The BlueCross BlueShield Service Benefit Plan for federal employees and retirees is a national plan administered by local BCBS plans across the country. BCBS FEP patients are easily identified by the ID number on their insurance card, which is the letter “R” followed by 8 digits.
The outpatient psychotherapy copayment is based upon the group number on the patient’s insurance card:
104 - Standard Option individual coverage $15.00
105 - Standard Option family coverage $15.00
111 - Basic Option individual coverage $20.00
112 - Basic Option family coverage $20.00
Standard Option patients have 8 unmanaged visits each calendar year (shared among all providers). Basic Option patients must personally call for preauthorization before their first appointment; they do not need a referral from their Primary Care Physician (PCP).
Complete descriptions of BCBS FEP benefits are available at their dedicated Web site, http://www.fepblue.org
TIP: Patients are allowed up to two hours of psychotherapy per day, but only one copayment per day may be charged. If two CPT codes are rendered on the same day, only one will have a copayment.
In Virginia, FEP claims are handled by two plans: Anthem Blue Cross and Blue Shield of Virginia and CareFirst BlueCross Blue Shield of the National Capital Area. Care is managed by and claims are filed to the plan whose service area includes your office address.
If there is any doubt about whether your office is located in the Anthem service area or the CareFirst service area, call Provider Services at both plans and give them your office nine-digit Zip Code. They should give you the same answer.
The patient’s home address or the BlueCross BlueShield plan that issued their insurance card is immaterial.
TIP: If Magellan authorizes more than one CPT code, multiple authorizations are downloaded into CareFirst’s system, but without CPT codes. This means you can use all authorized visits without reallocating CPT codes. Here’s how to do it:
Let’s say that Magellan authorized 6 90806, 3 90846, and 3 90847. The last CPT code and number of visits listed on the Magellan authorization is associated with the authorization number in CareFirst’s system. CareFirst sees Magellan’s authorization 123405678J as 3 visits (the 3 90847s). To get the CareFirst authorization number for the 3 90846, subtract one from the Magellan authorization number: 123405678J becomes 123405677J. Subtract one more to get the CareFirst authorization number for the 6 90806: 123405677J becomes 123405676J.
Now start submitting claims using the smallest authorization number, 123405676J. When that’s used up, move on to 123405677J, and so on!