OPM - 2022-CAAG-001 - 1

We recommend that OPM immediately implement internal controls, including written policies and procedures, over the disputed claims process to fully define what constitutes a timely review in the context of 5 CFR Section 890.105, including but not limited to: - policies/procedures to govern the 90-day window allotted for OPM to review disputed claims; - policies/procedures to govern how OPM will address disputed claims appealed to them when the carrier reviewed the disputed claim outside the allotted timeframe and/or the FEHBP member's window to appeal expired (either at the carrier level [FEHBP Benefit Brochures, Section 3 and Section 8, Step 1 and 2] or OPM's level [FEHBP Benefit Brochures, Section 8, Step 3 and 4]); and - roles and responsibilities by position title of OPM personnel tasked with duties during the disputed claims process.