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.
We also work with other Blue Plans to offer the Blue High Performance Network SM (Blue HPN SM)—a national limited network of providers that’s based on Blue Select network in Massachusetts.
| Plan | Network | Administered by |
|---|---|---|
HMO
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Blue Select | Blue Cross Blue Shield of Massachusetts |
PPO
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Select Blue | Blue Benefit Administrators of Massachusetts, our third party administrator |
EPO
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Blue High Performance Network | Blue Cross Blue Shield of Massachusetts |
Members with an HMO Blue Select plan have a smaller network of doctors and hospitals to choose from than our traditional HMO network.
- Functions like a traditional HMO, but with a concentrated network of lower-cost doctors and hospitals.
- 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.
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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. |
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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.
- In the EB05 segment, you’ll see “HMO BLUE SELECT”
- In the MSG segment, look for “HMO BLUE LIMITED NETWORK”
For in-network care, please refer to another Blue Select limited network provider.
- You can find a network provider using our Find a Doctor & Estimate Costs tool at bluecrossma.com/findadoctor.
- Choose Select your network to continue (not logged in)
- In the drop-down of network choices, choose HMO Blue Select (see example)
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.
| 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 |
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| Out-of-network provider |
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| Non-participating provider |
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- 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.
For eligibility and benefits, claim, reimbursement, or authorization inquiries, contact BBA:
- Online at bluebenefitma.com
- By phone at 1-877-707-2583
| Electronic | |
|---|---|
| Through a clearinghouse, use electronic payer ID 03036 | Blue Benefit Administrators of MA P.O. Box 55917 Boston, MA 02215-3326 |
| For services | Select Blue Exclusive Provider Organization (EPO) Plans | Select Blue PPO Plans |
|---|---|---|
| Performed by a participating Select Blue in-network provider |
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| Performed by a participating Select Blue out-of-network provider |
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| Performed by a non- participating provider |
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- Providers and members can use Blue Benefits Administrators' Locate a Network Provider tool to find a doctor or other health care provider.
- Our Blue Benefits Administrators Handbook. Log in and go to Office Resources>Policies & Guidelines>Provider Manuals.
- ConnectCenter
- Launched in 2021, this national high-performance network is available in more than 55 major U.S. markets.
- In Massachusetts, the Blue HPN service areas are Bristol, Essex, Middlesex, Norfolk, Plymouth, and Suffolk counties.
- In-network care only
- EPO benefits are limited to emergency care at a hospital facility only for non-Blue HPN providers.
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.
- Choose Select your network to continue (not logged in)
- In the drop-down of network choices, choose Blue High Performance Network (see example)
You’ll only see Blue HPN in-network providers when requesting authorization from AIM Specialty Health. AIM Specialty Health is the vendor we use for prior authorization for genetic testing, high-technology radiology, and sleep study outpatient services.
| 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. |
