Sep. 23, 2020
In January 2021, the Blue Cross and Blue Shield System is launching Blue High Performance NetworkSM (Blue HPNSM), a new national network for large commercial employer groups. While Blue Cross and Blue Shield of Montana (BCBSMT) doesn’t currently offer this network, providers in our networks may provide urgent and emergent care to Blue HPN members from other BCBS Plans.
What non-participating Blue HPN providers need to know
- Because Blue HPN is not available in Montana, urgent and emergent care provided by BlueCard® PPO providers is covered for Blue HPN members.
- For these limited benefits, non-Blue HPN providers will be reimbursed according to their BCBSMT provider contract, as they are for other Preferred Provider Organization (PPO) products. All other services are considered out-of-network, and the member will need to pay 100 percent of the billed charges.
- The network follows the same procedures as our BlueCard PPO for filing claims and checking eligibility and benefits.
Recognizing Blue HPN members
You can identify Blue HPN members by their member ID card. Look for the Blue High Performance Network name on the front, along with the “HPN in a suitcase” logo. This logo indicates that Blue HPN rates apply.
Checking eligibility and benefits: Use Availity® or your preferred vendor to check eligibility and benefits for all Blue Cross and Blue Shield members before every scheduled appointment, including for Blue HPN members. Eligibility and benefit quotes include membership confirmation, coverage status and applicable copayment, coinsurance and deductible amounts. The benefit quote may also include information on applicable benefit prior authorization requirements. Ask to see the member’s ID card and a driver’s license or other photo ID to help guard against medical identity theft.
Filing claims: Submit local and out-of-area claims to BCBSMT as you typically would. See the Eligibility and Claims section of our website for more details.
Questions? Call the Customer Service number on the member’s ID card.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSMT. BCBSMT makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by the vendor, you should contact the vendor directly.
Checking eligibility and/or benefit information and/or the fact that a service has been preauthorized is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have any questions, call the number on the member’s ID card.
