Medicare plan(s)
Medicare resources for providers
We’re here to help providers stay compliant with Medicare regulations. Find helpful information about Aetna Medicare Advantage plans, compliance and attestation requirements, training and more.
New CMS coverage guidelines coming January 1
Stop back soon to learn about the latest regulations and changes for prior authorization, coverage criteria and access to care from the Centers for Medicare & Medicaid Services (CMS).
Aetna Medicare Advantage plans include any of the following:
Aetna Medicare Advantage (MA) plans include HMO, PPO and SNP (Special Needs Plans) benefits to Medicare-qualified members. Aetna offers Dual Special Needs Plans (D-SNPs) to members who also receive Medicaid benefits and/or assistance with Medicare premiums or Parts A & B cost-sharing and live in a county where Aetna Medicare offers a D-SNP. D-SNPs include any of the following:
- Dual Eligible Special Needs Plans (D-SNPs)
- Highly Integrated Dual Special Needs Plans (HIDE-SNPs)
- Fully Integrated Special Needs Plans (FIDE-SNPs)
The Aetna Medicare-Medicaid (MMP) is not a Medicare Advantage plan. The MMP is a plan that provides coordinated Medicare and Medicaid benefits for dually eligible individuals.
Annual Medicare compliance program requirements
Annual Medicare compliance program requirements
Every year, all providers who participate in our MA plans are required to meet the Centers for Medicare & Medicaid Services (CMS) compliance program requirements for first-tier, downstream and related entities (FDR).
Keep in mind: We complete yearly random audits to help make sure you’re compliant.
Required compliance and training
Review Aetna FDR Medicare compliance guide (PDF)
For all Medicare providers/delegates, for all plan types.
Review SNP Model of Care/MOC training (PDF)
For all providers/delegates treating SNP members.
Questions about compliance requirements? We’ve got answers. Check out our frequently asked questions (PDF).
Annual Medicare compliance attestation
Once you’ve reviewed the required compliance and training, you can complete your yearly attestation, if required. This guide can help you with the next steps.
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Attestation requirements |
|---|---|
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MA only MA and MMP plans |
Attestation is not required. However, you need to meet the requirements in our FDR compliance guide (PDF). |
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MA and SNP plans |
Attestation is required. Complete your training and attestation by December 31.
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Delegated entities: MA only MMP only MA and MMP |
Attestation is required for first-tier entities. Complete your training and attestation by December 31.
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Delegated entities: MA and SNP |
Attestation is required for first-tier entities. Complete your training and attestation by December 31.
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Medicare plan(s) |
MA only MA and MMP plans |
|---|---|
Attestation requirements |
Attestation is not required. However, you need to meet the requirements in our FDR compliance guide (PDF). |
Medicare plan(s) |
MA and SNP plans |
Attestation requirements |
Attestation is required. Complete your training and attestation by December 31.
|
Medicare plan(s) |
Delegated entities: MA only MMP only MA and MMP |
Attestation requirements |
Attestation is required for first-tier entities. Complete your training and attestation by December 31.
|
Medicare plan(s) |
Delegated entities: MA and SNP |
Attestation requirements |
Attestation is required for first-tier entities. Complete your training and attestation by December 31.
|
Be on the lookout for Medicare compliance updates
Be on the lookout for Medicare compliance updates
We’ll keep you informed about annual compliance requirements through Adobe Acrobat Sign email or postcard. You can also check out our OfficeLink Updates™ for news throughout the year.
Browse OfficeLink Updates library
Additional resources
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.