Instructions for NOMNC and DENC have been updated. FORMS HAVEN'T CHANGED

From Judy:  They posted the updated instructions on both pages:  The PPS Page and the MA Plan page.  We've been using the same form for both for a couple of years now.  NOTE:  We all changed our QIO phone numbers last summer.  Those numbers are on the 'resources' section of my website.   I read the instructions, and see no substantive policy changes, but read them yourself. I may have missed something.  

http://www.cms.gov/Medicare/Medicare-General-Information/BNI/FFSEDNotices.html

January, 2015: New NOMNC and DENC form instructions available below, in 'Downloads'.  Neither the NOMNC or the DENC form has changed, and providers may continue using the current forms.

Full instructions on the Original Medicare, also known as Fee for Service (FFS), expedited determination process are available in Section 260, of Chapter 30 of the CMS Claims Processing Manual, available below in 'Related Links'.

To download the FFS Expedited Determination Notices and Instructions (the NOMNC and DENC), please click on the appropriate link below.

Downloads

• UPDATED - Notice of Medicare Non-Coverage (NOMNC) - English and Spanish [ZIP, 68KB]
• UPDATED - Instructions for Notice of Medicare Non-Coverage [PDF, 33KB]
• UPDATED - Detailed Explanation of Non-Coverage (DENC) - English and Spanish [ZIP, 87KB]
• UPDATED - Instructions for Detailed Explanation of Non-Coverage [PDF, 18KB]

Related Links

• Prospective Payment Systems - General Information
• Skilled Nursing Facility PPS
• Chapter 30 - Financial Liability Protections [PDF, 913KB]

http://www.cms.gov/Medicare/Medicare-General-Information/BNI/MAEDNotices.html

January 2015:  New NOMNC and DENC form instructions available below, in 'Downloads'.  Neither the NOMNC nor the DENC form has changed, and providers may continue using the current forms.

Full instructions on the Medicare health plan expedited determination process, also known as the Medicare Advantage (MA) QIO fast track appeals process, are available in Chapter 13 of the Medicare Managed Care Manual,  Section 90.2 - 90.10, available below in 'Related Links'.

Plans currently are required to use the versions of the Medicare notices and instructions posted below, under 'Downloads'.

To download the Medicare health plan expedited determination Notices and Instructions (the NOMNC and DENC), please click on the appropriate link below.

Downloads

• UPDATED - Notice of Medicare Non-Coverage (NOMNC) - English and Spanish [ZIP, 68KB]
• UPDATED - Detailed Explanation of Non-Coverage (DENC) - English and Spanish [ZIP, 87KB]
• UPDATED - Instructions for Notice of Medicare Non-Coverage [PDF, 33KB]
• UPDATED - Instructions for Detailed Explanation of Non-Coverage [PDF, 18KB]

Related Links

• Chapter 13 - Medicare Managed Care Beneficiary Grievances, Organization Determinations, and Appeals Applicable to Medicare Advantage Plans, Cost Plans, and Health Care Prepayment Plans (HCPPs), (collectively referred to as Medicare Health Plans) [PDF, 426KB]