Division of Appeals Policy

Part C Appeals & Grievances

Guidance Resources for Part C Appeals & Grievances

Guidance

CMS guidance links related to Part C appeals policy.

Resources

Resources if your questions do not relate to Part C appeals policy.

Please review the available guidance links and the resources below that may answer your question.

<a href="https://www.ecfr.gov/cgi-bin/text-idx?SID=1f450ef3db8f90e7c0f2c0fba827e8f3&amp;node=sp42.3.422.m&amp;rgn=div6" target="_blank"></a>&nbsp;&nbsp;<a href="https://www.ecfr.gov/cgi-bin/text-idx?SID=1f450ef3db8f90e7c0f2c0fba827e8f3&amp;node=sp42.3.422.m&amp;rgn=div6" target="_blank">Part C Appeals Regulations, Title 42 Code of Federal Regulations, Part 422, Subpart M</a>&nbsp;&nbsp;<a href="https://www.cms.gov/Medicare/Appeals-and-Grievances/MMCAG/Downloads/Parts-C-and-D-Enrollee-Grievances-Organization-Coverage-Determinations-and-Appeals-Guidance.pdf" target="_blank">Parts C &amp; D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance</a>&nbsp;&nbsp;<a href="https://www.cms.gov/Medicare/Appeals-and-Grievances/MMCAG/index.html" target="_blank">Medicare Advantage Appeals CMS.gov website</a>&nbsp;&nbsp;<a href="https://www.cms.gov/Medicare/Appeals-and-Grievances/MMCAG/Notices-and-Forms.html" target="_blank">Medicare Advantage Grievances and Appeals Notices &amp; Forms CMS.gov website</a>&nbsp;&nbsp;<a href="https://www.cms.gov/Medicare/Medicare-General-Information/BNI/index.html" target="_blank">Beneficiary Notices Initiative (BNI) CMS.gov website</a>&nbsp;&nbsp;<a href="/DAPMailbox/S3Browser/GetFile?path=Improper%20ABN%20Use%2005%2005%2014.pdf">Improper Use of Advance Notices of Non-coverage</a><a href="/DAPMailbox/Documents/Improper%20ABN%20Use%2005%2005%2014.pdf" target="_blank"></a>&nbsp;&nbsp;<a href="https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/WebBasedTraining.html" target="_blank" title="Medicare Advantage Grievances and Appeals web-based training (WBT) course">Medicare Advantage Grievances and Appeals web-based training (WBT) course</a>&nbsp;&nbsp;<a href="http://www.medicareappeals.com/" target="_blank">Part C IRE website</a><div></div>&nbsp;&nbsp;<a href="https://www.cms.gov/Medicare/Compliance-and-Audits/Part-C-and-Part-D-Compliance-and-Audits/ProgramAudits.html" target="_blank">Audit CMS.gov website</a>

Part C Appeals Regulations, Title 42 Code of Federal Regulations, Part 422, Subpart M

Parts C & D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance

Medicare Advantage Appeals CMS.gov website

Medicare Advantage Grievances and Appeals Notices & Forms CMS.gov website

Beneficiary Notices Initiative (BNI) CMS.gov website

Improper Use of Advance Notices of Non-coverage

Medicare Advantage Grievances and Appeals web-based training (WBT) course

Part C IRE website

Audit CMS.gov website

Answers to previously asked questions

The following are available resources if your questions do not relate to Part C appeals policy.

&nbsp; Part C/D Audit:&nbsp;<a href="mailto:part_c_part_d_audit@cms.hhs.gov" title="Follow link">Part_C_part_D_audit@cms.hhs.gov<img align="absmiddle" alt="" border="0" class="rendericon" height="12" src="https://team.lmi.org/jira/images/icons/mail_small.gif" style="margin:0px;padding:0px;border:0px;" width="13" /></a>&nbsp; Part C Marketing:&nbsp;<a href="mailto:Marketing@cms.hhs.gov" title="Follow link">Marketing@cms.hhs.gov<img align="absmiddle" alt="" border="0" class="rendericon" height="12" src="https://team.lmi.org/jira/images/icons/mail_small.gif" style="margin:0px;padding:0px;border:0px;" width="13" /></a>&nbsp; Part C Reporting Requirements:&nbsp;<a href="mailto:Partcplanreporting@cms.hhs.gov" title="Follow link">Partcplanreporting@cms.hhs.gov<img align="absmiddle" alt="" border="0" class="rendericon" height="12" src="https://team.lmi.org/jira/images/icons/mail_small.gif" style="margin:0px;padding:0px;border:0px;" width="13" /></a>&nbsp; Part C Medicare Advantage policy questions: <a href="https://dpap.lmi.org" target="_blank" title="DPAP Mailbox">Medicare Advantage Policy Mailbox</a>&nbsp; Guidance resources for MA, SNP, PACE, CHOW/Novations, MA/SNP-Applications, and SARs/Non-&nbsp; Renewals/Terminations:&nbsp;<a href="https://dmao.lmi.org/dmaomailbox" target="_blank" title="DMAO Mailbox">Medicare Advantage Operations Mailbox</a>&nbsp; Part D Appeals and Grievances:&nbsp;<a href="/DAPmailbox?PageFilter=pda" target="_blank">Part D Appeals and Grievances Mailbox</a>&nbsp; Division of Enrollment and Eligibility Policy:&nbsp;<a href="https://enrollment.lmi.org" rel="noreferrer noopener" tabindex="-1" target="_blank" title="https://enrollment.lmi.org">https://Enrollment.lmi.org</a>

Part C/D Audit: Part_C_part_D_audit@cms.hhs.gov

Part C Marketing: Marketing@cms.hhs.gov

Part C Reporting Requirements: Partcplanreporting@cms.hhs.gov

Part C Medicare Advantage policy questions: Medicare Advantage Policy Mailbox

Guidance resources for MA, SNP, PACE, CHOW/Novations, MA/SNP-Applications, and SARs/Non- Renewals/Terminations: Medicare Advantage Operations Mailbox

Part D Appeals and Grievances: Part D Appeals and Grievances Mailbox

Division of Enrollment and Eligibility Policy: https://Enrollment.lmi.org

Part C Organization Determinations, Appeals & Grievances Questions

Please review the available guidance documents and resources described above before submitting a question.