CommercialOctober 1, 2023
Blue High Performance Network
Blue High Performance NetworkSM (BlueHPNSM) plans offer access to providers with a record of delivering high-quality, efficient care. Since January 2021, we’ve been collaborating with select healthcare providers across the U.S. to make BlueHPN available to patients. Anthem Blue Cross and Blue Shield’s (Anthem) mission is to provide affordable, quality healthcare benefits to its members. This in-network only plan helps keep members’ healthcare costs more predictable and manageable.
It's important to know that only in-network care is covered. Members in the BlueHPN cannot go to out-of-network doctors or hospitals, except in an urgent and/or emergent situation. If they see a provider for routine or non-urgent care outside the BlueHPN, they will be responsible for paying the total billed charges.
Recognizing BlueHPN patients
You and your staff can identify patients enrolled in BlueHPN plans by their member ID card. The Blue High Performance Network name will be prominently displayed on the front of the member ID card, along with the BlueHPN suitcase logo, as shown on this sample card.
Eligibility and benefits
BlueHPN does not offer coverage for out-of-network care with the exception of urgent and/or emergent services. This means that BlueHPN patients will receive full benefits from in-network BlueHPN providers.
You can check BlueHPN plan member eligibility and benefits the same way you do today for HealthSync members — Either submit a HIPAA 270 eligibility and benefit request transaction or contact Provider Services at the number on the back of the member’s ID card.
Referrals to BlueHPN providers
BlueHPN is a comprehensive network that includes a full range of providers, from primary care doctors and specialists to hospitals. Not all healthcare providers are included. To ensure your BlueHPN patients will have full benefits when they need to see a specialist or another healthcare provider, it’s important that you only recommend other BlueHPN healthcare providers. You can use the Find a Doctor/Find Care tool at Anthem.com to identify BlueHPN healthcare providers by searching by the member’s ID or alpha prefix. This will help ensure your patients will be receiving care from healthcare providers who are also committed to quality care and cost-efficiency.
Formal physician-to-physician referrals are not required under BlueHPN plans, but out-of-network benefits are limited to urgent and/or emergent services only. That means referrals for non-emergency care to providers outside the BlueHPN network would be costly for your patients, including durable medical equipment and laboratory services.
Additional network information
More than 60 large metropolitan areas have their own high-performance networks sponsored by local Blue Cross and Blue Shield plans across the country, which gives national employers access to high quality, cost-efficient providers in these geographic areas. The Indiana BlueHPN uses the existing HealthSync network; therefore, you may see both local patients who have access to HealthSync through the Anthem plan and patients traveling from other cities where BlueHPN products are offered. Indiana-based employer-sponsored health plans with access to our Indiana High-Performance Network refer to the BlueHPN as HealthSync.
If you are not sure whether your practice is part of the Indiana BlueHPN — HealthSync, ask your office manager or business office or you can also contact your Anthem Provider Relationship account manager to find out or if you have any additional questions.
INBCBS-CM-033982-23
PUBLICATIONS: October 2023 Provider Newsletter
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