This is an Exclusive Provider Organization (EPO) prefix. EPO plans do not cover out-of-network care except in genuine emergencies. Members can see any in-network specialist without a referral from their primary care physician. Claims for out-of-network non-emergency services will be denied.
Under this prefix, the member may have Medicare Advantage coverage administered by this BCBS plan. MA claims are subject to CMS regulations in addition to the plan's own policies. Balance billing restrictions apply. Verify the member's specific MA plan details and confirm the correct payer ID for electronic submission.
This is a Health Maintenance Organization (HMO) prefix. HMO plans have stricter routing requirements than PPO plans. Members select a PCP who manages their care and issues referrals. Claims for specialist services should include the referral number. Out-of-network claims will typically be denied unless emergency criteria are met.
Part of the Blue Cross Blue Shield Association, serving New York members with commercial, Medicare and Medicaid plans.