New York • PPO, High-Deductible Health Plan (HDHP), Medicaid
PPO coverage under this prefix means the member can access any provider. In-network providers have negotiated rates with the plan, while out-of-network providers are reimbursed based on usual and customary charges. Prior authorization is generally not required for routine services but may be needed for high-cost procedures.
This prefix is associated with a High-Deductible Health Plan. HDHP members pay more out-of-pocket before insurance coverage begins. These plans are commonly paired with HSA or HRA accounts. When billing, be aware that the member may have significant cost-sharing responsibility until their annual deductible is satisfied.
Medicaid coverage under this prefix means the member's Medicaid benefits are administered by a BCBS managed care plan. Medicaid managed care claims may have different submission requirements, payer IDs, and timely filing deadlines than commercial claims. Verify the specific Medicaid plan details with the payer.
Part of the Blue Cross Blue Shield Association, serving New York members with commercial, Medicare and Medicaid plans.