Blue Cross and Blue Shield of North Carolina
North Carolina • POS, PPO, Traditional Indemnity
POS coverage under this prefix operates on a tiered system. Tier 1 (in-network with referral) provides the highest coverage. Tier 2 (in-network without referral) provides moderate coverage. Tier 3 (out-of-network) provides the lowest coverage. Verify which tier applies before submitting the claim.
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 is a traditional indemnity prefix. Unlike managed care plans (HMO, PPO, EPO), indemnity plans do not use provider networks. There are no referral requirements and no restrictions on which providers the member can see. Submit claims to the payer listed above for reimbursement at the plan's allowed rate.
Independent licensee providing commercial, Medicare and Medicaid plans to North Carolina members.