When a contracting facility or service provider fails to obtain the required precertification or notification on behalf of a Federal Employee Program member, Wellmark is required to apply a $500 benefit reduction.

The member cannot be billed for this amount.

This change in benefits occurred January 1, 2011. Wellmark will begin administering the reduction effective July 1, 2011.

Requirements                                                                                                    

Hospital precertification is required before elective admissions and following emergency admissions for all FEP members:

• Before being admitted for inpatient care, including mental health/substance abuse admissions and admissions for other medical care
• Within two business days following a hospital admission for emergency care
• When a maternity stay extends beyond two days for vaginal or four days for cesarean delivery
• For extended newborns stays                                 

To Precertify

To begin the process, call 800-532-1537.

Other Services Requiring Precertification

 In addition to hospital admissions, the following continue to require precertification for FEP members. Please contact us before these admissions:

• Skilled nursing
• Hospice
• Acute rehabilitation

If you have questions, contact our FEP Customer Service area at 800-532-1537.

*This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. Before making a final decision, please read this plan’s federal brochure, RI 71-005. All benefits are subject to the definitions, limitations, and exclusions set forth in the federal brochure.