OSMA meets monthly with staff from the Centers for Medicare & Medicaid Services (CMS) Chicago Regional Office to discuss a variety of issues affecting physicians and their patients, including ongoing challenges with Medicare Advantage plans.

During a recent meeting, CMS officials reminded OSMA that physicians and medical practices now have access to a specific complaint form designed to alert the agency to problems they are experiencing with Medicare Advantage plans. The form allows providers to report concerns related to coverage determinations, claims processing, prior authorization, and other administrative barriers that may affect patient care.

OSMA encourages its members to utilize this complaint process to ensure CMS is aware of the challenges physicians continue to face when working with Medicare Advantage plans. Increased reporting can help the agency identify patterns and address systemic issues that may be affecting patient access to timely and appropriate care.

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Using the complaint form:

On December 22, 2025, CMS implemented an online form on cms.gov for providers that need to report a complaint about a Medicare Advantage plan. Upon submission, these complaints will be sent to the HPMS Complaints Tracking Module (CTM). The process will flow as described below: 

• Providers will access the online complaint using the following steps:
• Go to https://www.cms.gov.
• Select “Medicare” from the top left dropdown menu.
• Select “Health & drug plans” from the left-hand navigation.
• Select “Report a provider complaint about an MA plan.”
  
  
• The online form will capture basic information about the complainant, beneficiary, provider, and Medicare Advantage plan, a complaint summary, and optional fields for date(s) of service and claim number.