Under this POS prefix, the member can access care both in-network and out-of-network, with cost-sharing that varies based on how the care is accessed. In-network care coordinated through the member's PCP has the lowest out-of-pocket cost. Include referral documentation when billing at the in-network benefit level.
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.
PPO coverage under this prefix means the member can access any provider. In-network providers have negotiated rates with the plan, while out-of-network providers are reimbursed based on usual and customary charges. Prior authorization is generally not required for routine services but may be needed for high-cost procedures.
Premera Blue Cross has operated in Alaska since 1957. Serves over 500,000 members. Part of the Blue Cross Blue Shield Association.