POS (Point of Service) plans combine features of HMO and PPO coverage. Members choose a primary care physician and can get referrals to see in-network specialists at lower cost, or self-refer to out-of-network providers at higher cost. Claims should include referral information when the member uses the in-network benefit level.
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.
Traditional indemnity coverage under this prefix is a fee-for-service plan. Members can see any provider without network restrictions or referral requirements. The plan reimburses a set percentage of usual and customary charges. Claims are submitted directly to the payer listed above.
Independent licensee of the Blue Cross Blue Shield Association serving 21 counties in Central Pennsylvania and the Lehigh Valley.