Anthem Blue Cross and Blue Shield of Georgia
Georgia • POS, Medicare Advantage, High-Deductible Health Plan (HDHP)
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.
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.
Under this HDHP prefix, the member's plan has a higher deductible than traditional coverage. This affects patient cost-sharing but does not change how claims are submitted or processed. Use the same payer ID, claims address, and filing procedures listed above. Verify the member's remaining deductible before estimating patient responsibility.
Independent licensee of the Blue Cross Blue Shield Association providing commercial, Medicare, and Medicaid plans in Georgia.