OBRA 90 and 93 sets FEP reimbursement rates

May 3, 2012

As a result of the Omnibus Budget Reconciliation Act (OBRA), provider reimbursement for federal retirees or annuitants enrolled in the Federal Employees Health Benefits Program (FEHBP) is based on Medicare allowable. This act applies to federal employees who are over age 65 and do not have Medicare part A and Part B.

As a FEHBP participating health plan, Blue Cross and Blue Shield of Oklahoma will process all claims for services included in the Medicare fee schedule and pay the current amount allowed by Medicare.

Providers who have signed participation agreements with Medicare may not bill FEHBP enrollees for any amount over the Medicare fee schedule amount. Services that are not included in the Medicare fee schedule will be reimbursed according to the participating provider agreement.