CommercialAdministrativeMedium impact
Remind Blue High Performance Network® Members To See In-Network Providers
BCBS Illinois·IL·General
We identified it
Sep 11, 2026
Summary
This policy reminds providers that Blue High Performance Network (BlueHPN) members have coverage ONLY when seeing in-network BlueHPN providers, except in emergencies. Providers should verify member eligibility via Availity before rendering care and remind members to use in-network providers to avoid out-of-pocket costs. Claims should be submitted following standard BlueCard procedures.
Action Required
Immediately: (1) Billing and front desk staff must verify BlueHPN member eligibility and in-network status via Availity Essentials BEFORE rendering any services. (2) When recommending specialists or other providers to BlueHPN members, remind them to select in-network BlueHPN providers to ensure full coverage and avoid unexpected out-of-pocket costs. (3) Identify BlueHPN members by looking for 'Blue High-Performance Network' on the front of their member ID card. (4) Submit all BlueHPN claims (both local and out-of-area) to BCBSIL following standard BlueCard claim procedures, including the three-character member ID prefix. (5) Educate clinical staff that BlueHPN members do NOT need to select a primary care physician or obtain referrals for in-network specialists, but out-of-network coverage is limited to emergent care within BlueHPN geographic areas and urgent/emergent care outside those areas. Failure to verify in-network status may result in claim denials and member complaints regarding unexpected out-of-pocket costs.