First Tier, Downstream or Related Entity (FDR) Information
Resources to assist our Delegated Entities
In this section, our First Tier delegated entities can access important information and regulatory guidelines applicable to your Mercy Care and Mercy Care Advantage FDR contracts.
Medicare Managed Care Manual; Chapter 21 Compliance Program Guidelines PDF Opens In New Window - Please reference Section 40, Sponsor Accountability for and Oversight of FDRs. This section explains CMS’ expectations of oversight and accountability responsibilities when Mercy Care has delegated administrative or health care service functions under our Medicare Advantage plan contract.
FDR Compliance Packet and Attestation PDF Opens In New Window - Mercy Care FDR Compliance packet explains the Medicare Compliance Program requirements that apply to our First Tier delegates, Downstream Entities, and individual employees who perform services for our Medicare Advantage plan contract.
Aetna Code of Conduct - Under a Plan Management Services Agreement with Aetna, Mercy Care uses the Aetna Code of Conduct to comply with the Medicare compliance program requirements. Contracted FDRs must provide either Aetna’s code of conduct and MCA’s Medicare compliance policies or your own comparable code of conduct/compliance policies (collectively, “standards of conduct”) to all employees and Downstream Entities who provide administrative and/or health care services for our Medicare Advantage plan.
MCA Compliance Program and Policies PDF Opens In New Window - The MCA Medicare Compliance Program and policies are designed to prevent, detect, and correct Part C and D Medicare Program non-compliance and fraud, waste and abuse (FWA). Policies are as follows:
- Compliance Training and Education PDF Opens In New Window
- Deficit Reduction Act and False Claims PDF Opens In New Window
- Disciplinary Action and Enforcement Policy PDF Opens In New Window
- Effective Lines of Communication PDF Opens In New Window
- Federal Disaster or Public Health Emergency Declarations PDF Opens In New Window
- Maintenance and Record Retention PDF Opens In New Window