OBRA 93 claim filing for Federal Employee Program

The Blue Cross and Blue Shield Service Benefit Plan, also known as the Federal Employee Program, FEP, is now requiring new information on claims that are required by OBRA93 law to be priced at the Medicare allowance. Members that are over 64 years old and do not have Medicare Part B coverage fall under the OBRA93 law for Medicare pricing. In order for us to obtain the Medicare pricing, the CMS 1500 claim must have a rendering provider ID submitted on the claim. Claims submitted without the rendering provider ID will deny with the following message on the remit and require the provider to resubmit with this required field.  

Remit message: 339 NEED PROVIDER NAME & NPI IN ORDER TO DETERMINE MEDICARE FEE SCHEDULE

 

This claim submission requirement applies to Federal employee member claims only. An FEP member can be identified with an ID number beginning with R followed by 8 digits (for example, Rxxxxxxxx).

 

If you have any questions, please contact FEP Customer Service at CT 800-438-5356 ME 800-722-0203 NH 800-852-3316.

CTBCBS-CM-004479-22