Behavioral Health Areas of Expertise Survey (Professional)

Blue Cross and Blue Shield of Illinois (BCBSIL) has enhanced its provider file to include Behavioral Health Areas of Expertise for Professional Providers. This enhancement will help us more accurately represent the services you provide to our members. Please complete and submit the survey below so that we may update our records accordingly. Select no more than five areas of expertise, along with the applicable age ranges. If you provide services at multiple locations, the areas of expertise you select will be applicable to all locations. Thank you for your participation!

Section 1: Demographics

Provider First Name:*
Provider Middle Initial:
Provider Last Name:*
Language(s) Spoken (other than English):
Practice Location Address:
Address Line 1:*
Address Line 2:
Contact Telephone Number:*
Questions marked with an asterisk (*) are mandatory.