CommercialPrior AuthHigh impact
Federal Employee Program (FEP) Prior Authorization (PA) Process Change
Blue Cross Blue Shield of North Dakota·ND · Orthopedics, Neurosurgery, General Surgery·Prior Authorization
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of North Dakota's Federal Employee Program (FEP) has updated their prior authorization requirements for 2026. They are now requiring PA for elective hip, knee, and spine surgeries, while removing PA requirements for outpatient hospice, certain genetic testing, and gender reassignment services (benefit removed entirely).
Action Required
For 2026: Billing team must update prior authorization workflows to require PA for all elective hip, knee, and spine surgeries for FEP members. Remove PA requirements for outpatient hospice services, certain genetic testing, and gender reassignment procedures. Update encounter forms and billing system alerts accordingly. Check the full PA list at https://www.fepblue.org/ for specific procedure codes. Contact Provider Service at 800-368-2312 with questions.