Skip to main content

Medicare

Information and resources for health care providers.

Important: Annual Medicare Compliance Program Requirements



Participating providers in our Medicare Advantage (MA), Medicare-Medicaid (MMP), Dual Eligible (DSNP) or Fully Integrated (FIDE) Special Needs Plans are required to meet the Centers for Medicare & Medicaid Services (CMS) compliance program requirements for first-tier, downstream and related entities (FDR) as identified in the Medicare compliance FDR program guide and/or DSNP Model of Care (MOC) training.

 

New for 2021

 

  • MA/MMP: Providers who participate only in our MA/MMP plans no longer need to complete an annual FDR Attestation.
  • DSNP/FIDE: Providers who also participate in our DSNP/FIDE plans continue to be required to complete the Annual DSNP Model of Care (MOC) training and attestation requirements.

Notification regarding requirements will be sent directly to providers via Adobe Sign email, postcard or you can access the training and attestation at the link(s) below. Our Compliance Department completes random audits to ensure compliance on an annual basis.

Review Compliance Training(s):

Proactively review our training resources to ensure you’re in compliance:

Medicare compliance FDR program guide (PDF)

DSNP Model of Care (MOC) – Required only if you are in our DSNP network (PDF)

Provider and delegate frequently asked questions (PDF)

 

Read our Office Manual and/or Newsletters to learn more on Medicare program requirements:

Office Manual (PDF)

FDR Compliance Newsletters

OfficeLink Newsletters

2021 DSNP MOC Attestation

All Providers participating in DSNP or FIDE Plans, complete the attestation here:

DSNP/FIDE Attestation

 

Delegated provider / entity Attestation (only)

Delegated provider/entity: Is contracted with Aetna to perform specific delegated function(s) for example, credentialing or utilization management, etc.

Delegated provider/entity is required to attest based on contracted plan(s).

Delegated provider/entity participating in MA/MMP plan(s) attestation

Delegated provider/entity participating in MA/MMP and/or DSNP/FIDE plans attestation

Have questions on the Medicare Compliance or DSNP Programs? Review the provider and delegate frequently asked questions (PDF) for more information and contacts.

Join our Medicare Advantage Quality Incentive Program

Join our Medicare Advantage Quality Incentive Program

This program includes ways to promote early detection and assessment of chronic conditions. You'll provide the care your patients need, while earning incentives. You can participate if you are a primary care physician with 50 to 749 attributed Aetna Medicare Advantage members and are not participating in another Aetna/Coventry value-based contract or program.

Part D prescriber enrollment requirement

Part D prescriber enrollment requirement

Any health care professional who prescribes drugs to patients with Part D plans must now enroll in the Medicare program or opt out. If you do not enroll or opt out, Medicare Part D may no longer cover these drugs as of February 1, 2017. Please try to enroll or opt out by November 1, 2016. This will allow time for application processing and ensure that patients get their prescriptions without disruption.

For non-participating Aetna Medicare PPO providers

For non-participating Aetna Medicare PPO providers

We are expecting an increase in membership for our Medicare Advantage preferred provider organizations. You are likely to see more patients with these health plans.

Legal notices

Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).

Health benefits and health insurance plans contain exclusions and limitations.