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MA Denial Notices

DENIAL NOTICE (AND INSTRUCTIONS) POSTED BELOW.

Medicare health plans are required to issue the Integrated Denial Notice (IDN) upon denial, in whole or in part, of an enrollee's request for coverage and upon discontinuation or reduction of a previously authorized course of treatment.  The IDN consolidates Medicare Advantage coverage and payment denial notices and integrates, where applicable, Medicaid appeal rights information.  Medicare plans were required to begin issuing the IDN no later than November 1, 2013.

The IDN combines and replaces the standardized Medicare Part C denial notices entitled “Notice of Denial of Payment” and “Notice of Denial of Medical Coverage” (Form CMS-10003-NDP and Form CMS-10003-NDMC, respectively).  In addition to combining the NDP and NDMC, the IDN integrates Medicaid appeal rights information for Medicare health plan enrollees receiving full benefits under a State Medical Assistance (Medicaid) program.  Plans administering Medicaid benefits in addition to Medicare benefits are responsible for including applicable Medicaid information in the notice.

Medicare health plans and Fully Integrated Dual Eligible (FIDE) plans will issue the IDN to inform enrollees of their appeal rights, as applicable, upon denial of coverage of items and services, and for discontinuation or reduction of a previously authorized course of treatment.  Medicare-Medicaid Plans (MMPs) within the Financial Alignment Demonstrations also will use the IDN.  

To download the IDN and its corresponding instructions, please click on the links below under "Downloads."