California • HMO, Medicare Advantage, High-Deductible Health Plan (HDHP)
This prefix is linked to an HMO plan. Health Maintenance Organization coverage requires members to use in-network providers and coordinate care through a designated primary care physician. Referrals are typically required for specialist visits. Claims submitted without proper referral documentation may be denied.
This prefix is associated with Medicare Advantage. MA plans combine hospital (Part A) and medical (Part B) coverage, and many include prescription drug coverage (Part D). When billing, confirm whether the plan uses the same payer ID for MA claims as for commercial claims, as many BCBS companies use separate IDs.
HDHP (High-Deductible Health Plan) coverage means the member has a higher deductible than traditional plans, often paired with a Health Savings Account (HSA). Most services require the member to pay out-of-pocket until the deductible is met. Preventive care is typically covered before the deductible. Submit claims normally to the payer listed above.
Nonprofit health plan providing 6 million Californians with affordable healthcare coverage including HMO, PPO, dental, and vision plans for individuals, families, and employers.