Blue High Performance Network^SM (Blue HPN)^SM to launch in January 2021

Beginning Jan. 1, 2021, Blue Cross and Blue Shield of Texas (BCBSTX) is launching Blue HPN, a new national high-performance network for large Administrative Services Only (ASO) employer groups. Blue HPN will provide additional access to quality and affordable health care nationwide in 55 major markets. For Blue HPN service areas within Texas, see the table below of counties in and near Austin, Dallas-Fort Worth, Houston and San Antonio^*.

Blue HPN value

Provider participation in Blue HPN is based on a range of factors, including:

• Performance on national quality indicators, such as measures to close clinical care gaps and impact patients’ quality of life
• Performance on local quality indicators, including measures to address local health care challenges and align with community health disparities
• Partnership with BCBSTX to improve affordability, efficiency and health outcomes

Treating Blue HPN patients

• Blue HPN follows the current processes and requirements of our Blue Choice^® PPO network^*
• There are no Primary Care Provider (PCP) or referral requirements for in-network specialists
• In Blue HPN service areas, patients have access to emergent care with non-Blue HPN providers
• In non-Blue HPN service areas, patients have access to urgent and emergent care

Recognizing Blue HPN members

You can identify Blue HPN members by their BCBSTX ID card. Look for the Blue High Performance Network name and the “HPN in the suitcase” logo on the front. This logo indicates that Blue HPN rates apply. To receive additional information on rates, please contact your local Network Management office.

Checking eligibility and benefits

Patient eligibility and benefits should be checked using Availity^® Provider Portal  or your preferred vendor before every scheduled appointment. Eligibility and benefit quotes include patients' coverage status and other important information, such as applicable copays, coinsurance and deductibles. It's strongly recommended that providers ask to see patients' ID card and photo ID to guard against medical identity theft. If services may not be covered, patients should be notified that they may be billed directly.

Prior Authorization

• You can check the Prior Authorization and Predeterminations page for the list of ASO services and procedure codes that require prior authorization for Blue HPN. Refer to How to Submit a Prior Authorization or Prenotification to learn about submission processes.
• For out-of-area members, see our BlueCard^® information and the BlueCard authorization process and requirements.

Reminders

Submit claims to BCBSTX as you typically would for Blue Choice PPO. Refer to Claims and Eligibility for more details. Watch News and Updates and our Blue Review newsletter for more details on Blue HPN.

If you have additional questions, need Blue HPN rates, would like to apply to join the network or do not have Internet access, please contact your local BCBSTX Network Management Office:

As a reminder, it is important to check eligibility and benefits before rendering services. This step will help you determine if benefit prior authorization is required for a member. For additional information, such as definitions and links to helpful resources, refer to the Eligibility and Benefits section on BCBSTX’s provider website.

Please note that checking eligibility and benefits, and/or the fact that a service or treatment has been prior authorized or predetermined for benefits are not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things the participant's eligibility and the terms of the member's certificate of coverage applicable on the date services were rendered. If you have questions, contact the number on the ID card.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third-party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.