EPO coverage under this prefix means the member must use network providers but does not need referrals for specialist visits. This plan type is becoming more common as it offers lower premiums than PPO plans while providing more flexibility than HMOs. Verify network status before providing services.
This is a Point of Service (POS) prefix. POS plans offer flexibility similar to a PPO but incentivize in-network care through lower cost-sharing. Members designate a primary care physician who can issue referrals for the highest level of benefits. Out-of-network claims are covered but at significantly reduced rates.
Medicaid coverage under this prefix means the member's Medicaid benefits are administered by a BCBS managed care plan. Medicaid managed care claims may have different submission requirements, payer IDs, and timely filing deadlines than commercial claims. Verify the specific Medicaid plan details with the payer.
Independent licensee providing commercial, Medicare and Medicaid plans to Ohio members.