ABBREVIATIONS
FEHP
Federal Employee Health Benefits (Program)
This represents a significant portion of the nearly 8 million people who receive benefits through the FEHB and Postal Service Health Benefits (PSHB) program.
Blue Cross and Blue Shield Service Benefit Plan (FEP)
The act of intentionally making false representation to obtain a benefit or payment for which no entitlement exists.
What is Fraud?
When was the FEP established?
1960
What's the purpose of the U.S. Office of Personnel Management (OPM).
· Negotiating contracts with the BCBSA and other vendors
· Setting benefits and premiums for the FEP
· Monitoring the performance of the FEP and its vendors
· Resolving disputes and addressing concerns from FEP members
FEP
Federal Employee Program
Who Manages the FEP?
The FEP is managed by the Blue Cross and Blue Shield Association (BCBSA) and is divided into several parts.
Consumer Value Stores
CVS
Current and former Federal employees, Retirees, Family members, Former spouses.
Where's the FEP Located?
The FEP Association, located in Washington, D.C. and established by the Blue Cross Blue Shield Association (BCBSA), serves as the central hub for managing the Federal Employee Program (FEP).
FEPOC
FEDERAL EMPLOYEMENT PROGRAM OPERATIONS CENTER
Manages end to end enrollment processing, Claims, Seamless delivery of claims processing and Enhances customer self service capabilities.
FEPOC
This is the unintentional human or system errors resultng in lost of program.
Waste.
What is the difference between Standard Option and the Basic option from the FEP?
STANDARD OPTION: HAS DEDUCTABLE. CAN SEE ANY PROVIDER EVEN OUTSIDE NETWORK. OUT OF POCKET COSTS INCLUDE COPAYING AND COINSURANCE.
BASIC OPTION: HAS NO DEDUCTABLE. MUST BE PREFFERED PROVIDERS, MOST OUT OF POCKET ARE COPAYMENTS.
List the FEP vendors.
Caremark/CVS Specialty
Teladoc
Health Equity
WebMD
Cognizant/Medicare Prescription Drug Program (MDPD)
OPM
U.S. OFFICE of PERSONNEL MANAGEMENT
Provides services to FEP members such as; TELADOC, Health Equity, WebMD, Cognizant/Medicare Prescription Drug Program
FEP Vendors
a virtual healthcare service that provides 24/7 access to licensed medical professionals via phone, video, or mobile app, offering convenient, non-emergency medical care.
Teladoc
What are the 3 FEP offered plans?
FEP Blue Standard
FEP Blue Basic
FEP Blue Focus
Give 1 law or guideline related to FED Employee Program.
SECTION 1557 ACT
FALSCE CLAIM ACT
FEDERAL HEALTH CARE PROGRAM ANTI K BACK
COMBATING TRAFFICKING IN PERSONS
BCBSA
BLUE CROSS AND BLUE SHIELD ASSOCIATION
Providing coverage to over 8 million individuals. Including Former Spouses, Retirees, Current and Former Federal Employees.
Federal Employee Health Benefits (FEHB) Program
This is data in any form that identifies an individual and relates to that person's health, health care, or payment for health care. A doctor, health plan or insurer, can create, maintain, or receive PHI.
Protected health information (commonly referred to as PHI)
What is and who uses Genesys?
Genesys is the platform you will use to manage member calls, handle interactions, and support members every day in your role as an FEP service advocate
What are the parts of Original Medicare? Give 2 examples of each.
PART A: Inpatient hospital stays
Skilled nursing facilities
Hospice care
Home health care
PART B:
Outpatient hospital services
Ambulance rides
Durable Medical Equipment (DME)
Mental health services (inpatient, outpatient, and partial hospitalization)
Doctor visits and services