Division of Appeals Policy

Part D Coverage Determinations, Appeals and Grievances

Guidance resources for Part D Coverage Determinations, Appeals and Grievances

Guidance

CMS guidance links related to Part D appeals.

Resources

Resources if your questions do not relate to Part D appeals.

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

Part D Appeals Regulations, Title 42 Code of Federal Regulations, Part 423, Subpart M

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

Prescription Drug Appeals CMS.gov website

Program Audit CMS.gov website

Formulary Guidance CMS.gov website

Part D Independent Review Entity (IRE) website

Part D Grievances and Appeals web-based training (WBT) course

Answers to previously asked questions

Following are available resources if your questions do not relate to Part D Appeals and Grievances

Part D Benefits:&nbsp; <a href="mailto:Partdbenefits@cms.hhs.gov" rel="nofollow" style="color:#3b73af;text-decoration-line:none;" title="Follow link">Partdbenefits@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>Star Ratings:&nbsp;<a href="mailto:PartCandDStarRatings@cms.hhs.gov" rel="nofollow" style="color:#3b73af;text-decoration-line:none;" title="Follow link">PartCandDStarRatings@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>Formulary:&nbsp;<a href="mailto:PartDformularies@cms.hhs.gov" rel="nofollow" style="color:#3b73af;text-decoration-line:none;" title="Follow link">PartDformularies@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>Reporting Requirements:&nbsp;<ins><a href="mailto:partd-planreporting@cms.hhs.gov" rel="nofollow" style="color:#3b73af;text-decoration-line:none;" title="Follow link">PartD-planreporting@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></ins>Opioid overutilization policy:&nbsp;<a class="external-link" href="mailto:PartD_OM@cms.hhs.gov" rel="nofollow" style="color:#3b73af;text-decoration-line:none;" title="Follow link">PartD_OM@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>Part C/D Audit:&nbsp; <a href="mailto:Part_c_part_d_audit@cms.hhs.gov" style="color:#3b73af;text-decoration-line:none;">Part_C_part_D_audit@cms.hhs.gov</a><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" />Part C Appeals and Grievances: <a href="/DAPmailbox?PageFilter=pca" style="color:#3b73af;text-decoration-line:none;" target="_blank">Part C Appeals and Grievances Mailbox</a>

Part D Benefits: Partdbenefits@cms.hhs.gov

Star Ratings: PartCandDStarRatings@cms.hhs.gov

Formulary: PartDformularies@cms.hhs.gov

Reporting Requirements: PartD-planreporting@cms.hhs.gov

Opioid overutilization policy: PartD_OM@cms.hhs.gov

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

Part C Appeals and Grievances: Part C Appeals and Grievances Mailbox

Part D Appeals & Grievance Questions

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