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Individual & Group Coverage: (800) 400-PCHP
Medicare Advantage: (877) 210-1719

Instructions & Requirements

TRAINING INSTRUCTIONS AND REQUIREMENTS FOR FIRST-TIER, DOWNSTREAM AND RELATED ENTITIES (FDRs)

As a Medicare Advantage Plan Sponsor, Piedmont Community HealthCare (Piedmont) maintains ultimate responsibility for adhering to, and otherwise fully complying with, all terms and conditions of our contract with CMS (Centers for Medicare and Medicaid), and for maintaining a compliance and Fraud, Waste & Abuse (FWA) program that meets CMS Program Requirements.

If your organization contracts with Piedmont in the administration or delivery of our Medicare Advantage plans, you are considered a “First Tier Entity” by CMS.  As such, we are required to ensure that you, your employees, and your Downstream and Related Entity employees complete certain trainings and other requirements including:

    • Code of Conduct (within 90 days of hire/contract and annually thereafter)
    • FWA and General Compliance Training (within 90 days of hire/contract and annually thereafter)
    • HIPAA Training (within 90 days of hire/contract and as regulations change thereafter)
    • OIG/GSA Exclusion Checks (prior to hire and monthly thereafter)

Your Downstream and/or Related Entity’s must also follow these timeframes.

The information below outlines the requirements and gives complete instructions on what you need to do.

1. CODE OF CONDUCT

2. FWA AND COMPLIANCE TRAINING

3. HIPAA PRIVACY TRAINING

4. OIG/GSA EXCLUSIONS

5. ATTESTATION

6. REPORTING FWA AND/OR NON-COMPLIANCE

7. DELEGATED ENTITIES FAQs

8. POLICIES AND PROCEDURES

 For questions on any of the above instructions or requirements, please call the Piedmont Compliance Department at 434-947-4463, ext. 306.

 

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