions shall be the U.S. District Court located in or near Chicago, Illinois, or if there is no federal jurisdiction, in the state courts located in Illinois. Each of the parties to this Terms of Use hereby consents to exclusive personal jurisdiction, service of process and venue in the Illinois courts for such interim measures of protection and for disputes relating to arbitration.

Contact Us

If you have any questions or concerns about the Terms of Use or Privacy Statement, please contact us at:

Blue Access Internet Help Desk
(888) 706-0583
Monday - Friday 7 a.m. - 10 p.m. CT
Saturday 7 a.m. - 3:30 p.m. CT

v08.27.2013