We are required to monitor and ensure your organization operates in compliance with applicable laws and regulations required by CMS and your Participating Dentist Agreement. You must annually affirm your compliance with each of the listed topics in the attestation that apply to your organization and the services you provide for Medicare Advantage.
Medicare Advantage Network
Credentialing & Compliance
We are excited to welcome you to the Delta Dental Medicare Advantage network as a participating provider. With a continued increase in annual membership, this is a great opportunity to welcome new patients to your practice. Welcome to new providers and thank you to our participating providers for serving these members.
Important Information: If your office is considering joining our Medicare Advantage network or is already participating you will need to be in compliance with the Centers for Medicaid and Medicare Services (CMS) requirements for Medicare Advantage providers. Please refer to the Compliance Attestation and the information on this page to assist in meeting these requirements.
Required forms
Policies
Fraud, Waste & Abuse Training
All of your employees must complete our General Compliance and FWA Training annually and within 90 days of hire. This training also includes a cultural competency component to help dental office staff understand and accommodate diverse patient needs.
Office of Inspector General (OIG) List of Excluded Individuals and Entities (LEIE)
OIG's LEIE provides information regarding individuals and entities currently excluded from participation in Medicare, Medicaid, and all other federal health care programs. You should check the list monthly to ensure that new hires and current employees are not on it.
General Services Administration (GSA) or System for Award Management (SAM) List
The GSA similarly maintains several exclusion lists, managed through the System for Award Management (SAM). You should routinely check SAM to ensure that excluded individuals and/or entities are not involved in provision of care services on behalf of your office.
CMS Preclusion List
CMS maintains a list of providers and prescribers who are precluded from receiving payment for Medicare Advantage items or services or Part D drugs furnished or prescribed to Medicare beneficiaries. You will receive an email and a letter from CMS/Medicare Administrative Contractors in advance of your inclusion on the preclusion list. The email and letter will be sent to your Provider Enrollment Chain and Ownership System (PECOS) address or National Plan and Provider Enumeration System (NPPES) mailing. The letter will contain the reason you are precluded, the effective date of your preclusion, and your applicable rights to appeal. Medicare Advantage plans are required to deny payment for a health care item or service furnished by an individual or entity on the preclusion list. To learn more about the CMS Preclusion List, visit CMS.gov.