Highmark Blue Cross Blue Shield
New York • High-Deductible Health Plan (HDHP), Medicare Advantage, HMO
This is a High-Deductible Health Plan (HDHP) prefix. These plans have minimum deductible thresholds set by the IRS. Members often use HSA funds to cover out-of-pocket costs. The plan's claims processing and payer ID are the same as the standard plan, but expect higher patient responsibility amounts on remittance.
Medicare Advantage coverage under this prefix means the plan administers Medicare Part A and Part B benefits on behalf of CMS. These claims may have different processing rules than commercial claims, including different prior authorization requirements and appeal timelines. CMS timely filing rules (365 days) typically apply.
This is a Health Maintenance Organization (HMO) prefix. HMO plans have stricter routing requirements than PPO plans. Members select a PCP who manages their care and issues referrals. Claims for specialist services should include the referral number. Out-of-network claims will typically be denied unless emergency criteria are met.
Highmark Inc. providing commercial, Medicare and Medicaid plans in Pennsylvania.