Federal Employee Program: Waiver Copy Required for Denial Review

Policy Number: GP-F-004

Last Updated: Sept. 26, 2022 

If a Federal Employee Program (FEP) member has signed a waiver and files an appeal on a claim denied as not medically necessary, the Office of Personnel Management (OPM) requires the provider to send us a copy of the waiver for final review. If the provider cannot present the signed waiver, the member must be held harmless. OPM will not allow the submission of medical record documentation.  

For requirements of an Advanced Beneficiary Notice or waiver, see the Hold Harmless and Balance Billing policy.   

For billing and claim guidelines and other information for FEP members, please see the appropriate topic.