BCBS Prefix PQM

New York • Traditional Indemnity, HMO, Medicare Advantage

Billing essentials

Provider phone: (866) 763-3224
Electronic payer ID: 03036
Claims mailing address: P.O. Box 890089, Camp Hill, PA 17089-0089
Timely filing limit: 365 daysCompare all plans
Prior authorization phone: (866) 763-3224
Provider website: https://providers.highmark.com/

Coverage under prefix PQM

Traditional Indemnity

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.

HMO

HMO (Health Maintenance Organization) plans require members to choose a primary care physician (PCP) and obtain referrals before seeing specialists. Out-of-network services are generally not covered except in emergencies. Claims must be submitted to the payer listed above and should include referral authorization when applicable.

Medicare Advantage

This prefix includes Medicare Advantage coverage. MA plans follow CMS guidelines for timely filing (365 days from date of service), which may differ from the commercial plan's deadline. The payer ID for Medicare Advantage claims may differ from the standard commercial payer ID. Verify before submitting.