October 20, 2020
Area(s) of Interest: Payor Issues and Reimbursement Payor Contracting
Anthem Blue Cross has begun marketing a new, narrow “high performance” network for 2021. The Anthem High Performance/Blue High Performance Network (Blue HPN®) is part of a national network of Blue High Performance networks being created in collaboration with the Blue Cross Blue Shield Association. The new narrow network of physicians is a subset of its broader Anthem Prudent Buyer PPO network and will be utilized for its EPO (Exclusive Provider Organization) product line. While specific criteria for physician participation in the Blue HPN are unspecified, Anthem’s notice states that the Blue HPN is designed to focused on improved health outcomes and affordability of care for national employer groups.
Anthem’s Blue HPN will be available in six metropolitan service areas located in the following Northern and Southern California areas.
- San Francisco-Oakland-Hayward
- San Jose-Sunnyvale-Santa Clara
- Los Angeles-Long Beach-Anaheim
- San Diego-Carlsbad
- Riverside-San Bernardino-Ontario
Anthem recently issued notices automatically opting-in providers who have been selected to participate in the Blue HPN. According to the notices, issued by Anthem on October 6, the terms of each physician’s underlying commercial PPO contract will apply to the new Blue HPN network. On or prior to January 1, 2021, provider directories will be updated to reflect providers participating in the new Blue HPN.
Blue HPN patients will be issued new ID cards reflecting Blue HPN in a suitcase on the front of the card, signifying access to Blue HPN providers. Similar to other EPO narrow network plans, services rendered by non-Blue HPN providers are limited to only urgent and emergent care.
Physicians who are unsure whether or not they will be part of Blue HPN or those who have general questions about the program can contact Anthem Contract Support at CAContractSupport@Anthem.com.