Blue Cross Blue Shield of Texas
Texas • Traditional Indemnity, Medicare Advantage, HMO
This prefix includes traditional indemnity coverage. Indemnity plans are the oldest form of health insurance and offer maximum provider choice with no network restrictions. Members pay a percentage of charges after meeting their deductible. Reimbursement is based on reasonable and customary rates for the service area.
Under this prefix, the member may have Medicare Advantage coverage administered by this BCBS plan. MA claims are subject to CMS regulations in addition to the plan's own policies. Balance billing restrictions apply. Verify the member's specific MA plan details and confirm the correct payer ID for electronic submission.
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.
Independent licensee providing commercial, Medicare and Medicaid plans to Texas members.