Medicare Advantage: Grievances, Organization Determinations, and Appeals

The Medicare Part C program provides coverage for medical benefits for eligible Medicare beneficiaries. This course describes the grievance, organization determination, and appeal processes that are required in order to protect the rights of Medicare Part C enrollees. This course discusses the Part C regulations and CMS instructions for grievances, organization determinations, and appeals. Users will learn the definitions and regulatory requirements for processing grievances, organization determinations, and appeals including time limits, documentation, follow-up, and reporting procedures. Instructions for handling Part D grievances, coverage determinations, and appeals are found in the course entitled Medicare Part D: Appeals and Grievances.