CMS Compliance Regulation

Issue Identification, Tracking, Escalation, and Resolution Training

The Centers for Medicare and Medicaid Services (CMS) requires that Health Net operate in compliance with CMS regulations and report any issues that may be out of compliance. Therefore, Health Net requires that all Medicare Advantage (MA) first-tier, downstream and related entities (FDRs) report any issues that may be considered out of compliance to their Health Net representative immediately upon learning of the issue. In addition, FDRs may report potential issues that may be considered out of compliance to Health Net as follows:

  • Health Net Medicare Compliance Officer
    Gay Ann Williams
    21650 Oxnard Street, Mail Stop: CA-102-22-07
    Woodland Hills, CA 91367
  • Health Net's Fraud Hotline: (800) 977-3565
  • Health Net's Integrity Line: (888) 866-1366

All Health Net first-tier providers (those who hold a direct contract with Health Net) and downstream providers (entities with which a first-tier entity contracts to provide services to MA members) and first-tier and downstream employees must complete this training. First-tier entities are responsible for their downstream entities' completion of the training. Training must be completed annually by December 31 and must also be a part of orientation for new employees. This is subject to audit upon request from Health Net. This process is not related to and is separate from any provider appeals and grievance processes.

First-tier entities may download and distribute this training to their downstream providers

Documentation Retention

Once a first-tier entity has completed the training, no further action is required. There are no acknowledgment or attestation forms to be returned to Health Net. First-tier entities must have documentation that the training was distributed to all of its downstream entities readily available for audit upon request from Health Net in the form of a mailing list, fax list or other equivalent format. Downstream entities do not need to submit acknowledgment or attestation forms to first-tier providers. Policies and procedures should also reflect inclusion of the training in new employee orientation processes.

To access hard-copy training, contact the Health Net Provider Services Center by email at provider_services@healthnet.com, or by telephone at (800) 929-9224.

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