California • Medicare Advantage, Medicaid, Traditional Indemnity
Medicare Advantage coverage under this prefix means the plan administers Medicare Part A and Part B benefits on behalf of CMS. These claims may have different processing rules than commercial claims, including different prior authorization requirements and appeal timelines. CMS timely filing rules (365 days) typically apply.
This prefix is associated with Medicaid managed care. When a BCBS plan administers Medicaid, the claims process may differ from commercial coverage: different payer ID, different claims address, different prior authorization rules, and different timely filing limits. Always verify Medicaid-specific details before submitting.
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.
Nonprofit health plan providing 6 million Californians with affordable healthcare coverage including HMO, PPO, dental, and vision plans for individuals, families, and employers.