Blue Cross and Blue Shield of Massachusetts
Massachusetts • Medicaid, High-Deductible Health Plan (HDHP), HMO
Under this prefix, the member may have Medicaid coverage managed by this BCBS plan. Medicaid claims have specific rules around cost-sharing, balance billing, and timely filing that override the plan's standard commercial policies. Contact the plan's Medicaid provider services line for submission details.
This is a High-Deductible Health Plan (HDHP) prefix. These plans have minimum deductible thresholds set by the IRS. Members often use HSA funds to cover out-of-pocket costs. The plan's claims processing and payer ID are the same as the standard plan, but expect higher patient responsibility amounts on remittance.
HMO coverage means this member must use providers within the plan's network. A primary care physician serves as the care coordinator and must authorize specialist referrals. Emergency services are the primary exception to the network requirement. Always verify referral status before providing non-emergency specialty care.
Independent licensee serving Massachusetts members with commercial, Medicare and Medicaid plans.