Federal Employee Program (FEP) Quality Program 2026 Launch

By March 2026: (1) Billing and clinical teams must review and complete all mandatory training webinars referenced in the update, particularly regarding FEP Quality Program 2026 requirements and 2026 Horizon NJ TotalCare (HMO D-SNP) Model of Care training. (2) Obtain and send accreditation documentation to Evicore as required for participating providers. (3) Implement use of HorizonDocs for submitting post-service medical records and appeals documentation to expedite processing. (4) Review updated Medical Policy Manual for drug policies and clinical laboratory referral procedures; update billing system rules accordingly. (5) Familiarize billing staff with new BlueCard ID card formats and BlueCard Executive program changes to ensure correct claim submission. (6) Implement standardized depression treatment follow-up tools per HEDIS measures to ensure compliance with quality reporting. (7) Use Veradigm tool and participate in Risk Adjustment webinars to identify and close care gaps, improving HCC documentation for better reimbursement outcomes. (8) Ensure providers document falls prevention and diabetic foot care per updated clinical guidelines. Non-compliance with mandatory attestations and training requirements may result in loss of network participation or claim processing delays.