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Medicare Part C & D - General Compliance Training 2020
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Medicare Part C & D - Fraud Waste and Abuse Training 2020
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NMM General Compliance Training 2022
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NMM Fraud Waste and Abuse (FWA) Training 2022
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Fraud & Abuse MLN Booklet (4649244)
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Compliance Program
Help Us Help You
Network Medical Management has published a Compliance Program, which reflects our attention to caring for all of our providers and members' guidance to ensure that our business is conducted in an ethical manner. Your adherence to complying with our Compliance Program is absolutely critical to our mutual success in delivering quality care.
If you have any questions or concerns, please contact our Compliance Department via phone, fax, email, or mail.
Compliance Hotline: (626) 943-6286
Fax: (626) 943-6329
Email: fwacompliance@networkmedicalmanagement.com
Mailing Address: 1680 South Garfield Ave. #2017 Alhambra, CA 91801 (please address to NMM Compliance Department)
Provider Training
Network Medical Management (NMM) is committed to conducting its business operations with the highest ethical standards and in full compliance with healthcare industry standards and regulations and all applicable Federal and State laws. In keeping with this pledge, NMM has implemented a comprehensive Training Program for network providers inclusive of Compliance items and Utilization Management Protocols and Policies. All network providers are required to review and attest annually to completing the trainings using the 2023 Annual Provider Training Attestation Form.
Fraud, Waste & Abuse (FWA) | General Compliance
HIPAA Privacy Training
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HIPAA Basics for Providers 2022 (MLN Booklet)
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NMM HIPAA Training - 2022
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Model of Care Training (MOC)
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Alignment Provider - MOC Training
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Blue Shield Promise - CMC and D-SNP MOC Training
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Brand New Day (BHC) - SNP MOC Training
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Central Health Plan SNP MOC Training
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Health Net SNP MOC Training
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L.A. Care – MOC Overview (CMC manual, sec. 4.5.1)
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Molina Healthcare MOC Training
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SCAN Health Plan SNP MOC Training
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United Healthcare SNP MOC Training
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Wellcare - SNP MOC Training
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Additional Provider Training Resources
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Access to Care Standards
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Balance Billing Training
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Fraud Impersonation Guidelines
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Initial Health Assessment Guidelines
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NMM Contracted OB-GYN Providers Responsibilities
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NMM Contracted PCP Responsibilities
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NMM Contracted SPECIALISTS Responsibilities
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SCAN IHA Requirements
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Timely Response To Grievance Requests - Alpha Care Medical Group
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Timely Response To Grievance Requests - LaSalle Medical Associate
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2023 NMM Provider Manual
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Additional Compliance Resources
Code of Conduct
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NMM Standards of Conduct
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NMM Standards of Conduct Training
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DHCS Screening and Enrollment
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APL Highlights
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DHCS Managed Care All Plan Letters
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DHCS Providers and Partners
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Provider Enrollment FAQ 5.31.2018
Excluded Parties
In accordance with the Network Medical Management group policy, all providers, vendors, and contractors are prohibited from contracting with Excluded Parties.
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Excluded Parties
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Policy Template Exclusion Screenings
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Screening Against Government Exclusions Lists Guidance Overview
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Miscellaneous
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Behavioral Health Treatment FAQ
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California Department of Developmental Services
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Health Plan Language Assistance
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Hospice & Palliative Care
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Medicare Managed Care Manual (Refer to Chapter 9 and 21)
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Office of the Inspector General (OIG) Exclusion Database
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Patient Rights and Responsibilities
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Provider Compliance
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Policies and Procedures
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If you need to obtain a copy of a specific policy, please contact our Provider Services Department from Monday to Friday between 9:00 AM and 5:00 PM PST at (626) 943-6100.
- Breach of Protected Health Information
- Identifier Standards
- Privacy
- References
- Security
- Transactions and Code Sets
Health Education
Utilization Management
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California Children’s Services Conditions
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NMM California Children’s Services (CCS) Training
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NMM Sterilization and Informed Consent Training
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Interdisciplinary Care Team (ICT) Training
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Preventive Services
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General Education Materials
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Access To Care Flyer – Chinese
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Access To Care Flyer - English
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Access To Care Flyer - Spanish
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Blue Shield Promise Health Education Link
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California Department of Developmental Services Regional Centers
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CHCS Health Literacy Fact Sheets
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Dietary Guide for Americans
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LA Care Health Education Link
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Medi-Cal Early & Periodic Screening Diagnosis & Treatment For Children & Young Adults
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Sterilization - Consent Form PM 330 Department of Health Services
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Sterilization - Permanent Birth Control for Men
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Sterilization - Permanent Birth Control for Men (Spanish)
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Sterilization - Permanent Birth Control for Women
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Sterilization - Permanent Birth Control for Women (Spanish)
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WIC Program Guide
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Resources
HEDIS
LA Care HEDIS Resources
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2020 HEDIS Measures
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HEDIS 2020 Hybrid Measure Quick Guide
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HEDIS 2020 Administrative Measure Quick Guide with Codes
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HEDIS 2020 Chart Submission Requirements
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HEDIS 2020 Hybrid Measure
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PM160 Notification Letter
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Updated PM160 Notification Letter
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QI Interventions Reported by Top Performing IPAs
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Templates
Claims
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Provider Dispute Resolution Request Form (ADV)
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Provider Dispute Resolution Request Form (AHC)
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Provider Dispute Resolution Request Form (ALPHA)
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Provider Dispute Resolution Request Form (APC)
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Provider Dispute Resolution Request Form (APCMG)
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Provider Dispute Resolution Request Form (BAIPA)
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Provider Dispute Resolution Request Form (CFC)
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Provider Dispute Resolution Request Form (CVIPA)
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Provider Dispute Resolution Request Form (GOM)
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Provider Dispute Resolution Request Form (LSMA)
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Provider Dispute Resolution Request Form (NCPN)
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Waiver of Liability Statement
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Utilization Management
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AHC Authorization Request Form
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ALPHA Authorization Form
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APC and Affiliate IPAs Authorization Form
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BAIPA Authorization Form
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CFC Authorization Form
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EHIPA Authorization Form
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