Pre-Certification Required for FEP Member Inpatient Stay

December 16, 2021

Starting January 1, 2022, pre-certification will be required for inpatient stays for all Blue Cross and Blue Shield Federal Employee Program (FEP) members.

How to Pre-Certify:

• For a planned procedure admission, fax the pre-service/prior authorization request form to 800-843-1114.
• For an urgent/emergent admission, when a newborn stays after the mother is discharged, and when a maternity stay is more than 48 hours after a vaginal delivery or 96 hours after a cesarean section, fax the precertification/concurrent review request form to 888-742-1487. 

If the FEP member is not pre-certified for an inpatient stay and:

• The inpatient level of care is determined as medically necessary: payments for the inpatient hospital stay are reduced by $500.
• The inpatient level of care is determined as not medically necessary: FEP will not provide benefits for inpatient room and board or inpatient physician care.
• The service associated with the admission is determined as not medically necessary, or is experimental/investigational,or not a covered service: all charges will be denied.

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