Blue Cross and Blue Shield of Massachusetts
Massachusetts • PPO, Medicaid, High-Deductible Health Plan (HDHP)
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.
Medicaid managed care under this BCBS prefix means the state has contracted with this plan to administer Medicaid benefits. Balance billing Medicaid members is prohibited. Timely filing requirements may follow state Medicaid rules rather than the plan's commercial deadlines. Contact the plan to confirm submission requirements.
This prefix is associated with a High-Deductible Health Plan. HDHP members pay more out-of-pocket before insurance coverage begins. These plans are commonly paired with HSA or HRA accounts. When billing, be aware that the member may have significant cost-sharing responsibility until their annual deductible is satisfied.
Independent licensee serving Massachusetts members with commercial, Medicare and Medicaid plans.