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.
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.
This is a Preferred Provider Organization (PPO) prefix. PPO plans are the most common BCBS plan type. Members have the freedom to self-refer to specialists. Claims for in-network services are typically processed faster and reimbursed at higher rates than out-of-network claims.
Independent licensee providing commercial, Medicare and Medicaid plans to Rhode Island members.