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Overview
The Helper Bees contracts with vendors as a cost-effective and efficient way of providing administrative and health care services to our members. We are required to perform these services under our contract(s) with our plan sponsors and CMS guidelines.
All service providers, contractors, subcontractors, and vendors must undergo a pre-delegation assessment prior to performing delegated activities or providing services. This assessment includes evaluation against certain specific criteria, carefully considered by The Helper Bees Management, Legal, and Compliance teams. A first tier, downstream, and related entities (FDR) can be identified as any entity meeting some or all of the following criteria:
- The Helper Bees is required to provide this function under its plan sponsors contract(s), federal regulations, or CMS guidance
- The function directly impacts members or prospective members
- The entity interacts directly with members or prospective members either orally or in writing
- The delegated entity has access to beneficiary information or personal health information (PHI or PII)
- The delegated entity has decision-making authority (e.g., enrollment vendor deciding time frames) or whether the entity strictly takes direction from the sponsor
- The delegated entity is in a position to potentially commit health care fraud, waste, or abuse (FWA)
- There is risk that the entity could harm enrollees or otherwise violate CMS program requirements or commit FWA
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