Blue Cross and Blue Shield of North Carolina (Blue Cross NC) contracts with health care providers to be in BlueHPN. Your office manager or contracting manager / representative will have information on the networks you participate in, including BlueHPN.

As a BlueHPN health care provider, your practice will appear on our online “Find Care” tool when a provider search is done in your geographic area. If you would like to confirm this, we can instruct you on how to conduct a search using the “Find Care” tool, or please reference the instructions below. Please contact the Provider Blue Line at 800-214-4844 if you need additional assistance.

• Click the "Look up a Doctor or Drug" button from our Find Care page.
• Log in to Blue Connect or browse as a guest.
• Select the "Doctor or facility" button.
• Once redirected, choose the Blue High Performance Network plan from the drop-down Network box at the top of the page.
  • Once the plan has been selected, select the care you need.
  • You also have the option of a keyword search in the Search field.
    
  • If using the search field, type your practice or provider name in the search field.
  • Once you have selected your practice or provider name that meets your search, click on the provider name to find more details on the profile, and verify BlueHPN par status under the plans accepted section. If not using the search field, the steps below outline directions to browse by Medical Specialty.
  • Click the appropriate item that suits your practice (e.g., Medical Specialties).
  • Click the appropriate medical specialty (e.g., Specialist).
  • Click the appropriate specialist category (e.g., Dermatology). Each item represents a group of certain types of providers.
  • Select the item that appropriately suits your needs. A listing of the selected specialists appears. This list can span multiple pages.
  • Once you have selected the type of provider that fits your search, click on the provider to find more details on their profiles, and verify BlueHPN par status under the plans accepted section.

If your practice is a BlueHPN provider, all providers under that practice are considered participating in the BlueHPN product. To confirm participation details, check with your office manager or contracting representative. You can also use the Find Care tool or call the Provider Blue Line at 800‑214‑4844 for assistance.

If you are a Blue Distinction Specialty Care (BDSC) or Total Care designated healthcare provider and have a signed agreement to participate in BlueHPN, you are considered a BDSC and/or Total Care Designated Health Care provider. Please contact the Provider Blue Line at 800-214-4844 if you have any further questions.

It depends on whether BlueHPN patients are included in your value-based contract with us. To confirm how BlueHPN patients are handled and whether they’re attributed under your contract, contact your Blue Cross NC contracting representative.

At this time, BlueHPN^℠ is only offered to Administrative Services Only (ASO), Self-Funded commercial employer groups. It is not available for fully insured / individual U65 groups, State Health Plan (SHP), Medicare, Federal Employee Program^® (FEP), or Medicaid patients.

Review the patient’s Blue Cross NC ID card. BlueHPN members will have Blue High Performance Network and the BlueHPN suitcase logo on the front. If those indicators are not present, the patient is not enrolled in BlueHPN.

Please contact Blue Cross NC by using the Provider Blue Line at 800-214-4844. There are exceptions to make sure your BlueHPN patients get the care they need. Naturally, our priority is the health of our members.

Before referring your patient, use the Find Care tool to identify specialists who participate in BlueHPN. This helps prevent unexpected out‑of‑pocket costs for your patient.

If you’re unable to find an appropriate in‑network specialist for your patient’s condition, contact the Provider Blue Line at 800‑214‑4844. Exceptions may be available to help ensure your BlueHPN patients get the care they need.

BlueHPN members have limited out-of-network benefits. Eligibility and benefit checks, pre-service review, and claims submission processes are the same. 

BlueHPN is currently closed to network additions. When the anchoring health systems and Blue Cross NC developed these networks, we did an intensive analysis of network adequacy, accessibility, and marketability, incorporating both CMS and NCDOI guidelines. We review network adequacy for each product annually. If you have further questions or concerns, please call Provider Blue Line at 800-214-4844.

BlueHPN health care providers are measured individually and at an aggregate network level. Quality is measured across all aspects of care delivery (e.g., inpatient, outpatient) and within each provider type (e.g., primary care, specialist, hospital or health system). This approach was established because:

• Individual performance results allow us to identify opportunities for improvement and to recognize higher-value care
• Aggregating quality results allows us to understand BlueHPN market level performance in comparison to our BlueCard PPO healthcare provider population

We select quality measures that address key healthcare challenges in each local market, prioritizing measures that align with community health disparities, or those that incentivize better performance in areas that address local needs or challenges. For example, diabetes management might be a critical quality indicator in one community while improving immunization adherence is higher priority in another.

When selecting national measures for BlueHPN, we identified measures that:

• Are aligned with industry-recognized standards, such as the Catalyst for Payment Reform
• Are most commonly used to establish healthcare provider accountability for better patient outcomes
• Closed clinical care gaps, impact longevity and quality of life and/or lower costs
• Spanned care settings and provider types (primary care, specialists and hospitals) to provide a more holistic view of clinical quality performance
• Accounted for regulatory and/or state mandates
• Created a foundation and framework for continuous improvement

BlueHPN quality measurements are designed to evolve over time. As provider performance improves and care models change, quality measures may focus more on outcomes. We’ll continue working with you by sharing data and insights to help you understand performance expectations and support ongoing improvements in care quality and affordability.

There isn’t a single quality performance threshold that applies to all healthcare providers. Inclusion in BlueHPN is evaluated using quality performance requirements that reflect local, regional, state, and national benchmarks. This approach helps account for differences in local healthcare needs and population health priorities. Quality performance criteria may change over time as these needs evolve.