Horizon Blue Cross and Blue Shield of New Jersey
New Jersey • High-Deductible Health Plan (HDHP), Medicare Advantage, EPO
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.
Medicare Advantage (MA) coverage means this member receives their Medicare benefits through a private BCBS plan rather than through original Medicare. MA plans may have different payer IDs and claims addresses than the commercial plan. Check with the payer to confirm the correct submission details for Medicare Advantage claims.
This is an Exclusive Provider Organization (EPO) prefix. EPO plans do not cover out-of-network care except in genuine emergencies. Members can see any in-network specialist without a referral from their primary care physician. Claims for out-of-network non-emergency services will be denied.
Largest health insurer in New Jersey serving over 3.8 million members with commercial, Medicare and Medicaid plans.