Admission review process for Anthem Blue Cross and Blue Shield Federal Employee Program® (FEP) members

We all want to reduce unnecessary contacts and coordinate excellent quality of care for your patients, our members. To help expedite claims payment, all FEP member days of care will need to be certified. We will also assist you in discharge planning/case management services in order to help provide optimal patient outcomes.

 

How do we accomplish those activities while minimizing your time involvement?

 

Initial admission review process

 

Contact us by phone at 1-800-860-2156 or electronically through Anthem’s online inpatient review system for providers. 

 

Whether you call us or electronically submit information to Anthem’s FEP Medical Management Department to report an inpatient admission, once we certify the admission we’ll provide an initial length of stay determination. At that time, we will also request the discharge planner’s name and phone number to help facilitate discharge planning/case management.

 

Next steps after initial admission approval

 

After you receive initial admission approval, you will need to call:

• With a discharge date if it falls within the initial length of stay period OR
• If the patient stays one or more days longer than the initial length of stay approved, we require updated clinical information for review and for approval of any subsequent length of stay decisions.
• We will also need an update on any discharge plans.

 

Working together

 

The Anthem FEP Medical Management Department is committed to working with you and look for opportunities to coordinate the patient’s benefits and discharge plans. Please feel free to contact the Anthem FEP UM team members for assistance at 1-800-860-2156. 

 

517-0720-PN-CNT