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November 2018
Reminder: FEP made changes to care admissions request for skilled nursing facility
On April 30, 2018, all post-acute care admissions, including skilled nursing facilities, were routed to the Precertification Utilization Management team. Federal Employee Program® members must sign a consent for case management to use their benefit for a skilled nursing facility. All clinical information along with the member’s signed consent for case management can be faxed to 1-866-411-2573 for precertification review.
Note: If an FEP member has Medicare Part B, and also has Medicare Part B services on the claim, then that claim must be submitted to Medicare for processing before FEP can process the claim.
FEP benefit coverage |
SNF benefit |
Basic Option |
No benefit for inpatient skilled nursing facility care. |
Standard Option with primary Medicare Part A |
Limited to coverage of the first through 30th day for each benefit period as defined by Medicare. Medicare covers days 1-20 in full.
For days 21-30, Medicare covers the stay except for the copayment, which FEP covers.
There’s no FEP benefits beyond 30 days. Members can’t use a Flexible Option Benefit to cover SNF additional days.
FEP considers medical necessity as being met when Medicare Part A has made a payment for the stay. |
Standard Option with no primary Medicare Part A**
**Member doesn’t have Medicare Part A or has Secondary Medicare Part A |
FEP covers SNF admissions for a maximum of 30 days annually. The benefit is also available to overseas members.
Requires precertification for medical necessity for the SNF setting.
Before admission, the member must provide signed consent for case management services enrollment and participate in case management throughout his or her SNF stay. |
If you have benefit questions, contact FEP Customer Service at 1-800-482-3600. If you have facility precertification questions, contact precertification at 1-800-572-3413. If you have questions about case management services, call 1-800-325-6278. |
