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Check if member has a limited network plan
August 18, 2022

We want to remind you that some of our members have plans with a limited network of providers. Not all providers are eligible to participate in these networks and you may not be eligible for reimbursement if you are an out-of-network provider delivering services to these members. It’s important that you check your patients’ member eligibility using ConnectCenter to ensure you are an in-network provider according to their plan.

What are our limited network plans?

Members with limited network plans only have coverage for in-network providers, except in certain circumstances such as emergencies or when out-of-network coverage has been pre-approved. There are three networks covering patients in limited network plans.

Network Plans

Blue Select
Functions like a traditional HMO, but with a concentrated network of lower-cost doctors and hospitals
  • HMO Blue Select
  • Access Blue Select Saver Network
  • Network Blue Select Deductible

Select Blue®
Covers members in certain PPO and EPO benefit plans administered by Blue Benefit Administrators of Massachusetts, our third-party administrator
  • PPO with Select Blue
  • EPO with Select Blue

Blue High Performance Network
A national, limited network of providers in more than 65 major markets covering members in certain EPO benefit plans

  • Advantage Blue Performance
  • Advantage Blue Performance Saver Advantage Blue Performance Deductible
  • Advantage Blue Performance Deductible Coinsurance

How do you check member eligibility?

You can identify members in limited network plans and determine whether they’re covered using our eTool, ConnectCenter™.

  • Log in to Provider Central. On the left-hand side of the secure homepagesecure homepage, you’ll see an eTools box. Click on ConnectCenter.
  • Go to Verification>New Eligibility Request.
  • Enter or find the requesting provider.
  • For detailed benefits information, go to the Service Type dropdown menu andselect a specific service type. The default option, Health Benefit Plan Coverage, includes many common services.
  • Click Submit. Eligibility results will appear below the Submit button.
  • Click Human Readable to view limited network information.
  • Use the search field to search for “Plan coverage description” and scroll to the matching text to find the name of the member’s plan.
  • Use the search field to search for “Services restricted” and scroll to the matching text to find the plan network and information about coverage.

For detailed instructions on eligibility requests with visual aids, please see our Limited Network Information in ConnectCenter Quick Tip.

How do you refer patients with limited network plans?

Please refer your patients to in-network providers for their care.

  • Use our Find a Doctor & Estimate Costs tool to locate an in-network provider.
  • Select the appropriate network in the Select a network dropdown menu, enter a location and appropriate provider specialty in the search fields, and click Search.

Questions?

If you have any questions, please call Network Management and Credentialing Services at
1-800-316-BLUE (2583). As always, thank you for the care you provide to our members.

Resources

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