December 2, 2021
For dates of service
January 1, 2022, and after, pre-certification will be required for inpatient
stays for all Blue Cross and Blue Shield Federal Employee Program (FEP)
members.
- Payments for the inpatient hospital stay will be reduced by
$500 if an inpatient stay is not pre-certified but inpatient level of care is
determined to be medically necessary.
- If the stay is not pre-certified and inpatient level
of care is determined not medically necessary, FEP will not provide
benefits for inpatient room and board or inpatient physician care.
- If the stay is not pre-certified and the service
associated with the admission is determined to not be medically necessary, is
experimental/investigational, or is not a covered service, all charges will be
denied.
The updated
pre-certification form and an explanation of process will be in the December 16
issue of Provider News.