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Medicare Enrollees Health Plans Medicare Advtg Medicare Advtg Process Manual Reconsideration Background Data Form Key Contact Form CMS Website Medicare Managed Care Manual PACE Cost and HCPP Search for Your Appeals Case Laws & Regulations Researchers/Data Medicare Links Newsletters/ Conferences		MEDICARE ADVANTAGE   General Information   Medicare Advantage plans are managed care plans that contract with Medicare to offer all Medicare covered services plus additional services outside of traditional Medicare (e.g. vision coverage or prescription drug coverage).   Medicare Advantage plans are required to follow all Medicare laws and coverage policies, including LMRPs (Local Medical Review Policies - policies set by Medicare Fee-for-Service Contractors in your geographic area), when determining coverage for a particular service. Select "Laws and Regulations" to find helpful links to Medicare laws and other CMS coverage policies.   Select "CMS web site" (below) to find useful industry and program information. Select CMS Medicare Managed Care Manual for CMS program and policy guidance to Medicare Advantage plans.   Appeal Information   Medicare Advantage plans are required to submit all denied enrollee appeals (Reconsiderations) to an Independent Review Entity (MAXIMUS Federal Services). Medicare Advantage plans should carefully review and follow the instructions in the "MAXIMUS Federal Services Reconsideration Process Manual for Medicare Advantage Organizations."   The "MAXIMUS Federal Services Reconsideration Process Manual for Medicare Advantage Organizations (updated 9/2009)" contains required forms for creating and submitting a case to MAXIMUS Federal Services. Select "Medicare Advantage Forms" to download these forms and the relevant instructions.   MAXIMUS Federal Services Reconsideration Process Manual for Medicare Advantage Organizations (updated 9/2009)   Reconsideration Background Data Form (PDF)   Reconsideration Background Data Form (MS-Word Document)   Key Contact Form   CMS Web site   CMS Medicare Managed Care Manual