Anthem Blue Cross Blue Shield Federal Employee Program® admission review process

We all want to reduce unnecessary contacts and coordinate excellent quality of care for all of our patients.  In order to expedite claims payment, you will need to have all the patient’s days of care certified. We will also need to assist you in discharge planning/case management services, in order to provide optimal patient outcomes.

 

So how do we accomplish those activities balancing your time and our time?

 

Initial admission review process

 

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

 

Regardless of whether you call or electronically submit information to Anthem’s FEP Medical Management Department to report an inpatient admission, once we certify the admission, an initial length of stay will be given to you. At this time, we would also request the discharge planner’s name and phone number in order to help facilitate discharge planning/case management as soon as possible. 

 

Next steps after initial admission approval

 

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

 

• With a discharge date if it falls on the initial length of stay period OR

 

• If the patient stays a day or longer than the initial length of stay approved, we require updated clinical 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 work 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.