CommercialMay 31, 2023
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 requiring information on claims that are required by the Omnibus Budget Reconciliation Act of 1993 (OBRA 93) law to be priced at the Medicare allowance. Members who are over 64 years old and do not have Medicare Part B coverage fall under the OBRA 93 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 for the following message on the remittance 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. A federal member can be identified with an R followed by 8 digits (for example, Rxxxxxxxx).
If you have any questions, please contact FEP Customer Service at 800-852-3316.
NHBCBS-CM-023612-23-CPN22610
PUBLICATIONS: June 2023 Provider Newsletter
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