BlueCross BlueShield of Texas
 
 

Network Selection Criteria for Doctors and Hospitals


Network Selection Criteria for Doctors

Blue Cross and Blue Shield of Texas (BCBSTX) does not use quality measures, member experience measures or cost-related measures to select practitioners for participation in the Blue Choice PPO, Blue Advantage (BAV) HMO, Blue Advantage Plus HMO, Blue Cross Medicare Advantage (PPO), Blue Cross Medicare Advantage (HMO), Blue Essentials, HealthSelect, Blue Premier and Blue Premier Access Marketplace plans. BCBSTX evaluates the Blue Choice PPO, Blue Advantage (BAV) HMO, Blue Advantage Plus HMO, Blue Cross Medicare Advantage (PPO), Blue Cross Medicare Advantage (HMO), Blue Essentials, HealthSelect, Blue Premier and Blue Premier Access networks and takes into consideration the geographic distribution of medical and behavioral health providers to ensure that BCBSTX members have access to participating providers within federal and state availability and accessibility standards.

BCBSTX ensures that our practitioner network includes primary care practitioners, behavioral health practitioners and specialists that treat the highest volume conditions to meet our members' needs, including Cardiology, Endocrinology, OB/GYN, Oncology and Orthopedics among others.

The behavioral health specialty types available in these BCBSTX networks include, Psychiatry (including Psychiatry, Child Adolescent Psychiatry and Geriatric Psychiatry), Clinical Psychology, Licensed Clinical Social Worker, Licensed Counselor (including Licensed Professional Clinical Counselor and Licensed Marriage and Family Therapist).

Network Selection Criteria for Hospitals

Blue Cross and Blue Shield of Texas (BCBSTX) does not use quality measures, member experience measures or cost-related measures to select hospitals for participation in the Blue Choice PPO, Blue Advantage (BAV) HMO, Blue Advantage Plus HMO, Blue Cross Medicare Advantage (PPO), Blue Cross Medicare Advantage (HMO), Blue Essentials, HealthSelect, Blue Premier and Blue Premier Access Marketplace plans. BCBSTX evaluates the Blue Choice PPO, Blue Advantage (BAV) HMO, Blue Advantage Plus HMO, Blue Cross Medicare Advantage (PPO), Blue Cross Medicare Advantage (HMO), Blue Essentials, HealthSelect, Blue Premier and Blue Premier Access networks and takes into consideration the geographic distribution of hospitals to ensure that BCBSTX members have access to participating hospitals within federal and state availability and accessibility standards.