Horizon Blue Cross and Blue Shield of New Jersey
New Jersey • HMO, PPO, Medicare Advantage
HMO coverage means this member must use providers within the plan's network. A primary care physician serves as the care coordinator and must authorize specialist referrals. Emergency services are the primary exception to the network requirement. Always verify referral status before providing non-emergency specialty care.
This is a Preferred Provider Organization (PPO) prefix. PPO plans are the most common BCBS plan type. Members have the freedom to self-refer to specialists. Claims for in-network services are typically processed faster and reimbursed at higher rates than out-of-network claims.
Medicare Advantage (MA) coverage means this member receives their Medicare benefits through a private BCBS plan rather than through original Medicare. MA plans may have different payer IDs and claims addresses than the commercial plan. Check with the payer to confirm the correct submission details for Medicare Advantage claims.
Largest health insurer in New Jersey serving over 3.8 million members with commercial, Medicare and Medicaid plans.