Under this indemnity prefix, the member has fee-for-service coverage. There is no provider network, no referral requirement, and no primary care physician gatekeeper. Claims are processed based on the plan's fee schedule. While less common than managed care plans, indemnity coverage is still offered by some BCBS companies.
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.
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.
Nonprofit health insurance company serving seven million members nationwide with strongest presence in Philadelphia area and Southeastern Pennsylvania. Member of the Blue Cross Blue Shield Association for over 85 years.