Cooperative Advantage Provider Resources

 

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Forms and Resources

Get Help

If you have questions regarding benefits, claims, our network, or your plan materials, please contact Member and Provider Services at:

Toll-free: (800) 460-4641
Fax: (715) 836-7683

Hours:
OCTOBER 1 - MARCH 31 7 DAYS A WEEK 8AM-8PM CST
APRIL 1 - SEPTEMBER 30 MONDAY-FRIDAY 8AM-8PM CST

General Info                                    

Cooperative Advantage Model of Care Training

Claims Forms                                  

Waiver of Liability

Prior Authorization Resources

Prior Authorization Guidelines

FDR Compliance

Group Health Cooperative of Eau Claire (the Cooperative) is contracted with the Centers for Medicare and Medicaid Services (CMS) to provide Medicare Advantage (MA) and Part D programs and services to Medicare beneficiaries. The Cooperative delegates some of the administrative and health care services required under these contracts to external delegated entities. CMS refers to these delegated entities as First-tier, Downstream, and Related entities (FDRs). FDRs are required to fulfill certain Medicare compliance program requirements, and some of those are highlighted below.

Code of Conduct and Cooperative Advantage Compliance Program

Code of Conduct Cooperative Advantage Compliance Program

Compliance Program Policies                                             

Compliance Concern Communications Compliance Training Fraud, Waste & Abuse Policy

General Compliance and FWA Training                                           

Medicare Parts C and D General Compliance Training (cms.gov) Combating Medicare Parts C & D Fraud, Waste, & Abuse (cms.gov)

Medicare Managed Care and Prescription Drug Benefit Manuals

Medicare Managed Care Manual Chapter 21 Prescription Drug Benefit Manual Chapter 9

Required Annual Compliance Attestations                   

Required FDR Annual Compliance Attestation Required FDR Offshore Services Annual Compliance Attestation

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