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Hospitals provide Hospital-Issued Notices of Noncoverage (HINNs) to beneficiaries prior to admission, at admission, or at any point during an inpatient stay if the hospital determines that the care the beneficiary is receiving, or is about to receive, is not covered because it is:

  • Not medically necessary;
  • Not delivered in the most appropriate setting; or
  • Is custodial in nature.

Click on the link "Hospital Discharge Appeal Notices" for notices used to inform beneficiaries of their right to request QIO review of discharge decisions on or after July 2, 2007.

Please note:

  • HINN 10, also known as the Notice of Hospital Requested Review (HRR), should be issued by hospitals to beneficiaries in Original Medicare whenever a hospital requests QIO review of a discharge decision without physician concurrence.
  • HINN 11, which is used for noncovered items or services provided during an otherwise covered stay, and its instructions have not yet been incorporated into Chapter 30 of the Online Claims Processing Manual.
  • HINN 12 should be used in association with the Hospital Discharge Appeal Notices to inform beneficiaries of their potential liability for a noncovered continued stay.
  • The Preadmission/Admission HINN, used prior to an entirely noncovered stay, is also known as HINN 1 and replaces HINNs 1 and 9.


Original Medicare providers, suppliers, as well as Medicare Advantage Organizations and Prescription Drug Plans should update their Medicare notices with the correct Quality Improvement Organization (QIO) contact information as quickly as possible and no later than September 1, 2014.  Please see  for QIO details.

To download the HINNs and instructions, please click on the appropriate link below.