Help
 

Welcome SelectHealth Advantage® ​Providers

 

 
 

At SelectHealth we value our contracted providers, pharmacies, vendors, and other business partners and we understand that navigating Medicare Advantage rules and regulations can be difficult. If you or your organization is contracted with SelectHealth for participation in the SelectHealth Advantage provider or pharmacy network, you are considered a “first-tier entity, downstream, and related entity” (FDR) under the Centers for Medicare & Medicaid Services (CMS) guidelines.


View FDR definitions

 

To assist our contracted business partners who are FDRs, SelectHealth provides reference tools for your use in understanding the Medicare Advantage compliance requirements.  Our commitment to compliance includes ensuring our FDRs also observe applicable laws, regulations, and sub-regulatory guidance. 

 

One of the compliance obligations for FDRs is annual training on General Compliance as well as Fraud, Waste, and Abuse (FWA).  The information below outlines the training requirements and provides instructions for what you need to do. 

General Compliance and Fraud, Waste, and Abuse trainings

There are two parts to the trainings: General Compliance training, and FWA training. ​

 

 

  • ​General Compliance training: Every person or downstream entity, including employees, who perform services for SelectHealth Advantage enrollees are required to take the General Compliance training within 90 days of becoming contracted with SelectHealth, and each calendar year thereafter.

  • ​Fraud, Waste, and Abuse training: 
​​​​​If you are "deemed" for FWA: If you have met the FWA certification requirement through enrollment into Parts A or B of the Medicare program or through accreditation as a supplier of DMEPOS, then you are deemed to have met the FWA training and education requirements and there is no need to take FWA training.

​​​​​If you are not "deemed" for FWA: If you have not met the FWA certification requirement, you must complete the FWA training within 90 days of becoming contracted with SelectHealth, and each calendar year thereafter.  

  •  If you have employees or downstream entities: Deliver the General Compliance and FWA trainings to your employees and your downstream contractors who support the SelectHealth Advantage product and who are not deemed to have met the requirement, as indicated above. 

  • Compliance Attestation: If your employees and downstream contractors have already taken FWA training this year by completing the CMS FWA training module, there is no need to repeat the FWA training. However, they must still complete the CMS standardized General Compliance training and submit an attestation to SelectHealth of the completion. You must maintain documentation that your employees and downstream contractors completed the other training and be able to produce such evidence upon request.​ Preview the compliance requirements covered in the Attestation​​​.


 


 
The Medicare compliance requirements apply to you, any of your downstream entities, and all of your employees who perform services related to the SelectHealth Advantage product or enrollees. Therefore, please also share the SelectHealth FDR Compliance Guide information with your downstream contractors and employees.  

 

Record Retention

You are responsible for maintaining records of training completion and distribution of standards of conduct as proof of your organization's compliance with Medicare requirements for a period of 10 years. (Examples of proof of training may include copies of sign-in sheets, employee attestations, and electronic certifications from the employees taking and completing the training.) SelectHealth or CMS may request that you provide documentation of your compliance, please be prepared to produce the required documentation.
 
 
 
Standards of Conduct

Your organization's standards of conduct must be distributed annually. If your organization does not have its own standards of conduct, share the SelectHealth Code of Ethics​ with your employees. ​

Medicare Advantage Regulations and Guidance
 
 
  • CMS provides additional guidance for MA plans in the Medicare Managed Care Manual (Publication # 100-16) available through the CMS Internet-Only Manuals.
 
 
  • CMS provides additional guidance for Prescription Drug Plans in the Medicare Prescription Drug Benefit Manual (Publication # 100-18) available through the CMS Internet-Only Manuals​.
 
 
  • CMS requires MA plans and their FDRs to check the OIG/GSA Exclusion lists each month to prevent inappropriate payment to providers, pharmacies, and other entities that have been excluded from participation in federal programs. 

 

OIG’s List of Excluded Individuals and Entities (LEIE) includes all health care providers and suppliers that are excluded from participation in federal health care programs. 

 

GSA’s System for Award Management (SAM) includes health care providers on the LEIE and also includes other non-health care contractors that are excluded from federal programs. ​​​​​

 



 

SelectHealth Reporting Flyer

 

Reporting is essential for the prevention, detection, and correction of fraud, waste and abuse. The SelectHealth Reporting Flyer is a document you can post in your facilities or distribute to employees to let them know how to report Medicare program compliance concerns and/or FWA to SelectHealth without fear of intimidation or retaliation.

 


 

Reporting Fraud, Waste, and Abuse

 

To report potential fraud, waste, and abuse, call the Compliance Hotline at 800-442-4845. Anonymous reporting and interpretation services are available. To speak to someone or ask questions about plan benefits or coverage, call Member Services at 855-442-9900 (TTY: 711).

 

More information is available by requesting the guide titled “Protecting Medicare and You from Fraud” by calling 800-Medicare (800-633-4227). TTY/TDD users should call 877-486-2048. A Medicare Customer Service representative can answer your questions 24 hours a day, 7 days a week.

 
 
 
 
​​​
© 2018 SelectHealth, All rights reserved.