Medicare Managed Care Appeals & Grievances Training

WEB BASED TRAINING COURSE AVAILABLE FOR PART C AND PART D

The Centers for Medicare & Medicaid Services (CMS) has developed two web-based training (WBT) courses.  The courses are:

• Part C Organization Determinations, Appeals, and Grievances, and
• Part D Coverage Determinations, Appeals, and Grievances.

The courses cover information found at 42 CFR Part 422, Subpart M for Part C, 42 CFR Part 423, Subparts M and U for Part D, and the Parts C & D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance.

Specifically, the courses include:

• A pre-assessment;
• Part C and Part D definitions;
• Requirements for Part C organization determinations, reconsiderations, and grievances;
• Requirements for Part D coverage determinations, redeterminations, and grievances;
• Common audit findings and frequently asked questions;
• A post-assessment knowledge check and certificate of completion; and

CMS recommends that plans identify appropriate personnel in their organizations to review the WBT courses.  These courses are designed for compliance officers, staff involved with initial coverage decisions, appeals and grievances, and customer service representatives.  Although this training is not mandatory, CMS strongly suggests that compliance officers incorporate these courses into their existing in-house training protocols and use the certificate to track course completion within their organizations.  

Each course takes approximately 60 minutes to complete. Both courses were created in conjunction with the Medicare Learning Network (MLN)®. To start the training course, go to: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/WebBasedTraining and search on the page for the training courses:

The Part D WBT course is named: Part D Coverage Determinations, Appeals, & Grievances

The Part C WBT course is named: Part C Organization Determination, Appeals, & Grievances