(Jan. 17, 2025) – Organizations representing Medicare providers and seeking assistance from the Centers for Medicare & Medicaid Services in resolving Medicare Advantage claims issues must complete this form by following these instructions:
- Please submit one form for each complainant/beneficiary, ensuring all information on the form is populated. Each file must be password protected.
- If you have multiple complainant/beneficiaries for the same parent organization (MAPD plan) you may bundle them in one email to the Medicare Part CDQuestions mailbox; however, make sure to complete/submit one form per individual.
- Do not submit medical records – summarize specific issues.
CMS will enter complete complaint forms into the Complaints Tracking Module, directing MA to investigate the case. MAs have 30 days to work directly with the submitter(s) toward resolution. In general, CMS' role is to facilitate communication between the MA and the submitter. CMS does not determine medical necessity nor determine or resolve claim payments or payment disputes. CMS will identify and escalate repeated trends as warranted.
CMS has oversight of all MA plans nationally; however, all complaints are processed using one centralized email box (below) where password protected files should be sent to MedicarePartCDQuestions@cms.hhs.gov.
Upon entry of the complaint, CMS staff will provide the submitter with the complaint ID. Please click here to review the procedures and information needed to submit.
--Shannan Flach