Blue Cross NC Launches Newly Expanded High-Performance Network for 2022

Effective January 1, 2022, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is excited to expand the Blue High Performance Network℠ (BlueHPN℠) in the Triangle and Hickory areas. BlueHPN is a national quality-based network that will provide members with access to a comprehensive set of high-quality doctors, hospitals, and specialists, while lowering costs for employers. More than 185 million Americans in over 65 major markets will have access to BlueHPN across the country. Blue Cross NC previously shared information about BlueHPN in December of 2020.

BlueHPN Providers  

• Blue Cross NC is collaborating with participants of Blue Premier for BlueHPN. Blue Premier holds health systems and Blue Cross NC jointly accountable for better health outcomes, exceptional experience and lower costs.   
  
• Triad area: Wake Forest Baptist Health/Atrium Health Wake Forest Baptist   
• Charlotte area: Atrium Health  
• Triangle area: Duke Health/Aledade 
• Hickory area: Frye Regional Medical Center and Iredell Memorial Medical Center 
• BlueHPN will expand to other areas of the state beyond January 2022 

BlueHPN as an EPO Health Plan   

BlueHPN is an Exclusive Provider Organization (EPO). An EPO is a health plan that offers a large, national network of doctors and hospitals for members to choose from. If a member seeks medical care outside of their EPO plan’s network (such as a doctor, hospital, clinic or pharmacy that is not an EPO provider), those out-of-network services are typically not covered under your EPO health plan. Urgent/emergent care will be covered out-of-network outside of the member’s medical service area.  

Please refer to the grid below for further details:  

Participating BlueHPN Provider

Non-Participating BlueHPN Provider

Blue Cross NC EPO Product High Level Benefit Comparison

Blue Options EPO ID Card Disclaimer – OON Emergency Care –   

• No Out of Network benefits except for emergencies  
  

BlueHPN EPO ID Card Disclaimer – Urgent and Emergency Care –   

• Visit BlueHPN Urgent Care provider if in BlueHPN area. Visit any Urgent Care provider if outside of BlueHPN area. Emergency Care is covered.  
  

Recognizing BlueHPN Members  

A BlueHPN member can easily be identified by their member ID card. The BlueHPN name will be prominently displayed on the front of the member ID card, along with the “BlueHPN in a suitcase” logo. This “BlueHPN in a suitcase” logo indicates that BlueHPN rates apply. If the BlueHPN name or logo is not on the front of the member ID card, member is not in BlueHPN and other rates apply. Detailed information for providers describing the specifics of BlueHPN can be found in the BlueHPN Provider Playbook (PDF). 

Member Benefits 

Enrolled members have in-network benefits only. There are no out of network benefits except for urgent and emergent care. However, members enrolled in BlueHPN will have seamless access to quality care with the following benefits:  

• Over 10 percent total cost of care savings, on average, on top of the five to nine percent savings delivered by BlueCard, Blue Cross and Blue Shield companies’ broad preferred provider organization (PPO)  
  
• Area-specific savings for employers, including savings of up to 12.3 percent in the Triad, up to 16.8% percent in Charlotte, 13.3 percent in Raleigh and 10.2 percent in Hickory

Allowance for Covered Services 

Coverage for services to HPN members by providers that are not contracted to be in-network for BlueHPN will be subject to eligibility and available member benefits. The CMM/Indemnity/Traditional allowance will be applied and accepted by provider for that service for both local and host HPN members unless a separate or more specific allowance has been negotiated with that provider. 

Impacted Lines of Business  

At this time, BlueHPN is only offered to Administrative Services Only (ASO), Self-Funded commercial employer groups. Fully insured group, U65, State Health Plan (SHP), Medicare, Federal Employee Program (FEP) and Medicaid patients are NOT included in BlueHPN.

Resources 

For further information, see the BlueHPN FAQs document, service map and playbook:   

• BlueHPN Provider FAQs (PDF) 
  
• BlueHPN Maps (PDF)
• BlueHPN Provider Playbook (PDF)