Horizon Blue Cross and Blue Shield of New Jersey
New Jersey • PPO, Medicaid, Traditional Indemnity
This prefix is associated with a PPO plan. Preferred Provider Organization coverage gives members flexibility to see specialists without referrals and to use out-of-network providers at higher cost-sharing. Claims can be submitted for both in-network and out-of-network services, though reimbursement rates differ.
Under this prefix, the member may have Medicaid coverage managed by this BCBS plan. Medicaid claims have specific rules around cost-sharing, balance billing, and timely filing that override the plan's standard commercial policies. Contact the plan's Medicaid provider services line for submission details.
Traditional indemnity coverage means the member has fee-for-service insurance with no network limitations. Any licensed provider can be seen without referrals. Claims are reimbursed based on usual, customary, and reasonable (UCR) charges. The member typically pays a deductible and a percentage of allowed charges.
Largest health insurer in New Jersey serving over 3.8 million members with commercial, Medicare and Medicaid plans.