This prefix includes Medicaid managed care coverage. The BCBS plan administers Medicaid benefits on behalf of the state. Claims submission, prior authorization, and reimbursement rules may follow state Medicaid guidelines rather than the plan's standard commercial policies. Confirm the correct payer ID for Medicaid claims.
This prefix is associated with a PPO plan. Preferred Provider Organization coverage gives members flexibility to see specialists without referrals and to use out-of-network providers at higher cost-sharing. Claims can be submitted for both in-network and out-of-network services, though reimbursement rates differ.
EPO (Exclusive Provider Organization) plans require members to use in-network providers, similar to an HMO. The key difference is that referrals are usually not required to see a specialist. Out-of-network care is not covered except in emergency situations. Submit claims to the payer listed above.
Largest health insurer in New Jersey serving over 3.8 million members with commercial, Medicare and Medicaid plans.