Centers for Medicare and Medicaid

Delivering innovative program solutions that result in improved health outcomes

Touching millions of lives through medical reviews, eligibility appeals services, targeted outreach and enrollment assistance.

30+

years of experience supporting CMS

44 million

calls fielded annually to support health insurance enrollment for CMS

15+

years as a QIO-like Entity

 

Collaborating to achieve the promises of healthcare reform

Maximus possesses unmatched experience with the Affordable Care Act (ACA), as our support covers all the various facets of the law, ranging from choice counseling and eligibility appeals to education and outreach, training, and value-based programs. Through our work managing citizen engagement centers for publicly funded healthcare recipients, we answer thousands of ACA-related questions every day, helping consumers with gaining access to health insurance.

Learn how our contact centers connect millions of citizens to government
Collaborating to achieve the promises of healthcare reform

Medicare appeals

Since 1989, CMS has relied on Maximus to provide Medicare beneficiaries and providers with independent, conflict-free appeal decisions of health insurance denials. Because we have no financial affiliation with insurers or providers, we are the only conflict-free Independent Review Organization (IRO) providing Medicare appeals. We receive and review more than 600,000 appeals claims a year for Medicare, helping expedite the process to appeals determinations for citizens.

Medicare appeals

Expertise managing caseloads and backlogs

For decades we have worked collaboratively with CMS to implement process improvements and sustain a high level of customer satisfaction. With the adoption of our proven approaches, we have increased program efficiencies, reduced costs, and improved quality outcomes.

Connecting citizens with access to health information

Maximus supports the CMS Customer Accessibility Resource Staff in its effort to enhance beneficiary services and access to health information. This work is critical to achieving CMS’ mission to improve communications and implementations of agency enterprise solutions to meet the requirements of Section 504 of the Rehabilitation Act of 1973. As health communication experts, we specialize in making health information accessible and easy to understand.

Discover how our Center for Health Literacy empowers citizens to make decisions
Connecting citizens with access to health information

Competencies, accreditations, and certifications

  • QIO-like Entity for over 15 years
  • Full accreditation by the Utilization Review Accreditation Commission (URAC) since 2000
  • Only Conflict-free IRO by providing zero commercial services
  • Served as a Qualified Independent Contractor for CMS for over 30 years
  • Beneficiary engagement with over 60% of the nation’s Medicaid population
  • The nation's largest provider of federal and state external review services with more than 50 state and federal clients
Learn more about our accreditation and certifications
Competencies, accreditations, and certifications