MA Denial Notices
Medicare health plans are required to issue the Notice of Denial of Medical Coverage (or Payment), also known as 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 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."
Questions regarding the IDN can be emailed to: https://appeals.lmi.org
UPDATE - Revised Notice of Denial of Medical Coverage (or Payment) Available
March 30, 2020: As a result of minor changes made to the IDN, CMS will be extending the implementation date for both the English and Spanish versions of the form. CMS strongly encourages plans to begin using the revised IDN as soon as possible, but no later than May 15, 2020.
March 9, 2020: The Spanish version of the IDN is now available, and minor formatting updates were made to the English version. Plans should begin using the revised Spanish version of the IDN as soon as possible, but no later than April 15, 2020. Both the previous and new versions of the Spanish notice are acceptable for use through April 14, 2020.
February 19, 2020: The Office of Management and Budget (OMB) has approved revisions to the Notice of Denial of Medical Coverage (or Payment), also known as the Integrated Denial Notice (IDN). The expiration date is different on this renewed notice. Plans should begin using the revised IDN as soon as possible, but no later than April 1, 2020. Both the previous and new versions of the notice are acceptable for use through March 31, 2020.
Significant revisions made to the notice and instructions include:
- Addition of adjudication timeframes for Part B drugs.
- Removal of language regarding State Fair Hearing as first level of appeal.
- Removal of option to add state specific Medicaid appeal filing timeframe.
- New determination option if an item, service, Part B drug, or payment is partially approved.
- New language notifying enrollees they cannot request an expedited appeal for a request for payment.
- New language informing enrollees they may ask for a good cause extension and should include their reason for being late.
- Option to add information for submitting appeal via plan website.