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Administrative Manual

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Federal Employee Program (FEP)

The Federal Office of Personnel Management (OPM) contracts with health plans throughout the United States providing medical and dental coverage for federal employees and their families. Use of Blue Cross and/or Blue Shield provider networks gives eligible FEP members world-wide access to Participating and Preferred providers.

Claims are processed according to the benefits, rules, guidelines and regulations of the federal government, which supersede state laws. Blue Cross and/or Blue Shield Plans offer two coverage options: Basic and Standard.

Identifying members
All FEP member numbers start with the letter “R”, followed by eight numerical digits. Payment Vouchers show that member number with an “8” rather than an “R”.

The enrollment code on member cards (PDF) indicates the coverage type.

Coverage Type

Basic Option

Standard Option

Self Only

111

104

Self and Family

112

105

Pre-authorization
Both the Basic and Standard Option Plans require that some services and supplies be pre-authorized. View the Federal Employee Program Medical Pre-Authorization List.

Claims and contact information

  • Claims for members over the age of 65 are subject to Medicare pricing.
  • Prior Plan approval must be obtained for certain services The pre-service claim approval processes for inpatient hospital admissions (called precertification) and for Other services (called prior approval), are detailed in the Benefit Plan Brochure. A pre-service claim is any claim, in whole or in part, that requires approval from us before members receive medical care or services. In other words, a pre-service claim for benefits (1) requires precertification or prior approval and (2) will result in a reduction of benefits if precertification or prior approval is not obtained.
  • Several care management programs are available for FEP members. Our care managers are available to coordinate care for a variety of health conditions. Learn more about these programs, available at no cost to our FEP members.

Timely claims filing guidelines:

  • Participating and Preferred providers: Submit clean claims up to one year from the date of service. Note: if the local Blue Plan’s provider contract includes a timely filing provision that is less than FEP’s, the local Plan will follow that guideline.
  • Non-participating providers and members: Submit claims no later than December 31 of the calendar year after the year in which the service was rendered (e.g., date of service is April 30, 2010. Claim must be submitted by December 31, 2011).

We encourage you to submit electronic claims. Submit paper claims on a CMS-1500 or an ADA J-400 claim form.

Mail FEP correspondence to:

Regence BlueCross BlueShield of Oregon – FEP
P.O. BOX 2668
Seattle, WA 98111-2668

Coordination of Benefits
FEP members may only have benefits under one FEP plan; however:

  • They may have benefits under a non-FEP plan, in addition to their FEP coverage.
  • If Regence FEP is not the primary insurer, submit claims to the primary insurer first.
  • Please include primary payment information when submitting paper or electronic claims to Regence FEP for secondary payment.

Disputed Claims
If the rendering provider disagrees with the payment determination on a particular claim, he or she may request reconsideration. If the claim was denied as a provider write-off, the provider may appeal the decision. Learn more about the Appeals process.

If the claim was denied as member responsibility, the member may request reconsideration as outlined in their Blue Cross and Blue Shield Service Benefit Plan brochure (federal benefits brochure). 

  • If the member is still dissatisfied with the outcome, he or she may submit a written appeal to the OPM.
  • Parties acting as a representative for the member, such as medical providers, must include a copy of the member’s specific written consent with the review request.
  • This procedure is outlined in detail in the federal benefits brochure.

Contact FEP Provider Customer Service

Revised January, 2012

 

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