Good morning,
Is United Health Care Medicare Advantage required to follow the same appeals process as MAC? In other words, do the utilize the standard MAC, QIC, ALJ process or are they allowed to use their own appeals process that they use for their commercial products? Any links or references will be most helpful.Thank You - shashank32
There is 2024 Medicare C D Appeals Guidance Update (cms.gov)-https://www.cms.gov/medicare/appeals-and-grievances/mmcag/downloads/parts-c-and-d-enrollee-grievances-organization-coverage-determinations-and-appeals-guidance.pdf
I was always under the impression that they do in a similar fashion.
Recent reserach bears this out.
There is an excellet website that CMS provides, which outlines this information in great detail.
Please visit https://www.cms.gov/Medicare/appeals-grievances/managed-care#:~:text=Medicare%20health%20plans%2C%20which%20include,the%20requirements%20for%20grievance%2C%20organization
It provides in great details the answers to your question.
In essence the answer to your question is thus yes!