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Does your patient have Access Blue? If so, no referrals required!

April 22, 2024

This article is for all providers caring for our members

Access Blue and Access Blue New England are two of our managed care plans. However, unlike a typical HMO plan, these members do not require a referral to see a specialist. Please see below for more important information.

As always, please verify benefits and eligibility for each member prior to rendering services, including authorization requirements and member cost (copayment, deductible, co-insurance).

	Access Blue	Access Blue New England
How do I identify an Access Blue or Access Blue New England member?	Their member ID number will begin with one of the following three-letter prefixes: XXF XXT	Their member ID number will begin with one of the following three-letter prefixes based on their home plan: Massachusetts: EHJ Connecticut: EHF Maine: EHG New Hampshire: EHH or BPP
Which providers can these members see?	Members can use any provider in our HMO Blue network, without the need for a referral.	Members can use any provider in our HMO Blue New England network, including participating providers in all New England states, without the need for a referral.
Do these members need to have a primary care provider (PCP)?	We recommend that the member chooses a PCP, but it is not required.	The member must choose a PCP from any of the six New England states: Connecticut Maine Massachusetts New Hampshire Rhode Island Vermont
Are referrals and authorizations required?	No referrals are required. Authorization is required for inpatient admissions. Certain outpatient services require authorization.	No referrals are required. Authorization requirements are determined by the state where the PCP participates, except mental health services which are determined by the home plan. For members with a Massachusetts PCP, certain outpatient services require authorization.

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