CMS Appeals & Grievances
Annual Reports
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.

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

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.

Expertise to make high-accurate decisions

We protect the rights of members by
making timely and informed decisions

1.8 M

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.

Flexible Image

Improve healthcare quality oversight with
our cross-functional solutions

Recruit
External Quality Review

Meet EQR requirements and improve patient care with sophisticated data analysis.

Action Report
Standard of Care Review

Promote continuous quality improvement through objective quality reviews.

CMS Waiver
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.