Under this HMO prefix, the member's coverage is limited to the plan's provider network. Care is coordinated through a primary care physician. Specialist visits require a referral from the PCP. When billing, confirm that the referring provider and the referral authorization number are included on the claim.
Under this HDHP prefix, the member's plan has a higher deductible than traditional coverage. This affects patient cost-sharing but does not change how claims are submitted or processed. Use the same payer ID, claims address, and filing procedures listed above. Verify the member's remaining deductible before estimating patient responsibility.
Medicare Advantage coverage under this prefix means the plan administers Medicare Part A and Part B benefits on behalf of CMS. These claims may have different processing rules than commercial claims, including different prior authorization requirements and appeal timelines. CMS timely filing rules (365 days) typically apply.
Independent licensee providing commercial, Medicare and Medicaid plans to Virginia members.