Note Changes to 2016 Fraud, Waste and Abuse Training and General Compliance Training Requirements

Corrected Claim Tips

Provider entities supporting Humana’s Medicare and/or Medicaid and/or dual-eligible Medicare-Medicaid members must complete fraud, waste and abuse (FWA) training and general compliance training. This year’s changes are:

  • Nondeemed organizations must use content on these topics that is published by the Centers for Medicare & Medicaid Services (CMS); and
  • While deemed organizations meet the requirement for FWA training by their deemed status, they must use CMS content to meet the general compliance training requirement.

Note: Organization-specific material may also be provided in training materials to supplement the CMS content.

These changes are based on a CMS requirement for provider entities supporting Humana’s Medicare members, although Humana extends them to those supporting members eligible for Medicaid.

The CMS training content can be accessed using any of the following methods:

  • By reviewing and/or downloading separate PDF documents on each topic from the CMS website
  • By logging onto Humana’s website or the Availity Web Portal and accessing the training via the compliance section
  • By taking two, separate interactive web-based training (WBT) modules via the CMS Medicare Learning Network.
  • Organizations choosing the WBT option can receive a CMS certificate of completion from CMS for each module.
  • Organizations pursuing this approach need to provide Humana with the CMS certificates and complete Humana’s attestation.

A CMS guidance document that includes links to the CMS training content, as well as additional information about the WBT option, is available under the “Downloads” section on the CMS website at:

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/ProviderCompliance.html .

Find additional information about Humana’s compliance requirements, including web instructions and frequently asked questions and answers, as well as information for nondeemed providers, at https://www.humana.com/provider/medical-providers/education/whats-new/compliance-requirements