Policies

Operations Policies

THN provides the following operations-related policies and documents:

• ACO Communications and Marketing Materials
• Advanced Payment Option
• Availability of Services/Medical Necessity
• Authority to Commit or Expend Funds
• Beneficiary Complaints Grievance Appeals
• Beneficiary Engagement, Patient Centeredness & Evidence Based Medicine
• Beneficiary Enhancements and Beneficiary Engagement Incentives
• Beneficiary Freedom of Choice
• Beneficiary Notifications and Data Sharing Preferences
• Beneficiary Termination, Referrals and Prohibition on Cost Shifting
• Benefit Enhancement 3 Day SNF Waiver
• Board of Managers
• Care Coordination
• Chronic Disease Management Reward
• Financial Guarantee
• Health Equity Plan
• Participant/Preferred Provider Eligibility, Enrollment, Reassignment & Termination
• Participant Preferred Provider List Updates and Notice of Termination
• Primary Care Capitation Payment Mechanism
• Provider Credentialing
• Public Reporting Requirements
• Quality
• Voluntary Alignment

Compliance

• Beneficiary Inducements and In-Kind Incentives
• Education and Training
• FWA Laws and Utilization of Safe Harbors
• Record Retention

Resources

• Medicare Advantage Regulations & Guidelines
• Fraud & Abuse Waivers for CMS Models and Programs
• Medicare Shared Savings Program Guidance