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Optimizing Care Management And Compliance With First-Tier, Downstream, And Related (FDR) Entities Under Medicare Advantage

by ZeOmega

February 4, 2019

FDR’s offer a long list of services to Medicare Advantage (MA) members that includes everything from utilization management (UM) to case management, health risk assessments, behavioral health care, home visits, and more. With each year that passes, that list expands, but the growth can be challenging.

For instance, key administrative and care management functions can live with the plan sponsor, the FDR, or both—which can create numerous co-management problems. Complying with data management and reporting requirements presents another challenge when working with FDRs. And with sponsors ultimately bearing the responsibility for fulfilling the terms and conditions of contracts, a lot is riding on a plan’s ability to keep track of the complex web of information.

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This [presentation/paper/etc.] represents the views of the author, not America’s Health Insurance Plans (AHIP).  The publication, distribution or posting of this [presentation/paper/etc.] by AHIP does not constitute a guaranty of any product or service by AHIP.