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Limited Networks

Some of our HMO, PPO, and EPO members have a plan with a limited network of providers—a network that’s smaller than our traditional HMO and PPO networks.

 
  • For the limited network plans that we administer, the network is called HMO Blue Select.
  • This same network is called Select Blue® with the EPO and PPO limited network plans offered through Blue Benefit Administrators of Massachusetts.
We also work with other Blue Plans to offer a national limited network: the Blue High Performance NetworkSM (Blue HPN SM).
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HMO 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.

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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. 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 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.

  • In the drop-down of network choices, choose HMO Blue Select
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 HMO 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)
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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
Resources
Blue HPN
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Overview
  • Launched in 2021, this national high-performance network is available in more than 65 major U.S. markets, including all top 10 U.S. cities.
  • In Massachusetts, the Blue HPN service areas are Bristol, Essex, Middlesex, Norfolk, Plymouth, Suffolk, and Worcester counties.
Plan coverage
  • In-network care only
  • Members do not have access to out-of-network providers, except for emergent care in the Blue HPN geographic area or urgent and emergent care outside of a Blue HPN geographic area.
Where to refer limited network members for care

Members do not have coverage for out-of-network care. For in-network care, please refer to another Blue HPN provider.

  • You can find a network provider using our Find a Doctor & Estimate Costs tool at member.bluecrossma.com/fad.
  • In the drop-down of network choices, choose Blue High Performance
Reimbursement
For services Advantage Blue EPO plans
Performed by a participating Blue HPN in-network provider           Reimbursement is paid at PPO contracted rates.
Performed by a participating Blue HPN out-of-network provider         Reimbursement for urgent or emergent services only will be paid at PPO contracted rates. Members may not be balance billed.
Performed by a non-participating provider Except for emergency services, there are no benefits for members who choose to receive services outside of the Blue HPN provider network. Reimbursement for emergency services will be paid directly to the subscriber, who will be responsible for reimbursing the provider.

Plans with limited networks

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
HMO 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
EPO
  • Advantage Blue Performance
  • Advantage Blue Performance Saver Advantage Blue Performance Deductible
  • Advantage Blue Performance Deductible Coinsurance
  • Advantage Blue Performance Deductible Coinsurance Tiered
  • Advantage Blue Performance Deductible Tiered
  • Advantage Blue Performance Saver Tiered
  • Advantage Blue Performance Tiered
Blue High Performance Network Blue Cross Blue Shield of Massachusetts