Under this PPO prefix, members are covered for both in-network and out-of-network care. The plan pays a higher percentage of allowed charges when members use participating providers. No gatekeeper or primary care referral is required. Verify the member's specific benefits for cost-sharing details.
This prefix is associated with Medicare Advantage. MA plans combine hospital (Part A) and medical (Part B) coverage, and many include prescription drug coverage (Part D). When billing, confirm whether the plan uses the same payer ID for MA claims as for commercial claims, as many BCBS companies use separate IDs.
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.
This prefix is linked to a POS plan. Point of Service coverage gives members a choice at the time of service: use the HMO-style in-network benefit with a referral for lower costs, or access out-of-network providers at reduced coverage levels. The billing approach depends on which option the member chooses.
Independent licensee providing commercial, Medicare and Medicaid plans to Tennessee members.