Education


Medicare Compliance Training

Saint Alphonsus Health Alliance (SAHA) contracts with multiple payers to perform credentialing services through delegation agreements. Some of these payers hold direct contracts with the Centers for Medicare & Medicaid Services (CMS) to provide health care services to Medicare members through Medicare Advantage Plans and Medicare Part D prescription drug products, as well as the exchanges through the Qualified Health Plans (QHP). CMS requires these payers to oversee their first tier, downstream, and related entities (FDRs) and Downstream and Delegated Entities (DDEs) that assist them in providing services for their Medicare and QHP beneficiaries. Examples of FDRs and DDEs include providers, producers, pharmacies, claims processors, health care facilities and other vendors who help them deliver services and benefits, such as credentialing.

By performing delegated credentialing services on behalf of these payers, SAHA is considered a DDE and is also required to oversee our FDRs and to comply with CMS requirements. As an FDR of SAHA participating in Medicare Advantage, Part D or other QHP products, you play a critical part in ensuring the success of these government programs. Payments received for services under these programs come from federal funds and as such, CMS requires FDRs/DDEs to participate in a Medicare Compliance Program.

Expectations

  • Read the Medicare Compliance Training Requirements linked below to ensure understanding
  • Review the remaining linked materials for CMS compliance program information
  • Fill out and submit the web form below to indicate that you have read, understand and meet the obligations under this program for your clinic to participate in these plans through SAHA
  • Only one submission per contracted tax ID is required.

Resources