MA Denial Notices
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."
The revised Integrated Denial Notice (IDN), Form CMS-10003-NDMCP, and form instructions, have been approved by the Office of Management and Budget (OMB). Plans should take note of the expiration date in the revised form and instructions.
Significant revisions to the notice and instructions include:
- A suggestion that the enrollee share a copy of the decision with his or her doctor so that next steps can be discussed. The notice also explains that a copy of the decision was sent to the doctor if the doctor made the request on the enrollee’s behalf
- Clarification regarding what to include in the denial rationale;
- As applicable to integrated plans, instructions on determining if services are covered under Medicare and/or Medicaid, the criteria plans are to take into consideration when making this determination, and clarification on the circumstances under which the notice should be issued; and
- Language providing information on how enrollees can request the notice in alternative formats
All plans should begin using the IDN as soon as possible, but no later than April 10, 2017.
UPDATE MARCH 2017: The Spanish translation of the revised IDN can be found in the “Downloads” section below. All plans should be begin using the Spanish-translated version of the IDN no later than May 6, 2017.
Questions regarding the IDN can be emailed to: Part_C_Appeals@cms.hhs.gov
- Page last Modified: 03/10/2017 3:06 PM
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