CMS Appeals & Grievances
Acentra Health balances accuracy with efficiency
during the appeals and grievances process.
Experienced support for
providers and patients
Acentra Health performs appeals and grievances on behalf of CMS and state Medicaid agencies and commercial plans. We protect the rights of members by making timely and informed decisions. Our seasoned team works collaboratively with both members and providers to support many different appeals including:
- 1st and 2nd Level Medical Necessity Reviews
- Medical Appeals (State & Federal Levels)
- ACA Appeal Requirements
- 3rd Party Appeals
- Testifying for Fair Hearings
Acentra Health performs more than 1.8 million reviews of all types and completes more than 130,000 Medicaid appeals on an annual basis for our clients.
Expertise to make
high-accurate decisions
With more than 500 clinicians and 3,000 credentialed physicians on our
physician panel, we have the expertise needed to do all types of specialty
matches. These individuals use established nationally recognized criteria,
alongside current medical guidelines, to make highly-accurate decisions.
In addition, we manage grievances by acting as a mediator to resolve
issues between members and their providers while thoroughly investigating
the grievance.
We protect the rights of members by
making timely and informed decisions
1.8
Appeals
reviewed annually
3000
Credentialed
Physicians
130000
Medicaid appeals
reviewed annually
Flexible process based on your organization's unique systems
We also provide education on the appeals process. Throughout these efforts, Acentra Health maintains a flexible process based on your organization’s unique systems, regulatory criteria, time frames, and requirements. As a result, your team can focus on other mission-critical functions like managing claims while we take on these resource-intensive processes.
Improve healthcare quality oversight with
our cross-functional solutions
External Quality Review
Meet EQR requirements and improve patient care with sophisticated data analysis.
Standard of Care Review
Promote continuous quality improvement through objective quality reviews.
CMS Waiver Oversight
Achieve high-quality long-term services and supports with comprehensive Medicaid waiver oversight and accountability.
Get Started with Acentra Health
Connect with an expert from our team and learn more about how
Acentra Health's solutions and services can benefit your organization.