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Medicare Managed Care

APPEALS AND GRIEVANCES

• Letter Updated Information on the Fast-Track Appeals Process - (PDF 59K)
• OMB Approved Fast-Track Appeal Notices
• • New Notice of Medicare Non-Coverage (NOMNC) - (PDF 23K) or (Zipped Word 7K)
  • New Form Instructions for NOMNC - (PDF 26K)
  • New Detailed Explanation of Non-Coverage (DENC) - (PDF 25K) or (Zipped Word 7K)
  • New Form Instructions for DENC - (PDF 15K)
• MA Provider Education Article (PDF 20K)- June 2004 update
• Appeals Archive
• Chapter 13 - Medicare Advantage Beneficiary Grievances, Organization Determinations, and Appeals - The manual (pdf 566k) for appeals and grievance processing in Medicare Advantage organizations.
  
• Medicare Advantage Organization Performance Requirements For Appeals and Grievances - 2004 Monitoring guide for M+C organizations
  
• Beneficiary Notices Initiatives - Beneficiary notices including the Important Message from Medicare (IM), Notice of Denial of Payment (NDP) and Notice of Denial of Medical Coverage (NDMC).
  
• Standardized Coverage and Payment Denial Notice Letter
  
• Frequently Asked Questions - About the Standardized Appeal Notices
  
• Frequently Asked Questions - About the Fast-Track Appeals Process
  
• MAXIMUS CHDR - CMS's Independent Review Entity for Medicare Managed Care appeals
  
• Quality Improvement Organizations (QIOs) - CMS' link to Fast-Track Appeal Independent Review Entities
• Cost Plans - Information for Cost plans