Medicare Advantage Compliance and Training
Delta Dental's Compliance Program is our commitment to business integrity and ethical behavior. Part of this commitment is ensuring we are in full compliance with our obligations and responsibilities as a First Tier entity to the Medicare Advantage Organizations (MAO) with which we contract. Your written agreement with Delta Dental, as the ultimate provider of health or administrative services for Medicare Advantage dental benefits, means your organization is considered a downstream entity*.
Contracted Dentists and their employees and subcontractors are required to attest to required components and training by December 31st of each calendar year. The requirements are outlined on the Medicare Advantage Annual Attestation for Downstream Entities. You may use the links below to download and complete the required attestation forms, as applicable. The Medicare Advantage Compliance Attestation forms will apply to all practice locations under your dental organization.
- Medicare Advantage Annual Attestation for Downstream Entities(PDF, 162 KB)
- Offshore Subcontracting Attestation for Contracted Providers(PDF, 72 KB)
Medicare Advantage Annual Training requirements
Delta Dental's alliances with various Medicare Advantage Organizations (MAOs) require contracted dentists to complete the standardized General Compliance Training and Fraud, Waste and Abuse (FWA) training provided by CMS by December 31st of each year.
Newly contracted Delta Dental dentists must complete the standardized CMS training within 90 days from the contract effective date. Each new employee in a contracted dental office must also complete training within 90 days from the employee's hire date.Here are two ways to obtain the materials online:
- Download and incorporate unmodified training PDFs into your training program and/or written documents:
- Use CMS Web-based Medicare Learning Network Training. Upon completion, you will be issued a certificate that can be used as proof of completion for any carrier. Contracted providers will still need to complete the Medicare Advantage Annual Attestation for Downstream Entities (links to attestation forms are on this page above).
Please see CMS FAQs (PDF, 59 KB) for answers about how to create an account, how to find training, and how to print your certificate.
Code of Conduct and Ethics
Each practice must have a written Code of Conduct (CoC) that meets current CMS requirements in place. Your practice may also choose to incorporate Delta Dental's Code of Conduct to meet this requirement.
Our Delta Dental CoC includes ethics, values and principles about acceptable business conduct. Honesty, integrity, transparency, compliance and accountability are integrated into all business activities.
It is important that dentists and staff read and understand the CoC. The CoC below (or if you choose another one that meets or exceeds the elements found in it) should be adopted and distributed to each dental office employee within 90 days of hire each time it is updated and annually thereafter.
- *CMS considers Delta Dental and our contracted providers that treat (or may treat) Medicare Advantage patients as “first-tier, downstream and related entities”, abbreviated as FDRs. You may see the terms “downstream” or “FDR” in CMS training and other documents.