Medicare Advantage Provider
Policy and Procedures
- Medicare Advantage Provider Manual
- Annual Physical Exam Policy
- Benefits Summary - Topeka Region
- Benefits Summary - Wichita Region
- Blood and Blood Components Policy
- Blood Sugar Monitoring Policy
- Dental Care Benefit Policy
- Dental e-Payment Options
- Member Benefit Highlights and Cost-Sharing (Availity login required)
- Fitness Benefit Policy
- Hearing Care Policy
- Inpatient Hospital Care Policy
- Meal Benefit Policy
- Medical Policy Hierarchy
- Organ Acquisition Costs Policy
- Over-the-Counter Benefit
- Symphony Provider Portal Training Guide
- Transplant Travel Benefits Policy
- Vision Care Policy
- Worldwide Coverage Emergency Care Policy
Medical management Resources
- Controlling High Blood Pressure
- Drugs Covered Under Medical Benefits that Require Medical Necessity Review (coming 2021)
- Guidelines for Bundling Admissions
- Medicare Advantage Provider Incentive Program (coming 2020)
- Statin Use in Persons with Diabetes
- Statin Therapy for Patients with Cardiovascular Disease
- HEIDIS and Stars Program (coming 2020)
- Medical Benefit Drug Request Form (coming 2020)
Education
Newsletters
- 09/20/2021 - Encourage eligible Medicare Advantage patients to get screened for colorectal cancer
- 08/20/2021 - Remind your eligible patients to get regular mammograms
- 07/16/2021 - Remember to discuss fall risk, urinary incontinence, and physical activity with Medicare patients
- 06/11/2021- Importance of statin therapy for patients with cardiovascular disease and diabetes
- 05/12/2021 - Medication reconciliation post-discharge is critical to patient safety and care coordination efforts
- 04/13/2021 - Blood pressure coding can reduce HEDIS® medical record requests
- 03/17/2021 - Advanced illness and frailty exclusions allowed for HEDIS® star measures
- 03/09/2021 - New Medicare Advantage Payment Method – EFT and Paper Remittance
- 02/26/2021 - Telehealth visits available to Medicare Advantage patients including annual wellness visits
- 02/24/2021 - Gain insights from CAHPS research on improving the patient experience
- 02/23/2021 - UNDERSTANDING STAR RATINGS - An introduction to the Centers for Medicare & Medicaid Services star ratings program
- 02/15/2021 - New MA Alpha Prefix with New Look
- 12/11/2020 - Medicare Advantage Prior Authorization Change (Updated 12/23/2020)
- 11/18/2020 - Medicare Advantage Interim Rate Letters
- 11/12/2020 - COVID-19 Vaccine Coverage
- 05/20/2020 - Temporary Suspension of Sequestration
- 05/13/2020 - Remote Electronic Medical Records Access
- 03/20/2020 - Kansas Preferred Blue Medicare Advantage Utilization Management Changes Due to COVID-19
- 12/17/2019 - Welcome to Medicare Advantage
Institutional Relations Education Resources
- Medicare Advantage 101 workshop presentation slides (PowerPoint deck)
- Medicare Advantage 101 workshop frequently asked questions
Medicare Advantage Stars Tip Sheets
- 2021 HEDIS® Advanced Illness and Frailty Exclusions Guide
- Breast Cancer Screening (BCS)
- Colorectal cancer screening
- Comprehensive diabetes care
- Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey
- Controlling high blood pressure
- Health Outcomes Survey
- Medication Adherence
- Medication Reconciliation Post-Discharge
- Osteoporosis management in women with a fracture
- Plan All-cause Readmissions
- Statin therapy for patients with cardiovascular disease
- Statin use in persons with diabetes
Webinars
- 02/18/2020 - Tru Hearing Medicare Advantage
- 01/16/2020 - Medicare Advantage webinar recording with Q&A
Forms
Prior Authorization Assessment
- Acute Inpatient Hospital Admission
- Long Term Acute Care Hospital (LTACH)
- Skilled Nursing Facility (SNF) Rehabilitation
Advance Benefit Notices
- Advanced Directives
- Advanced Beneficiary Notice of Non-Coverage (ABN) (compressed zip file)
- Detailed Explanation of Non-Coverage (DENC) (compressed zip file)
- Medicare Outpatient Observation Notice (MOON)
- Notice of Medicare Non-Coverage (NOMNC) (compressed zip file)
Satisfaction Surveys
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey
- Medicare Health Outcomes Survey
Waiver of Liability
- Model Waiver of Liability (compressed zip file)