Policies

Compliance Policies

THN provides the following compliance-related policies and documents:

• Beneficiary Enhancements and Beneficiary Engagement Incentives
• Beneficiary Freedom of Choice
• Beneficiary Inducements and In-Kind Incentives
• Board of Managers
• CMS Evaluations, Shared Learning and Audits
• Code of Conduct
• Code of Conduct - Spanish
• Compliance and Integrity
• Compliance Log
• Compliance Monitoring & Audits
• Compliance Officer: Duties and Responsibilities
• Conflict of Interest
• Duty to Report Suspected Non-Compliance
• Education and Training
• Electronic Communications
• Exclusion Screening for Prospective and Current THN Related Individuals
• Non-Discrimination
• Participant/Preferred Provider Eligibility, Enrollment, Reassignment & Termination
• Policy and Procedure Process
• Provider Credentialing
• Public Reporting Requirements
• Record Retention
• Reporting Suspected Compliance Program Violations
• THN Annual Risk Assessment and Compliance Program Review

Fraud, Waste & Abuse Policies

THN is committed to detecting, correcting and preventing fraud, waste and abuse. This is a vital component of our compliance and integrity plan.

• FWA Laws and Utilization of Safe Harbors

HIPAA Policies

THN understands that our members expect privacy and security regarding all of their personal and financial information. We’re committed to protecting the privacy and security of your information.

We define personal information as any information obtained from you and other sources that allows us to provide you with health insurance products and services. We’ll always inform you of our policies for collecting, using, securing and sharing non-public personal financial information the first time we do business with you and every year that you are our member.

• Breach Notification
• Business Associate Agreement
• Compliance with Privacy Requirements
• Cone Health Notice of Privacy Practices
• Confidentiality
• Confidentiality Agreement
• Data Backup, Security, Privacy and Removal of User Access
• Data Use, Disclosures and Protections
• Disaster Recovery Plan
• Employee Rights Relating to PHI
• Facility Access and Security Policy
• HIPAA Privacy Officer
• Individual Revocation of Authorization to Disclose Protected Health Information (PHI)
• Password Policy
• Patient Photographing, Video or Audio Recording, and Other Imaging
• Request for Access to THN Data - Policy
• THN Authorized Access Request Form

Operations Policies

• Advanced Payment Option
• Authority to Commit or Expend Funds
• Availability of Services/Medical Necessity
• Beneficiary Complaints, Grievances and Appeals
• Beneficiary Engagement, Patient Centeredness & Evidence Based Medicine
• Beneficiary Notifications and Data Sharing Preferences
• Beneficiary Termination, Referrals and Prohibition on Cost Shifting
• Care Coordination
• Compliance and Privacy Committee
• ACO Communications and Marketing Materials
• Financial Guarantee
• Health Equity Plan
• Participant Preferred Provider List Updates and Notice of Termination
• Primary Care Capitation Payment Mechanism
• Quality
• Voluntary Alignment

Resources

• Cone Health Privacy Practices
• Medicare Advantage Regulations & Guidelines
• Next Generation ACO Fraud & Abuse Waivers
• Next Generation ACO Shared Savings Guidance
• Triad HealthCare Network Compliance Report Form
• Triad HealthCare Network Direct Contracting Entity Compliance Program
• Triad HealthCare Network Executed Participation Agreement Signature Page
• Triad HealthCare Network HIPAA Compliance Plan