September 22, 2020
In January 2021, Blue Cross and Blue Shield of Illinois (BCBSIL) is launching Blue HPN, a new national high-performance network for large commercial employer groups. Blue HPN will provide additional access to quality and affordable health care in more than 55 major U.S. markets. In Illinois, Blue HPN will be available in Chicago, Naperville-Elgin and East St. Louis.
Blue HPN Value
Provider participation in Blue HPN is based on a range of factors, including:
- Performance on national quality indicators, such as measures to close clinical care gaps and impact members’ quality of life
- Performance on local quality indicators, including measures to address local health care challenges and align with community health disparities
- Partnership with BCBSIL to improve affordability, efficiency and health outcomes
Visit the Network Participation page for details on joining the network.
Treating Blue HPN Members
Blue HPN members have full benefits only when receiving care from in-network Blue HPN providers contracted with BCBSIL and with other Blue Cross and Blue Shield (BCBS) Plans.1 Members do not need to choose a primary care physician or get referrals for in-network specialists.
- In Blue HPN service areas: Blue HPN members have access to emergent care with non-Blue HPN providers in Blue HPN service areas. They do not have out-of-network coverage for non-emergency care in these areas.
- In non-Blue HPN service areas: Blue HPN members have access to urgent and emergent care with non-Blue HPN providers in these areas.
- When Blue HPN members need to see a specialist or another health care provider, you can help ensure members receive the highest level of benefits by recommending other in-network Blue HPN providers. Check BCBSIL’s online Provider Finder® or call the number on the member ID card to identify in-network Blue HPN providers.
How to Recognize Blue HPN Members
You can identify Blue HPN members by their BCBSIL 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.
Reminder: Check eligibility and benefits first. Use the Availity® Provider Portal or your preferred vendor to check eligibility and benefits for all BCBSIL 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. Ask to see the member’s BCBSIL ID card and a driver’s license or other photo ID to help guard against medical identity theft.
Claim Filing
Blue HPN follows the same claims filing procedures as our BlueCard® PPO. Submit local and out-of-area BCBS member claims to BCBSIL as you typically would. See the Claim Submission page for more details, including a link to the updated BlueCard Program Manual.
Questions? Call the Customer Service number on the member’s ID card.
[1]The only out-of-network coverage available to Blue HPN members in Blue HPN service areas is out-of-network emergency care.
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 BCBSIL. BCBSIL 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.