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.
Under this EPO prefix, the member has no out-of-network coverage for routine care. However, unlike HMO plans, no referral is needed to see a specialist within the network. When billing, confirm the provider's network participation status with the plan before submitting the claim.
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.
Highmark Inc. providing commercial, Medicare and Medicaid plans in Pennsylvania.