Provider Resources
Welcome to the one-stop resource page for our physicians and office staff. Please visit this page to stay connected with up-to-date patient management tools, newsletters, trainings, and announcements from Greater Tri Cities IPA.
- 2020 P4P Best Practices Guidelines: One-page reference guide outlining the current year’s best practice for P4P measures related to commercial insurance plans.
- 2020 CMS 5 Star Best Practices Guidelines: One-page reference guide outlining the current year’s best practice for 5-star measures related to Medicare Advantage plans.
- Provider Dispute Resolution Forms: Please complete this form for all provider dispute resolution requests.
- Medicare Learning Network (MLN) Medicare Part C &D Compliance and FWA Trainings FAQ Guide: This guide summarizes CMS training requirements for compliance and fraud, waste, and abuse (FWA) and offers links and resources to materials.
- Access Guide to the CMS Medicare Learning Network (MLN): This guide provides steps and screenshots to aid in accessing the CMS MLN where you can access current versions of both the CMS required trainings – General Compliance and Fraud, Waste, and Abuse (FWA.)
- PDT HIPAA HITECH Training Materials Overview of HIPAA and HITECH training requirements.
- Medicare Parts C and D General Compliance Training: Medicare mandated general compliance training required for all individuals and entities conducting health or administrative services for Medicare enrollees.
- Combating Medicare Parts C and D Fraud, Waste, and Abuse: Medicare mandated training regarding avoiding, identifying, and reporting fraud, waste, and abuse, and how to Report Fraud, Waste, and Abuse for Greater Tri Cities IPA.
- CMS Strategic Language Access Plan (LAP): The CMS LAP programs aims to improve access to CMS federally conducted activities by persons with limited English proficiency (LEP.) Please reference the LAP Contacts by Health Plan for resources by health plan for patients requiring language assistance.
- ICE C&L Provider Toolkit- Cultural Sensitivity: Helpful background materials and tools produced by a nationwide team of healthcare professionals dedicated to high-quality, effective, and compassionate care.
- Access to Care Standards: There are certain care access standards that must be observed according to the required service. Please reference this sheet for guidelines.
- CMS Provider Marketing Guidelines: CMS has specific marketing guidelines and requirements for providers. Please use this resources as an overview of the dos and don’ts for provider marketing activities. This document should not be used as a substitute for CMS marketing guidelines.
- Aetna/CVS Health Code of Conduct: Aetna mandated training regarding the principles of ethics and integrity.
- Anthem Standards of Ethical Business Conduct: Anthem mandated training regarding the principles of ethics and integrity.
- Blue Shield Code of Conduct: Blue Shield mandated training regarding the principles of ethics and integrity.
- Humana Ethics Every Day: Humana mandated training regarding the principles of ethics and integrity.
- Sharp Code of Conduct: Sharp Healthcare mandated training regarding the principles of ethics and integrity.
- UHC Code of Conduct: United Healthcare mandated training regarding the principles of ethics and integrity.
- Care1st SNP Model of Care Training Presentation: Care1st required training designed to ensure the provision and coordination of specialized services that meet the needs of dual eligible beneficiaries.
Care 1st requires additional items on an annual basis including the SNP Model of Care Training Acknowledgementand the SNP Model of Care Evaluation form both for providers. Read more about the Care1st SNP Model of Care provider requirements.
- Affirmative Statement Memo 2019: Quality utilization statement reflecting the basis for all utilization decisions as required by the National Committee for Quality Assurance (NCQA.)
- Advance Health Care Directive – English/Spanish: Creating an Advanced Health Care Directive allows the physician, family, and friends know the health care preferences of the patient in case of incapacitation.
- Advanced Health Care Directive PCP Tool: This tool is intended to document your discussion with a patient regarding his or her advance directive.
- Consumer Notice Posting: Effective June 27, 2010, regulation by the Business and Professions Code section 138, requires physicians in California to inform their patients that they are licensed by the Medical Board of California and to include the Board contact information. This link offers sample signage to comply with this mandate.
- CDC Immunization Schedules –Adult: Center for Disease Control and Prevention adult immunization recommendations and details for healthcare professionals.
- CDC Immunization Schedule –Children (0-18 Years): Center for Disease Control and Prevention child immunization recommendations and details for healthcare professionals.
- PPACA: Important health care reform notice regarding preventive checkups, screenings and vaccines with no out-of -pocket costs.
- Preventive Health Guideline 2017: Coverage determination guideline from United Healthcare provides assistance in interpreting certain standard benefit plans.
- Diabetes Education Class Referral: Referral forms for the Greater Tri Cities IPA monthly diabetes education program.
- Required Prescription Drug Pre-Authorization form: Printable PDF tool for authorization requests for prescription drugs.
- MDX Login Instruction
- AV Training Form
