Highmark Blue Cross Blue Shield
New York • High-Deductible Health Plan (HDHP), Medicaid, HMO
HDHP coverage under this prefix means the member carries a higher annual deductible in exchange for lower monthly premiums. Claims are processed normally but the member's cost-sharing will be higher than standard plans until the deductible is met. Preventive services are typically the exception and are covered at no cost to the member.
This prefix includes Medicaid managed care coverage. The BCBS plan administers Medicaid benefits on behalf of the state. Claims submission, prior authorization, and reimbursement rules may follow state Medicaid guidelines rather than the plan's standard commercial policies. Confirm the correct payer ID for Medicaid claims.
HMO coverage means this member must use providers within the plan's network. A primary care physician serves as the care coordinator and must authorize specialist referrals. Emergency services are the primary exception to the network requirement. Always verify referral status before providing non-emergency specialty care.
Highmark Inc. providing commercial, Medicare and Medicaid plans in Pennsylvania.