12/14/2023
Thousands of BlueHPN members have access to quality and affordable health care in the Austin, Dallas-Fort Worth-Arlington, Houston and San Antonio areas.
BlueHPN is an exclusive provider network with participation from Blue Cross and Blue Shield Plans nationwide. BlueHPN members must stay in network to receive benefits. There are no out-of-network benefits except for emergency, accident and urgent care scenarios.
Here are some tips as you serve these members:
How to Recognize Blue HPN Members
You can identify BlueHPN members by their member ID card. Look for the Blue High Performance Network name on the front along with the initials “BlueHPN” in a suitcase. This logo indicates that BlueHPN rates apply.
Check eligibility and benefits first
Use Availity® Essentials or your preferred vendor to check eligibility and benefits for all BCBSTX members before every scheduled appointment. 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 prior authorization requirements.
Emergent Care
Members have access to BlueHPN providers as well as non-BlueHPN providers in an emergency situation.
Treating BlueHPN Members
You may work in multiple locations or for multiple medical groups with multiple tax identification numbers (TINs) or national provider identifiers (NPIs). Because BlueHPN members do not have out-of-network benefits, please make sure you’re rendering care at an in-network facility under the TIN or NPI that is contracted with BlueHPN.
Referring to Specialists
When BlueHPN members need to see a specialist or another health care provider, refer them to participating BlueHPN providers to ensure they receive in network benefits. Check BCBSTX’s online Provider Finder® or call the number on the member’s ID card to identify other providers in BlueHPN.
Claim Filing
BlueHPN follows the same claims filing process as our commercial members. Submit local and out-of-area BCBS member claims to BCBSTX as you typically would. See the Claim Filing Tips page for more details.
Joining BlueHPN
Visit our BCBSTX contracting web page for details on joining the BlueHPN network.
Questions? Call the Customer Service number on the member’s ID card.
Checking eligibility and/or benefit information and/or obtaining prior authorization 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, including, but not limited to, exclusions and limitations applicable on the date services were rendered. If you have any questions, call the 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 BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third party vendors.