This prefix is associated with Medicaid managed care. When a BCBS plan administers Medicaid, the claims process may differ from commercial coverage: different payer ID, different claims address, different prior authorization rules, and different timely filing limits. Always verify Medicaid-specific details before submitting.
This prefix is linked to a POS plan. Point of Service coverage gives members a choice at the time of service: use the HMO-style in-network benefit with a referral for lower costs, or access out-of-network providers at reduced coverage levels. The billing approach depends on which option the member chooses.
EPO coverage under this prefix means the member must use network providers but does not need referrals for specialist visits. This plan type is becoming more common as it offers lower premiums than PPO plans while providing more flexibility than HMOs. Verify network status before providing services.
Health insurance provider offering Medicare, Medicaid, commercial, dental and vision plans to over 8 million California members. Independent licensee of the Blue Cross Association founded in 1937.