Home > Office Resources > Plans & Products > Product Overview
Web Content Viewer
Limited Networks

Some members may have a plan with a limited network of providers—a network that’s smaller than our traditional HMO and PPO networks. For the plans that we administer, the network is “Blue Select." We use the “Select Blue®” name when offered through Blue Benefit Administrators of Massachusetts. Blue Select and Select Blue have the same network of providers.

Plan Network Administered by
HMO
  • HMO Blue Select (with a deductible of $1,000, $2,000, $3,000, or a deductible with a copayment)
  • Access Blue Select Saver (with a $2000 deductible)
  • Network Blue Select Deductible
Blue Select Blue Cross Blue Shield of Massachusetts
PPO
  • PPO with Select Blue
EPO
  • EPO with Select Blue
Select Blue Blue Benefit Administrators of Massachusetts, our third party administrator
Expand All
Blue Select limited network

Members with an HMO Blue Select plan have a smaller network of doctors and hospitals to choose from than our traditional HMO network.

Expand All
Overview of the limited network
  • Functions like a traditional HMO, but with a concentrated network of lower-cost doctors and hospitals.
Plan coverage
  • Members must choose a primary care provider (PCP) from their limited network of providers.
  • HMO members only have coverage from in-network providers, except in specific circumstances (for example, urgent or emergent care).
  • Prescription plan coverage may be with us (administered by Express Scripts). If it is, you’ll see an Rx symbol on the front of the member’s ID card.
  • Referral and authorization rules are the same as our non-limited network HMO plans.

HMO members with a limited network don’t have coverage for out-of-network services, except in certain circumstances, and will be financially responsible for out-of-network care.

How to identify a member with a limited network using their Member ID card

  • On the front of the card, we’ll indicate if they have a “limited” network of providers (see sample ID card below).

    Tip: Members who have our MyBlue member app can email you a copy of their ID card.

How to identify a member with a limited network using Online Services (through our Provider Central website)
  • Perform a check of the member’s eligibility and benefits:
  • Enter the member ID and date of birth
  • Under Service Type, click Health Benefit Plan Coverage
  • Press Send to payer
  • Under the General Eligibility Information section, look for the HMO Blue Select name
  • Under the Health Benefit Plan Coverage section, you’ll see that the member has a “limited network”

Example of an eligibility and benefit check in Online Services

How to identify a member with a limited network using a 270/271 transaction
  • In the EB05 segment, you’ll see “HMO BLUE SELECT”
  • In the MSG segment, look for “HMO BLUE LIMITED NETWORK”
Where to refer limited network members for care

For in-network care, please refer to another Blue Select limited network provider.

  • Choose Select your network to continue (not logged in)
  • In the drop-down of network choices, choose HMO Blue Select (see example)
AIM's website for pre-certification for high-technology radiology and sleep study services

AIM Specialty Health’s website includes our full network of HMO providers for you to choose from, but a member who has a limited network does not have access to the full network. Please check the member’s network of providers before referring them for high-technology radiology or sleep study services to make sure you are referring them to an in-network provider. To check, you can use the tools noted above in the “where to refer limited network members for care” section.

AIM Specialty Health is the vendor we use for pre-certification or prior authorization for a high-technology radiology or sleep study outpatient service.

Your reimbursement for plans with the Blue Select limited network
If your participation status for our limited network is And the member has an HMO plan with the Blue Select limited network
In-network provider
  • Reimbursement is paid at HMO contracted rates.
Out-of-network provider
  • Plan approval is required for any out-of-network service, unless the member requires emergent or urgent care.
  • Reimbursement for an approved, out-of-network service will be paid to the provider at HMO contracted rates.
Non-participating provider
  • In emergent or urgent situations, plan approval is not required. We reimburse at charges, paid to the subscriber.
  • If a member is admitted to a non-participating hospital for emergent care, we may request that the member be transferred to an in-network hospital for care, once stabilized.
  • Plan approval is required for any out-of-network service that is not emergent or urgent. Approved out-of-network services are paid at negotiated rates (if applicable), or at charges, and will be paid directly to the provider.
Select Blue limited network (administered by Blue Benefit Administrators of Massachusetts)
Expand All
Overview
  • Members are encouraged to seek care from an in-network provider whenever possible.
  • Referrals are not required.
  • Emergency care is covered.
  • Select Blue is available to self-insured employers who can choose PPO and EPO benefit plans with the Select Blue network.
  • Blue Benefits Administrators (BBA) administers the benefits.

Sample ID card for Select Blue members.

When to contact Blue Benefit Administrators of Massachusetts

For eligibility and benefits, claim, reimbursement, or authorization inquiries, contact BBA:

Submitting claims
Electronic Mail
Through a clearinghouse, use electronic payer ID 03036 Blue Benefit Administrators of MA
P.O. Box 55917
Boston, MA 02215-3326
Reimbursement
For services Select Blue Exclusive Provider Organization (EPO) Plans Select Blue PPO Plans
Performed by a participating Select Blue in-network provider
  • Reimbursement is paid at PPO contracted rates.
  • Reimbursement is paid at PPO contracted rates.
Performed by a participating Select Blue out-of-network provider
  • Plan approval is required for any out-of-network service, unless the member requires emergent or urgent care.
  • Reimbursement for an approved,
    out-of-network service or emergent and urgent care will be paid directly to the provider at PPO contracted rates. Members are responsible for their cost sharing and may not be balance billed.
  • Reimbursement for out-of-network services, including urgent and emergent services, will be paid directly to the provider at PPO contracted rates. Members are responsible for their cost sharing and may not be balance billed.
  • Members can use their out-of-network benefits; however, as with our other PPO plans, the member will incur a higher cost-share for out-of-network services.
Performed by a non-
participating
provider
  • Plan approval is required unless the member requires emergent or urgent care.
  • Reimbursement for a pre- approved service performed by a non-participating provider will be paid directly to the provider.
  • In emergent or urgent situations, reimbursement is paid directly to the subscriber who will be responsible for reimbursing the provider.
  • If a member is admitted to a non-participating hospital for emergent or urgent care, we may request that the member be transferred to an in-network hospital for care, once stabilized.
  • Members can use their out-of-network benefits; however, the member will incur a higher cost-share for out-of-network services performed by a non-participating provider.
  • Reimbursement for any services performed by a non-participating provider will be paid directly to the subscriber, who will be responsible for reimbursing the provider. Members may be balance billed (in addition to their cost share for the service) for amounts above the allowed amount under their Select Blue plan. An Indemnity, Medicare, or other fee schedule may apply in determining the allowed amount.
Resources