Here are requirements for submitting SNF and Flexible Benefit Option requests for FEP members

Before we can process Flexible Benefit Option requests and requests for skilled nursing facility admissions for Blue Cross and Blue Shield Federal Employee Program^® Service Benefit Plan members, the following consents must be obtained:

Skilled Nursing Facility

Standard Option Benefit

• The member’s verbal or signed consent for the Blue Cross Blue Shield of Michigan care management program, Blue Cross^® Coordinated Care, is required to process an SNF request. A signed consent must be returned by case closure.

Basic Option Benefit

• The member’s verbal or signed consent for Blue Cross^® Coordinated Care is required to process a SNF request. A signed consent must be returned by case closure.
• The Flexible Benefit Option is required for SNF benefits for Basic Option members. The Flexible Benefit Option must include a signed Alternative Benefit Agreement (also known as the Member Agreement letter) before services can be approved.
• Flexible Benefit Option must include a signed Provider Agreement letter by case closure.

FEP Blue Focus benefit — 14-day maximum

• Follows the Basic Option Benefit process

Flexible Benefit Option

Used for consideration of services for approval outside the defined plan benefits, such as:

• Skilled Nursing Home benefit for Basic or FEP Blue Focus option members
• Skilled Nursing Home benefit extension for Standard Option members
• Extension of exhausted benefits such as home health care or PT/OT/ST

Before we can process Flexible Benefit Option requests, the following must be completed:

• The member’s verbal or signed care management consent for Blue Cross^® Coordinated Care is required before services are provided. A signed consent must be returned by case closure.
• The Flexible Benefit Option must include a signed Alternative Benefit Agreement (also known as the Member Agreement letter) before services can be approved.
• The Flexible Benefit Option must include a signed Provider Agreement letter by case closure.

Providers can submit all required documents in one of the following ways:

• By faxing them to the Utilization Management department at 1-866-411-2573
• By attaching them to the authorization request in the e-referral system, in the Case Communication field. For instructions on how to do that, refer to the e-referral User Guide; look for “Create New (communication).”

No retrospective reviews are accepted.