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.
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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.
- You can find a network provider using our Find a Doctor & Estimate Costs tool at bluecrossma.com/findadoctor.
- 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 |
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| In-network provider |
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| Out-of-network provider |
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| Non-participating provider |
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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:
- Online at bluebenefitma.com
- By phone at 1-877-707-2583
Submitting claims
| Electronic | |
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| 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 |
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| 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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Resources
- 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
- ConnectCenter
Resources
- 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
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 |
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| 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 |
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HMO
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HMO 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 |
