The New England Health Plans (NEHP) are managed care products that offer accounts a regional managed care benefit plan that covers all employees regardless of where they live or work in New England.
The NEHP managed care products are the result of collaboration among the six New England Blue Cross Blue Shield (BCBS) Plans created to simplify claim processing for health care Providers and enrollment for Members. Participating BCBS Plans include:
Host Plan Only:
The Home Plan is the BCBS Plan with whom the Member has a contract. The Member’s benefits are determined by the Home BCBS plan.
The Host Plan is the BCBS Plan where the Member is receiving services if outside of their Home Plan.
BCBSMA offers health maintenance organization (HMO) and point-of-service (POS) plan designs through these five products:
HMO Blue New England plans require a primary care provider (PCP) for the coordination of the member's care and for referrals to an in-network specialist.
Blue Choice New England plans require a PCP for the coordination of the members care, but provides the member the flexibility to self-refer to any BCBS-participating provider.
Access Blue New England plans require a PCP for the coordination of the members care, but provides the member the flexibility to self-refer to specialists within the network.
You can identify NEHP Members by their BCBS Plan ID card. Be sure to ask all visiting members for their ID card. The main identifier for NEHP Plans is the name of the health plan/product in the upper right-hand corner of the ID card, and the three-character prefix preceding the ID. You’ll also see the suitcase logo on the card. Identifying members from other states is easy. Below we’ve listed the ID card prefixes for each state offering plans. Members from other states may be entitled to additional mandated benefits.
|Connecticut||CTN, CTP, EHF, APQ, APR, APG|
|Maine||MEN, MEP, EHG, BFZ, BDD, BHI, XJV, MEY, TXH|
|New Hampshire||NHN, NHP, EHH, NHN, BKA, YGL, BYV, YGI, BPP, YGE, ZZG, ZXW, NMY, YGL|
|Rhode Island||RIN, RIS, RIA|
The following guidelines apply for NEHP member services when the member has a Massachusetts PCP. If the member has a PCP in a different New England state, please contact the member's PCP directly.
|Plan notification for referrals to:||Are:||To submit the referral:|
|Out-of-state NEHP providers contracted outside of Massachusetts||Required||Call 1-800-327-6716. (Notification does not guarantee plan approval).|
|Non-participating specialists or to specialists outside of New England||Required||Call 1-800-327-6716.|
* An authorization may be required for chiropractic care after the 12th visit in a calendar year. Refer to our Authorization Quick Tip, or, if you are logged into Provider Central as a chiropractor, visit our Chiropractic Services page for more information.