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HMO specialty care benefit design launches for certain accounts
June 1, 2020

This article is for acute care hospitals and physicians caring for our members

We created the Blue Distinction for Specialty Care benefit design because employers are looking to us to customize health benefit designs, lower costs, and improve quality outcomes for their employees. Currently, we offer a PPO version of this benefit design and are making an HMO version available to our accounts on July 1, 2020.  

The Blue Distinction for Specialty Care benefit design provides incentives for members to seek care for certain conditions from Blue Distinction Centers (BDC) for Specialty Care. Members with this benefit design will not only experience lower cost share, but greater quality outcomes when they receive care for the conditions listed below at a BDC center.

What is Blue Distinction for Specialty Care?

The Blue Distinction Specialty Care Program is the Blue Cross Association’s national centers of excellence designation program. It recognizes providers that demonstrate expertise in delivering quality specialty care safely, effectively, and cost-efficiently for six high-impact specialties:

  • Bariatric surgery
  • Cardiac care
  • Knee and hip replacement
  • Maternity care
  • Spine surgery
  • Transplants.

How to identify members with this benefit design?

This new benefit design applies only to members whose employers offer them this product design. That’s why it’s important to check benefits and eligibility before requesting authorization and referring a member for specialty care.

If you offer one of the services listed above and your facility is not Blue Distinction-designated, avoid denied claims by checking eligibility and benefits when scheduling the service and again on the date of service.

Please note that an authorization approves medical necessity only. It does not tell you whether the member’s plan covers the service and if they are eligible.

How to confirm the Blue Distinction status of a facility

Members with this benefit design may request that their specialty care be performed at a BDC-designated facility or provider within their plan’s service area to minimize their out of pocket costs. To confirm the BDC status of a facility, or to find a BDC-designated provider, please visit: https://www.bcbs.com/blue-distinction-center/facility. Be sure to filter the results based on the member’s service area. 


To learn more, please call Network Management & Credentialing Services at 1-800-316-BLUE (2583)