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New CMS Online Form For Medicare Advantage Provider Complaints
The Centers for Medicare & Medicaid Services (CMS) recently implemented a new online form for physicians and providers to submit complaints related to Medicare Advantage (MA) plans.
A CMS memorandum announced the implementation of the form, which is now live and available for use. The online form collects key information about the complainant, beneficiary, provider, and the MA plan involved. Providers are also prompted to submit a complaint summary, with optional fields for service dates and claim numbers to support the review process.
Once a complaint is submitted, it is placed in a queue within the Health Plan Management System (HPMS) Complaints Tracking Module for review and triage. CMS will continue to serve as an arbitrator, working to facilitate resolution between the MA plan and the provider.
CMS encourages providers to use this form to report recurring or systemic issues with MA plans, as the information collected may also be used to identify compliance concerns, inform oversight activities, and improve plan performance over time.
MSMS members with questions may contact Dara J. Barrera, MSMS Director of Health Quality, Equity and Technology at djbarrera@msms.org or 517-336-5770.