CMS Medicare Appeals System (MAS 2.0)

The Medicare Appeals System (MAS) is a system that tracks and records Medicare appeals through multiple levels of the appeal process. MAS was developed to support legislatively mandated appeals processes for traditional Medicare Fee-for-Service (FFS) and Managed Care items and services. In addition, MAS is required to support judicially mandated notice and appeal procedures resulting from Grijalva v. Shalala. MAS is a system that tracks and records Medicare appeals through multiple levels of the appeal process. The system leverages processes and consolidates data to allow users across levels to realize benefits of reusable, centralized data. The system supports standard processing of appeals and availability of data to other levels while allowing stakeholders and user groups to shape procedures at their desired level. Currently, MAS supports Levels 1, 2, and 3 appeals processing. Level I appeals pertains to Part A Redeterminations of Fee-for-Service appeals by MACs and reopenings (clerical and non-clerical). Level II appeals pertains to reconsiderations of Fee-for-Service appeals by QICs, reconsiderations of Managed Care appeals by IRE, reconsiderations of Part D Prescription Drug Plan appeals by Part D QICs and reopenings (clerical and non-clerical). Level III appeals pertains to hearing requests by ALJs of all Level 3 appeals by the Office of Medicare Hearings and Appeals (OMHA). MAS supports unified case tracking to facilitate the maintenance and transfer of case-specific data for fee-for-service, managed care, and drug appeals. In addition, MAS provides the capability to report on appeals data, enable more accurate and expedient responses to Congressional questions, and provides more precise data for assessment and policy-setting. MAS fulfills these business needs by focusing on data collection, case management tracking, data storage and analysis, reporting, electronic document management, and workflow management.

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