This prefix includes Medicare Advantage coverage. MA plans follow CMS guidelines for timely filing (365 days from date of service), which may differ from the commercial plan's deadline. The payer ID for Medicare Advantage claims may differ from the standard commercial payer ID. Verify before submitting.
HMO coverage means this member must use providers within the plan's network. A primary care physician serves as the care coordinator and must authorize specialist referrals. Emergency services are the primary exception to the network requirement. Always verify referral status before providing non-emergency specialty care.
This is a Point of Service (POS) prefix. POS plans offer flexibility similar to a PPO but incentivize in-network care through lower cost-sharing. Members designate a primary care physician who can issue referrals for the highest level of benefits. Out-of-network claims are covered but at significantly reduced rates.
Independent licensee of the Blue Cross Blue Shield Association providing coverage in Maine.