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Health Plan Compliance – The Compliance Consortium

Health Plan Compliance Headlines 2/2016: 9 latest healthcare industry lawsuits, settlements  Full story  Aetna, Boston Children's Hospital resolve contract dispute Full story  Plan proposed to pay NY's big systems $2.5B to bailout Brooklyn hospitals  Full story Health Plan Compliance is a content-rich resource for Sponsor, Issuer and Plan professionals interested in the latest information related to Regulatory…

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Health Plan Compliance Headlines 2/2016: 9 latest healthcare industry lawsuits, settlements  Full story  Aetna, Boston Children's Hospital resolve contract dispute Full story  Plan proposed to pay NY's big systems $2.5B to bailout Brooklyn hospitals  Full story Health Plan Compliance is a content-rich resource for Sponsor, Issuer and Plan professionals interested in the latest information related to Regulatory…
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Health Plan Compliance – The Compliance Consortium | healthplancompliance.org Reviews

https://healthplancompliance.org

Health Plan Compliance Headlines 2/2016: 9 latest healthcare industry lawsuits, settlements  Full story  Aetna, Boston Children's Hospital resolve contract dispute Full story  Plan proposed to pay NY's big systems $2.5B to bailout Brooklyn hospitals  Full story Health Plan Compliance is a content-rich resource for Sponsor, Issuer and Plan professionals interested in the latest information related to Regulatory…

INTERNAL PAGES

healthplancompliance.org healthplancompliance.org
1

“The SME is in!” – Health Plan Compliance

https://healthplancompliance.org/welcome-to-the-plan-insider

8220;The SME is in! 8220;The SME is in! Ask a question – Get a private, confidential response from a knowledgeable subject matter expert. We know you don’t have to time to specialize in. But our SME’s do. The SME is in! Q – I need to know the best regulatory references for Organizational Determinations (Part C)/Coverage Determinations (Part D). Also, if you could point me to the departments (acronyms will do) in CMS who enforce these it would be great. It’s as simple as that.

2

Appeals and Grievances-ODAG – Health Plan Compliance

https://healthplancompliance.org/medicare-advantage/appeals-and-grievances

8220;The SME is in! Part C Organization Determinations, Appeals and Grievances (ODAG). Effectuation Timeliness ( click here for the tips and shortcuts to timeline regs. Effectuation timeliness, where different than the decision-making timeframe, for:. Create a free website or blog at WordPress.com.

3

Marketing – Health Plan Compliance

https://healthplancompliance.org/medicare-advantage/marketing

8220;The SME is in! Medicare Marketing Guidelines (MMG). Medicare Marketing resources ( Click here for links to the sections below. 42 CFR section 417.428. Section 422.2260, and section 423.2260. RHPMS memos: 2016 ANOC/EOC Standardized Models Instructions dated May 12, 2015 (Subject: Issuance of Contract Year 2016 Model Materials); Contract Year 2016 Annual Notice of Change/Evidence of Coverage Submission Requirements and Yearly Assessment dated 14, 2015. Create a free website or blog at WordPress.com.

4

Compliance – Health Plan Compliance

https://healthplancompliance.org/medicare-advantage/compliance

8220;The SME is in! Additional Guidance Compliance Program Training Requirements and Audit Process Update. Click here…. Sample Monitoring Questions to Ask: Be Ahead of the Curve. Who is responsible for receiving and identifying grievances calls/inquiries? Do you include identification of grievances in the required training for customer service staff? How do you ensure that staff responsible for identifying grievances receive and successfully complete this training? How frequently is this auditing?

5

CMS Resources – Health Plan Compliance

https://healthplancompliance.org/cms-resources

8220;The SME is in! Medicare Managed Care Appeals and Grievances. Medicare Prescription Drug Appeals and Grievances. Part C and Part D Compliance and Audits – Overview. Medicare Demonstration Projects and Evaluation Reports. Low Income Subsidy for Medicare Prescription Drug Coverage. Medicare Managed Care Eligibility and Enrollment. Medicare Prescription Drug Eligibility and Enrollment. Original Medicare (Part A and B) Eligibility and Enrollment. Medicare and the Marketplace. Medical Savings Account (MSA).

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Health Plan Compliance – The Compliance Consortium

8220;The SME is in! Health Plan Compliance Headlines 2/2016:. 9 latest healthcare industry lawsuits, settlements. Aetna, Boston Children’s Hospital resolve contract dispute. Plan proposed to pay NY’s big systems $2.5B to bailout Brooklyn hospitals. Report: Hacking led to 98 percent of breaches in 2015:. Hacking is at the top of the list of sources of healthcare data leaks in 2015, according to a Bitglass report. Hack, which impacted 11 million customers, and the Anthem. With fee to use Healthcare.gov...

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