Blue Cross and Blue Shield of Massachusetts
Massachusetts • High-Deductible Health Plan (HDHP), HMO, POS
Under this HDHP prefix, the member's plan has a higher deductible than traditional coverage. This affects patient cost-sharing but does not change how claims are submitted or processed. Use the same payer ID, claims address, and filing procedures listed above. Verify the member's remaining deductible before estimating patient responsibility.
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.
Under this POS prefix, the member can access care both in-network and out-of-network, with cost-sharing that varies based on how the care is accessed. In-network care coordinated through the member's PCP has the lowest out-of-pocket cost. Include referral documentation when billing at the in-network benefit level.
Independent licensee serving Massachusetts members with commercial, Medicare and Medicaid plans.