Compliance Program

Banner – University Health Plans (B – UHP) is committed to ethical and legal conduct. This includes meeting the obligations of a programs involving the delivery of health care services. B – UHP is a Medicare and Medicaid participant.

 

A key component of our commitment to meeting our obligations under these governmental programs and contractual relationships includes adopting standards that uphold these principles, which is the basis for this Compliance Program. The Compliance Program is described in several documents including the Code of Conduct, policies, and procedures, as well as the Fraud, Waste, and Abuse Plan.

 

All employees and the Governing Bodies as well as first tier, downstream and related entities, subcontractors, Providers, and agents (Business Partners) must make a personal commitment to adhere to the Code of Conduct. Please review our Compliance Program and Fraud, Waste and Abuse Plan (January 1 through December 31), which includes the B – UHP code of conduct.

 

Banner – University Health Plans is committed to compliance and meeting requirements of all applicable laws and regulations of CMS and AHCCCS. As part of our compliance program, please review the FDR Guide to help ensure your compliance with CMS, AHCCCS, and B – UHP requirements.

 

Related Documents

Annual Attestation and Disclosure Statement

Contracted providers and Subcontractors, with B – UHP are required to complete the Annual Attestation and Disclosure Statement. 

Instructions:

1. Review each section

  • Section 1: Medicare and Medicaid Participation Compliance Program Requirements
  • Section 2: Attestations
  • Section 3: Organization Information and Signature

2. Complete the 2023 Annual Compliance Attestation online here: https://eservices.uph.org 

*If you are unable to complete the online form above, below is the PDF version.

Required Trainings

B – UHP General Compliance and FWA training is now available on our website. FDRs can take our training or a comparable training. FDRs are required to complete an attestation and submit it to B – UHP indicating that the employees involved in the administration of Medicare Part C and D benefits have satisfied the training requirement. For FDRs (Subcontractors) under the Medicaid line of business, the following are required training elements:

a.   Detailed information about the Federal False Claims Act

b.   The administrative remedies for false claims and statements

c.   Any State laws relating to civil or criminal liability or penalties for false claims and statements

d.   The whistleblower protections under such laws


Documentation of internal training can be through an individual certificate or a list showing the information for all of those who completed it through the internal web-based training.

The Compliance Departments or Vendor Oversight Staff track completion of training by FDRs through the completion and collection of annual attestations from all FDRs.

Related Documents

Code of Conduct

The Code of Conduct states B – UHP’s over-arching principles and standards by which B – UHP operates and defines the underlying framework for the compliance policies and procedures. Staff, Providers, and Business Partners, from the top to the bottom of B – UHP’s organization, have the responsibility to perform their duties in an ethical manner in compliance with laws, regulations, and B – UHP’s policies.

B – UHP requires that all FDRs supporting the Medicare Advantage and Part D Prescription Drug Program adopt and abide by the B – UHP Code of Conduct or implement a Code of Conduct that incorporates standards of conduct and requirements consistent with B – UHP’s Code of Conduct.

All B – UHP Staff and Business Partners must read the Code of Conduct annually and sign an acknowledgement that they agree to abide by the Code of Conduct.

Related Documents

Compliance Department Contacts

Contact our Compliance Department with any questions and/or to report potential compliance issues and fraud, waste, and abuse.

ComplyLine (Confidential and Anonymous):

(888) 747-7989 (24 hours a day/7 days a week)

Email:

BHPCompliance@bannerhealth.com

Mail:

Banner Plans and Networks
Compliance Department
5255 E Williams Circle, Ste 2050 
Tucson, AZ 85711

Fax:

(520) 874-7072

Form:

Report Fraud, Waste, and Abuse Form


Compliance Officers:

Terri (Theresa) Dorazio, MS, CHC, CHPC, CPC
Senior Director of Compliance
Medicaid Compliance Officer
(520) 548-7862
Theresa.dorazio@bannerhealth.com

Raquel Chapman
Director, Corporate Compliance
Medicare Compliance Officer
(602) 747-1194
BMAComplianceOfficer@bannerhealth.com 

Fraud, Waste, & Abuse

B – UHP is committed to preventing Fraud, Waste, and Abuse (FWA).

If you suspect a provider or member of fraud and abuse, please contact us at any of the following methods:

Phone

B – UHP Customer Care

  • Banner – University Family Care/ACC: (800) 582-8686, TTY 711
  • Banner – University Family Care/ALTCS: (833) 318‐4146, TTY 711
  • Banner Medicare Advantage Dual: (877) 874‐3930, TTY 711
  • Confidential and Anonymous Compliance (ComplyLine) Hotline: (888) 747-7989; 24 hours a day/7 days a week.

Mail

Banner Plans and Networks
Compliance Department
5255 E Williams Circle, Ste 2050 
Tucson, AZ 85711

Fax

(520) 874-7072

Email

BHPCompliance@bannerhealth.com

You are also required to report directly to AHCCCS, Office of the Inspector General at: 

Provider Fraud:(602) 417-4045 or (888) 487-6686
Member Fraud:(602) 417-4793 or (888) 487-6686
www.azahcccs.gov
Mail: Inspector General
801 E. Jefferson Street
Phoenix, AZ 85034


Examples of Fraud, Waste, and Abuse

Member Fraud, Waste, and Abuse include, but are not limited to:

  • Lending or selling your AHCCCS Identification Card to anyone.
  • Using someone else's AHCCCS card to obtain services.
  • Changing prescriptions written by any B – UFC/ACC provider.
  • Not stating true income or living arrangements.
  • Providing false materials or documents.
  • Leaving out important information.
  • Failing to report another insurance that you have.
  • Continuing to use AHCCCS for services when you move out of the state or out of the country.

Provider Fraud, Waste, and Abuse include, but are not limited to:

  • Ordering tests, lab work, or x-rays that aren't needed.
  • Charging for medical services not provided.
  • Billing multiple payers and receiving double payments.
  • Using billing codes that pay higher rates to get more money even though those services weren't provided.
  • Billing for services under a member who is not their member.
  • Providing unnecessary medical services leading to unnecessary costs to the program.
  • Use of the Medicaid system by someone who is unqualified, unlicensed, or has lost their license.

The B – UHP Compliance Department received approval from AHCCCS Inspector General to resume the provider audits effective June 15, 2022. Previously, the audits were suspended due to the Public Health Emergency from March 2020 to present. These audits are required by AHCCCS but are applied to all lines of business. This type of audit compares medical record documentation to the claims submitted and paid by B – UHP to ensure both are proper and accurate. 

The Auditors have identified similar errors in multiple audits and some of the types of errors observed include the following:

The Top Three Commonly Seen Errors:

  1. Progress notes not signed appropriately – Progress notes are required to be signed and dated by the rendering/treating provider after each appointment and/or procedure prior to being billed.  What we see are notes that say pending; notes that are signed up to a year later; notes that are signed by someone on behalf of the provider or notes with no signature or date. These examples make the note invalid. 
  2. Services billed under the NPI of a provider who did not render the service for an AHCCCS service. For AHCCCS, providers are required to bill the claim under the NPI of the provider who rendered the service. Incident-to-services that are allowed under Medicare for Mid-levels to bill under a supervising physician is not allowed under AHCCCS. The PA and NP must be registered with AHCCCS and credentialed. If it is not billed under the rendering provider, the claim is null and void. 
  3. Upcoding of Evaluation and Management Services – Coding Guidelines require medical documentation to support the proper evaluation and management code billed. What we see in practice, is that the provider’s progress note does not support the level of service billed. Frequently, we are hearing that providers are using autofill and auto-prompts to facilitate and improve documentation, coding, and billing. If used inappropriately, these tools can suggest a higher billing code than the actual services furnished warrant.  

If you have any questions regarding the errors and trends, please contact us by email at: BHPCompliance@Bannerhealth.com. 

Policies

B – UHP has written policies in place to:

  • Articulate our commitment to comply with all applicable Federal and State standards
  • Describe compliance expectations as embodied in the Standards of Conduct
  • Implement the operations of the Compliance Program
  • Provide guidance to Staff and Business Partners on dealing with suspected, detected or reported compliance issues
  • Identify how to communicate compliance issues to appropriate compliance personnel
  • Describe how suspected, detected, or reported compliance issues are investigated and resolved by our company
  • Include a policy of non-intimidation and non-retaliation for good faith participating in the Compliance Program, including, but not limited to reporting potential issues, investigating issues, conducting self-evaluations, audits, and remedial actions, and reporting to appropriate officials

Related Documents

FDR Newsletters & Memos

B – UHP provides our network providers with our FDR quarterly newsletters and memos as necessary. Providers can find helpful information and updates about our compliance program and policies.

Newsletters

Memos