Medicare Compliance Program
CHRISTUS Health Plan is committed to operating a health plan that meets the requirements of all applicable laws and regulations of the Medicare Advantage and Part D programs. As part of an effective compliance program, the Centers for Medicare and Medicaid Services (CMS) requires Medicare Advantage plans to ensure that any FDRs to which the provision of administrative or health care services are delegated are also in compliance with applicable laws and regulations.
- FDR Medicare Compliance Program Guide (PDF)
- FDR Training Requirements (PDF)
- FDR Annual Compliance Attestation (PDF)
- Screening Log
- Employee Training Attendance Log Example (PDF)
- FDR Medicare Compliance Program Self-Assessment Tool (PDF)
- FDR Code of Conduct and Compliance Program Policies Announcement Template (PDF)
- Preclusion List Screening Log (PDF)
- OIGGSA Exclusion Screening Log (PDF)
- Offshore Services Attestation
Clinical Guidelines
CHRISTUS Health Plan uses MCG care guidelines to help review medical necessity for health services requests. MCG care guidelines are the protected intellectual property of MCG. MCG has provided a tool that allows CHRISTUS Health Plan members and prospective members to review relevant MCG care guidelines, however you will not be able to print them.
Follow the instructions below for access to MCG care guidelines.
Access instructions:
- Access the MCG Guidelines, read the disclaimer, and accept the terms and conditions.
- Complete the User Information form.
- Complete the verification process to continue.
- Click on the arrow icon to expand the list of guidelines in the content group.
- Click on the guideline you wish to view.
ERA Enrollment
CHRISTUS Health Plan - US Family Health Plan Remittance Advice (ERA) are now being handled by Change Healthcare.
If you would like to sign up for ERA’s please visit Optum for Business.
If you have any further questions please contact your provider Relations Representative at CHP.providernetwork@christushealth.org.
Other Resources for Providers
The Department of Defense, in collaboration with the Department of Veterans Affairs and other leading professional organizations, has developed clinical practice guidelines.