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Access our secured site to check eligibility, claims, certifications, referrals and much more
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Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements
View requirements for Local Plan and BlueCard Out-of-Area members.
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Search our online provider directory when you need a doctor, hospital, or other health care provider.
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Network Physician Rights and Responsibilities (HMO/POS)
PW_AD048501
HMO/POS
As a network Physician you have the right to:
 | Request that a patient be reassigned if an acceptable physician-patient relationship cannot be established |
| Receive timely payment for covered services according to their contract |
| Be treated courteously and with respect by BCBSHP members and personnel |
| Obtain all necessary information to treat their patients |
| Express their opinions, concerns, or complaints in a constructive and respectful manner to BCBSHP |
| File an appeal and be given due process |
| Collect any co-payment or co-insurance for covered services |
| Collect for non-covered services, with proper disclosure |
| Discuss, based on their opinions, all medically necessary or appropriate care with patients |
As a network Physician you have the responsibility to:
| Cooperate with all BCBSHP administrative, quality, and utilization management guidelines and programs |
| Ensure that the confidentiality of medical information is protected |
| Treat patients and BCBSHP personnel with courtesy and respect |
| Seek only authorized co-payments and specifically authorized payments for non-covered services from BCBSHP member patients |
| Strive to improve the health of all patients by offering and providing all necessary preventive services appropriate to their specialty |
| Discuss a patient’s health care status and treatment options with that patient or his or her legal guardian, regardless of whether the information concerns a covered treatment or benefit |
| When a patient requests it, disclose a general description of the way their BCBSHP reimbursement contract works |
| Respond to member requests for specific information about their practice, including practice statistics (i.e. the numbers of a specific procedure performed), their credentials (i.e. where they went to medical school, board certification), and patient satisfaction measures |
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