OPM - 2022-CAAG-001 - 5

We recommend that OPM immediately implement written policies and procedures for the administration and use of FDC to ensure: - All FDC users are tracking disputed claim cases in the system consistently. - Disputed claim cases are consistently opened and closed in FDC among all users. - Disputed claim cases remain open in FDC during the 30-day FEHBP member response window, and OPM's 90-day review time frame includes the FEHBP member additional information letter process in cases where the FEHBP member responds timely. - The date of the FEHBP member additional information letter and the FEHBP member response date (if applicable) are made reportable fields in FDC. - FDC stores sufficient evidence to prove the FEHBP member provided new information after OPM made its decision, which warrants the reopening of the case. - All data components, including the medical codes (Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), etc.), are populated in FDC. - A process is established to assess FDC data trends, issues, and errors, so that corrective action can be implemented timely.