The Centers for Medicare and Medicaid Services (CMS) recently
released a new
online form for providers to submit complaints about Medicare Advantage (MA) plans.
It is important to note that any submitted complaints must be beneficiary-focused for CMS to review.
The form requires information about the complainant, beneficiary, provider, MA plan, a complaint summary, date(s) of service, and claim number. Once submitted, the complaint will be sent to the
Health Plan Management System (HPMS) Complaints Tracking Module (CTM). Complaints will enter a queue in the CTM, where CMS will review and triage before assigning a contract number. As the information is submitted directly online, MA plans will not receive the original provider complaint form.
AHCA has long advocated for a provider‑initiated complaint process and is pleased to see this new option become available, as it helps ensure beneficiary access issues are addressed and provides CMS with valuable data to identify patterns and oversee plan performance. AHCA encourages providers to use this to highlight ongoing MA access and care-delivery issues in skilled nursing and post-acute care settings, thereby strengthening CMS’ ability to identify systemic problems and support meaningful improvements.
Please reach out to AHCA’s Population Health Policy Analyst Rohini Achal or Nisha Hammel, Vice President, Reimbursement Policy & Population Health, with any questions.
Access the Form