POS (Point of Service) plans combine features of HMO and PPO coverage. Members choose a primary care physician and can get referrals to see in-network specialists at lower cost, or self-refer to out-of-network providers at higher cost. Claims should include referral information when the member uses the in-network benefit level.
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.
Medicare Advantage (MA) coverage means this member receives their Medicare benefits through a private BCBS plan rather than through original Medicare. MA plans may have different payer IDs and claims addresses than the commercial plan. Check with the payer to confirm the correct submission details for Medicare Advantage claims.
Part of the Blue Cross Blue Shield Association, serving New York members with commercial, Medicare and Medicaid plans.