CommercialAdministrativeHigh impact
Remind Blue High-Performance Network® Members To See In-Network Providers
BCBS Texas·TX·General
We identified it
Sep 11, 2026
Summary
This policy clarifies that Blue High-Performance Network (BlueHPN) members have coverage ONLY when seeing in-network BlueHPN providers, except in emergencies. The billing team must verify BlueHPN membership via member ID card, check eligibility in real-time before rendering care, and remind members to use in-network providers to avoid unexpected out-of-pocket costs and claim denials.
Action Required
Immediately: (1) Billing team must implement pre-service eligibility verification workflow for all BlueHPN members using Availity Essentials or preferred web vendor before rendering care or services. (2) Front desk and clinical staff must verify member ID cards for BlueHPN designation at check-in. (3) Providers must remind BlueHPN members to select in-network BlueHPN providers before referring to specialists or other providers. (4) Update all referral forms and provider lists to highlight BlueHPN in-network requirements. (5) Billing team must use the three-character member ID prefix and submit claims to BCBSTX using standard BlueCard procedures. (6) Document all out-of-network services as emergent/urgent only per policy guidelines. Consequence: Claims for non-emergency out-of-network care will be denied, resulting in member liability and potential payment disputes.