The Blue Cross and Blue Shield Service Benefit Plan, also known as the BCBS Federal Employee Program® (BCBS FEP®), has been part of the Federal Employees Health Benefits Program (FEHBP) since its inception in 1960. It covers about 5.5 million federal employees, retirees and their families out of the nearly 8 million people who receive their benefits through the FEHBP. Show
The Blue Cross Blue Shield Association negotiates annually with the U.S. Office of Personnel Management (OPM) to determine the benefits and premiums for the Blue Cross and Blue Shield Service Benefit Plan. The 35 local member companies of the Blue Cross Blue Shield Association are the primary points of contact for Service Benefit Plan members. Those Plans, including Regence, are responsible for processing claims and providing customer service to BCBS FEP members. Claims are processed according to the benefits, rules, guidelines and regulations of the federal government, which supersede state laws. Blue Cross and/or Blue Shield Plans offer three coverage options: Basic Option, Standard Option and FEP Blue Focus. Identifying membersAll FEP member numbers start with the letter "R", followed by eight numerical digits. Note: On the provider remittance advice, the member number shows as an "8" rather than "R". The enrollment code on member ID cards indicates the coverage type. View sample member ID cards. Pre-authorizationBoth the Basic and Standard Option plans require that some services and supplies be pre-authorized. The Blue Focus plan has specific prior-approval requirements. View the lists:
Submit pre-authorization requests via Availity Essentials. Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association© Copyright Health Care Service Corporation. All Rights Reserved. File is in portable document format (PDF). To view this file, you may need to install a PDF reader program. Most PDF readers are a free download. One option is Adobe® Reader® which has a built-in screen reader. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com You are leaving this website/app ("site"). This new site may be offered by a vendor or an independent third party. The site may also contain non-Medicare related information. In addition, some sites may require you to agree to their terms of use and privacy policy. Body Claim filingIf the member receives covered services from a contracting provider, a claim will be filed on their behalf by the provider. If the provider is non-contracting and does not agree to file the claim or the member has a prescription benefit in which filing a claim is required for reimbursement, the member may access the Forms section to obtain the correct claim form. This form may also be obtained by contacting our customer service center at 800-432-3990. For prescription drug claimsFile one claim per patient and attach an itemized bill from the pharmacy with the pharmacist’s signature or the pharmacy receipts. Do not send cash register receipts. The proof of service must include patient’s name, prescription name, and prescription Rx number, National Drug Code, quantity, number of days supply, service date, cost for each prescription plus the complete name and address of the pharmacy, and the pharmacy tax ID number. For all other servicesFile one claim per patient and attach an itemized bill from the service provider. The itemization must include the patient’s name, the service provided, service date, cost for each service, diagnosis, and the provider’s name and tax ID number. Please complete a separate claim form in full for each hospital and/or doctor bill being submitted. Prompt filing of claimsNotice of your claim must reach Blue Cross and Blue Shield of Kansas within one (1) year and ninety (90) days from the date services were received. **NOTE: Claims for members that are insured by the Federal Employee Program must be received within 15 months of the date of service or by December 31 of the year following the year in which services were received. File claims to:
Payment for servicesPayment for covered services received from a contracting provider is made to the provider. Generally, we issue one check per week to the provider. An Explanation of Benefits (EOB) is issued to the member for each claim processed by BCBSKS. In the event that the provider is paid, an EOB will be sent to you indicating this information. BCBSKS claims processing goals
Member claim appeal rightsThe member may request the review of an adverse decision on a Pre or Post service claim, in which they are financially responsible. The Claim Appeal Form must be completed with the appropriate Explanation of Benefit (EOB) attached. The member may access the member Forms to obtain the correct Claim Appeal form. This form can also be obtained by contacting our customer service center at 800-432-3990. Provider claim appeal rightsContracting providers may appeal certain pre and post-service claim denials. All appeals must be submitted in writing with all pertinent medical records to BCBSKS customer service. Additional information regarding appeals can be found in Policy Memo No. 1, Policies and Procedures, which can be found under the provider publications section. How do I submit a claim to BCBS FEP?You can also call 1-800-624-5060 for more information, claim forms and customer service assistance. The claim form provides detailed instructions for submission of the form and should be mailed to: Service Benefit Plan Retail Pharmacy Program, P.O. Box 52057, Phoenix, AZ 85072-2057.
What is the payer ID for Blue Cross Blue Shield Federal Employee Program?Claims Submission:
The Electronic Payor ID for BCBSTX is 84980.
Is BCBS the same as BCBS FEP?The Blue Cross and Blue Shield Service Benefit Plan, also known as the Federal Employee Program® (FEP®), has been part of the Federal Employees Health Benefits (FEHB) Program since its inception in 1960.
Is BCBS Federal Employee Program a PPO?Anthem Blue Cross of California - Federal Employee Program (FEP) - PPO Accepted By These Sutter Hospitals & Medical Groups.
|