WASHINGTON—The Centers for Medicare & Medicaid Services (CMS) has released a new online complaint form for providers to submit grievances related to Medicare Advantage (MA) plans.
A release from CMS stated the form requires information about the complainant, beneficiary, provider, MA plan, a complaint summary, date(s) of service and claim number. CMS said upon submission, these complaints will be sent to the HPMS (Health Plan Management System) Complaints Tracking Module (CTM) for review. Complaints will enter a queue in the CTM, where CMS will review and triage before assigning a contract number. As the information is submitted directly online, MA plans will not receive the original provider complaint form.
Providers will access the online complaint using the following steps:
- Go to cms.gov
- Select “Medicare” from the top left dropdown menu
- Select “Health & drug plans” from the left-hand navigation
- Select “Report a provider complaint about an MA plan
The American Health Care Association (AHCA) released a response praising CMS's decision to launch the form
"AHCA has long advocated for a provider‑initiated complaint process, as it helps ensure beneficiary access issues are addressed and provides CMS with valuable data to identify patterns and oversee plan performance," the association said. "AHCA encourages providers to use this to highlight ongoing MA access and care-delivery issues in skilled nursing and post-acute care settings."