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

Before we can process Flexible Benefit Option requests for Blue Cross and Blue Shield Federal Employee Program^® Service Benefit Plan members, including those for skilled nursing facility admissions or extensions, Blue Cross must receive a member-signed Alternative Benefit Agreement and a verbal or signed consent for Blue Cross Coordinated Care℠.

Flexible Benefit Option

This option is used to approve services outside the defined plan benefits, including:

• Skilled nursing home benefit for Basic Option members
• Skilled nursing home benefit extension for FEP Blue Focus members (14-day maximum allowed per year)
• Skilled nursing facility benefit extension for Standard Option members
• Extension of exhausted benefits, such as home health care or for physical, occupational or speech therapy for all members

Before we can process Flexible Benefit Option requests, the following must be completed for Standard Option, Basic Option and FEP Blue Focus members:

• An Alternative Benefit Agreement (also known as the Member Agreement Letter), signed by the member is required before services can be approved.
• The member’s verbal or signed consent for Blue Cross Coordinated Care is required before services can be approved. A signed consent must be returned by case closure.

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

• Fax them to the Utilization Management department at 1-866-411-2573.
• Attach them to the authorization request in the e-referral system in the Case Communication field. For instructions, refer to the e-referral User Guide, under the Create New (communication) section.

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 prior to a SNF admission. A signed consent must be returned by the closure of the case.

Basic Option Benefit

• The member’s verbal or signed consent for Blue Cross Coordinated Care is required prior to a SNF admission. 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 before services can be approved.
• The Flexible Benefit Option must also include a signed Provider Agreement letter by case closure.

FEP Blue Focus benefit — 14-day maximum allowed per year

• This plan follows the Basic Option Benefit process.

Note: No retrospective reviews are accepted.