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.
This prefix is linked to a POS plan. Point of Service coverage gives members a choice at the time of service: use the HMO-style in-network benefit with a referral for lower costs, or access out-of-network providers at reduced coverage levels. The billing approach depends on which option the member chooses.
Medicaid managed care under this BCBS prefix means the state has contracted with this plan to administer Medicaid benefits. Balance billing Medicaid members is prohibited. Timely filing requirements may follow state Medicaid rules rather than the plan's commercial deadlines. Contact the plan to confirm submission requirements.
Independent licensee providing commercial, Medicare and Medicaid plans to Wisconsin members.