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Frequently Asked Questions Insurance

Our plan contracts for medical/clinical oversight. Is OPM requiring all plans to have in-house medical management?

OPM requires that each FEHB carrier has appropriate and verifiable oversight, but takes no position on whether Medical Direction should be an in-house or contracted function. The accreditation survey will examine how the Medical Director function is fulfilled and will also evaluate how the carrier ensures that continuity of care/services is provided to members, how quality is assessed and progress is monitored, how handoffs are facilitated, and how the carrier assures that any delegated function is competently performed.

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