Date

							March 25, 2008

Mr. Jeffrey S. Gold
Vice President, Managed Care and Special Counsel
Healthcare Association of New York State
One Empire Drive
Rensselaer, NY 12144

Re: Hospital Association Letter Regarding BlueCard®

Dear Jeffrey:

I wanted to follow-up on the concerns expressed in the March 17, 2008, letter from
the hospital associations regarding BlueCard. Please be assured that the Blue Cross
and Blue Shield Association (BCBSA), in collaboration with our member Plans, are
taking steps to resolve the issues that you raise. At this point, I would like to suggest
a personal meeting during which we can provide a comprehensive update on how we
are addressing your issues.

BlueCard Processing/Plan Performance Updates

The following is a general overview of some of the key initiatives that we discussed
with you last May. When we meet, we will review the status of these and other
planned changes.

     System Line Expansion: By October 2008, Blue Plans will have implemented
      changes to accommodate larger claims, 10-position dollar amounts, and 4-
      position units of service to eliminate most split claims.
     Enhanced Performance Measurement Program: By late 2008 the Blue
      System will introduce more comprehensive end-to-end timeliness and
      accuracy measures to include all Blue claims processing attempts, from receipt
      of claim to final adjudication, including adjustments.
     Eligibility/Claim Status Enhancements: Currently, Blue Plans support
      multiple service types on an eligibility inquiry, in addition to general inquiries,
      and will respond to that specific inquiry with benefit information in real-time.
      Effective December 31, 2008, all Blue Plans will also provide accumulated
      benefit information including deductibles, out-of-pocket and benefit limits.
     Medical Records Enhancements: Effective November 2007, a new
      technology was implemented to electronically forward, track and manage
      electronic records between Blue Plans.
Mr. Jeffrey S. Gold
March 25, 2008
Page 2




     Real-time Claims Adjudication: Beginning in 2010, the Blues will implement
      a multi-year approach to provider payment assurance that addresses provider
      challenges in determining and collecting consumer cost sharing. The
      approach includes implementing a provider-facing member liability estimation
      tool (2010) and real-time claims processing (2012).
     Provider Servicing Requirements: Effective April 1, 2008, all Blue Plans
      implemented new provider servicing requirements designed to support
      effective and timely resolution of inter-Plan claims issues.
     Medical Policy: While each Blue Plan currently makes an independent
      determination of the medical policy for its own members’ benefits, BCBSA has
      implemented a new process with an increased central capacity for medical
      policy research and development. This process, which includes enhanced
      clinical input from physician specialty societies and academic centers, could
      reduce the medical policy differences among the Blue Plans.

Blue Plan Contacts

To ensure that you have the ability to follow up directly with the Blue Plans serving
your state regarding the concerns you identified in your letter, please use the
following contact list. In addition, please feel free to contact me on any national
initiatives like the ones listed above.

     Blue Cross and Blue Shield of Florida: Brooks Stone, Vice President,
      Association Affairs; Telephone: 904.905.4434
     WellPoint: Jim Juliano, Director II, National Operations Management;
      Telephone: 203.234.5478
     Blue Cross and Blue Shield of Massachusetts: Walter Dennis, Vice
      President, Provider Services; Telephone: 617.246.7163
     Horizon Blue Cross and Blue Shield of New Jersey: Colleen Matthews,
      Director, Hospital Relations; Telephone: 973.466.7885
     HealthNow: Marisa Kelm, BlueCard Executive; Telephone: 716.887.2070
     Excellus: Lynn Persi, Vice President Inter-Plan Programs and Plan Relations;
      Telephone: 585.238.4580
     Blue Cross of Northeastern Pennsylvania: Walter Telech, BlueCard
      Executive and HIPAA Director; Telephone: 570.200.1638
     Capital Blue Cross: Nick Guarneschelli, Vice President, Provider Service;
      Telephone: 717.541.6651
Mr. Jeffrey S. Gold
March 25, 2008
Page 4




     Highmark Blue Cross Blue Shield: Augusta Kairys, Vice President, Provider
      Relations; Telephone: 412.544.8210
     Independence Blue Cross: Douglas Chaet, Senior Vice President
      Contracting & Provider Network; Telephone: 215.241.2120
     Blue Cross and Blue Shield of Rhode Island: John P. Tobin, Assistant Vice,
      President Contracting and Provider Services; Telephone: 401.459.1345
     BlueCross BlueShield of Tennessee: Maria Darras, Director, BlueCard
      Operations; Telephone: 423.535.7230

We appreciate your consideration and look forward to working with you and the other
hospital association members to evaluate and address any other concerns you have.

As an immediate next step, we would like to schedule a meeting between your
members, the Blue Plans, and BCBSA to discuss the issues in greater detail. You
can expect to hear more regarding the meeting within the next two weeks.

If you have any questions, please contact me at 312.297.5993 or Kari Hedges at
312.297.5648.

Sincerely,



Frank Coyne
Vice President, Inter-Plan Programs


cc:

Paula A. Bussard, Senior Vice President, Policy and Regulatory Services
The Hospital and Healthsystem of Pennsylvania

Pat Moran, Vice President, Finance
Hospital Association of Rhode Island

Karen Granoff, Senior Director, Managed Care Policy
Massachusetts Hospital Association

Paula Minnehan, Vice President, Finance and Rural Hospitals
New Hampshire Hospital Association

Jill Squiers, Assistant Vice President
New Jersey Hospital Association
Mr. Jeffrey S. Gold
March 25, 2008
Page 4




Kim Streit, Vice President, Healthcare Research and Information
Florida Hospital Association

Gwen Walters, Vice President for Research and Reimbursement
Tennessee Hospital Association

The Honorable Eric Dinallo, Superintendent, New York State Insurance Department

The Honorable Joel S. Ario, Acting Commissioner, Pennsylvania Insurance
Department

The Honorable Christopher F. Koller, Commissioner, Rhode Island Insurance
Department

The Honorable Nonnie Burnes, Commissioner, Massachusetts Division of Insurance

The Honorable Roger A. Sevigny, Commissioner, New Hampshire Insurance
Department

The Honorable Steven M. Goldman, Commissioner, New Jersey Department of
Banking and Insurance

The Honorable Kevin M. McCarty, Commissioner, Florida Office of Insurance
Regulation

The Honorable Leslie A. Newman, Commissioner, Tennessee Department of
Commerce & Insurance

Kari Hedges, Executive Director, Inter-Plan Programs, BCBSA