This prefix is associated with an EPO plan. Exclusive Provider Organization coverage combines elements of HMO and PPO plans: members must stay in-network like an HMO, but can self-refer to specialists like a PPO. Out-of-network services are not covered except for emergencies.
POS (Point of Service) plans combine features of HMO and PPO coverage. Members choose a primary care physician and can get referrals to see in-network specialists at lower cost, or self-refer to out-of-network providers at higher cost. Claims should include referral information when the member uses the in-network benefit level.
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.
Independent licensee providing commercial, Medicare and Medicaid plans to Ohio members.