Sept. 23, 2020
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. For Blue HPN service areas within Texas, refer to the table below of counties in and near Austin, Dallas-Fort Worth, Houston and San Antonio. *
How does this impact me?
- 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 service areas, members have access to emergent care with non-Blue HPN providers
- In non-Blue HPN service areas, members have access to urgent and emergent care
- Blue HPN member ID cards will have the Blue High Performance Network name and "HPN" in the suitcase logo on the front of ID cards issued before January 2021
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 Utilization Management - 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, please view 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 the Claims and Eligibility Section 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 or do not have Internet access, please contact your local BCBSTX Network Management Office.
* Network Management Office (city with designated Blue HPN county service areas) |
Telephone Number |
Fax Number |
|---|---|---|
Austin (Hayes, Travis and Williamson) |
512-349-4853 |
|
Dallas & Fort Worth |
972-766-2231 |
|
Houston & Beaumont |
1-713-663-1149 / 1-800-637-0171 press 3 |
713-663-1227 |
San Antonio & Laredo |
361-852-0624 |
|
Ancillary - Visit BCBSTX at Contact Us to find phone and fax by specialty. |
||
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.