Federal Employee Programs…aka FEP
Many patients of ours work for the federal government. USPS, FBI, FAA, HHS. You name an acronym, and we probably have a patient that works for it. And just like the federal bureaucracy, dental insurance through FEP is COMPLICATED. Further, because dental coverage under FEP leaves a lot of out-of-pocket expenses, many of our patients have secondary supplemental insurance to help defray costs. It took me a full year to finally understand the interaction between FEP medical, FEP dental, and secondary insurance policies. I’ve found it incredibly important to understand how this stuff works because it results in a more timely revenue cycle for the practice and - more importantly - cuts down on billing errors with our patients. We really do strive to get everything right the first time.
To start, let’s do a quick primer on claims processing. When a patient has insurance, they provide our practice their insurance information (e.g. member ID, group number, insurance carrier, etc.). We use that information to submit a claim which the insurance carrier processes according to the policy provisions and their clinical rules. Using those rules, the insurance carrier will either pay or deny the claim. We use Dentrix Ascend practice management software to create the claims and Change Healthcare Claims Exchange to interface with all the different insurance carriers. It’s an electronic process with built-in workflow that helps us keep track of what claims have been paid and which claims haven’t.
For patients with dental insurance through FEP, it’s a potential multi-step process that - if not configured correctly - can result in significant delays and potential billing errors (both are bad if you catch my drift). After a patient with FEP insurance comes in for a cleaning, we create a claim using their FEP medical insurance member ID (which is a 9 digit number starting with the letter “R”). For our patients, FEP medical insurance is administered by BlueCross BlueShield of Illinois (BCBSIL). BCBSIL processes the dental claim under the medical ID and cuts us a check. At the same time, if the patient is also enrolled in FEP dental insurance, BCBSIL with automatically forward a claim to the FEP Dental claims administrator (which is a totally different BlueCross BlueShield company than BCBSIL). BCBS FEP Dental will process the forwarded claim and cut us a check. Our practice is in-network with FEP medical insurance administered by BCBSIL. We’re also in-network with FEP dental insurance administered by BCBS. They operate on DIFFERENT fee schedules and I’ve yet to get a straight answer as to what to expect in terms of network adjustments for the procedures we perform.
Anyway….
While some patients have BCBSIL FEP medical + BCBS FEP dental insurance policies, others choose to go the route of getting supplemental dental insurance through another carrier (e.g. Aetna, MetLife, GEHA, etc.). Unlike the interaction between BCBSIL FEP medical and BCBS FEP dental, BCBSIL FEP medical supplemental dental with another carrier requires us to store information for both dental insurance policies and manage the claims separately. So for example, let’s say that we have a patient named Sally James who works for the post office and has BCBSIL FEP medical insurance and a supplemental dental plan through MetLife. After Sally comes to the practice for a cleaning, we submit a claim to her BCBSIL FEP medical plan. BCBSIL FEP usually takes 30 - 45 days to process the claim and cut us a check. Once we get that check (including an explanation of payment), we enter the information into Dentrix Ascend and create a secondary claim and send it to MetLife. MetLife then takes another 7 - 14 days to process the claim and cut us a check. Once we get that check, we enter the payment information into Dentrix Ascend and send a bill to our patients for any outstanding balances (if any exists).
Does that make sense? It took a year for it to make sense to me. The big lesson I took away from that experience is that it puts an incredible emphasis on making sure we have the right data and coordination of benefits defined in the system in order to maximize the timeliness of the revenue cycle and minimize billing errors (a lesson that we reinforce on a daily/weekly/monthly basis as we continue to scrub our data for accuracy).
So if you’re a federal employee, know that you’re in safe hands at Hofmeister Family Dentistry. We have the gumption and experience to get your claims processed correctly ;)