MA Expedited Determination Notices

HHAs, SNFs, and CORFs are required to provide a Notice of Medicare Non-Coverage (NOMNC) to Medicare health plan enrollees when their Medicare covered service(s) are ending.  The NOMNC informs enrollees on how to request an expedited determination from their Beneficiary nd Family Centered Care Quality Improvement Organization (BFCC-QIO) and gives enrollees the opportunity to request an expedited determination from a BFCC-QIO.  A Detailed Explanation of Non-Coverage (DENC) is given only if a beneficiary requests an expedited determination.  The DENC explains the specific reasons for the end of services.

Full instructions on the Medicare health plan expedited determination process, also known as the Medicare Advantage (MA) fast track appeals process, are available in the Parts C & D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance, in Section 100, available below in "Downloads."

Plans currently are required to use the CMS versions of the Medicare health plan expedited determination Notices and Instructions (the NOMNC and DENC), which can be accessed below in "Downloads."

Questions?

Questions regarding the NOMNC and DENC can be submitted at: https://appeals.lmi.org