PPO (Preferred Provider Organization) plans allow members to visit any healthcare provider without a referral. In-network providers cost less, but out-of-network care is still covered at a reduced rate. When billing for a PPO plan, submit claims directly to the payer listed above. No referral documentation is needed.
This prefix is linked to an HMO plan. Health Maintenance Organization coverage requires members to use in-network providers and coordinate care through a designated primary care physician. Referrals are typically required for specialist visits. Claims submitted without proper referral documentation may be denied.
Traditional indemnity coverage under this prefix is a fee-for-service plan. Members can see any provider without network restrictions or referral requirements. The plan reimburses a set percentage of usual and customary charges. Claims are submitted directly to the payer listed above.
Highmark Inc. providing commercial, Medicare and Medicaid plans in Pennsylvania.