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.
HMO (Health Maintenance Organization) plans require members to choose a primary care physician (PCP) and obtain referrals before seeing specialists. Out-of-network services are generally not covered except in emergencies. Claims must be submitted to the payer listed above and should include referral authorization when applicable.
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.
Highmark Inc. providing commercial, Medicare and Medicaid plans in Pennsylvania.