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.
This is a Point of Service (POS) prefix. POS plans offer flexibility similar to a PPO but incentivize in-network care through lower cost-sharing. Members designate a primary care physician who can issue referrals for the highest level of benefits. Out-of-network claims are covered but at significantly reduced rates.
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.
Part of the Blue Cross Blue Shield Association, serving New York members with commercial, Medicare and Medicaid plans.